“If I could, I would take the pain; put the pain inside an envelope and return it to the sender. “Mario Quintana
This article aims to address the concept of fibromyalgia as well as painful symptomatology, highlighting the relevance of this alteration in the health field. This is a review, conducted through consultation of scientific articles. Fibromyalgia is characterized as a syndrome that has as its main symptom pain without specific organic cause. For proper treatment you should seek a medical specialist. The form of evaluation of the pathology, occurs through clinical exams in the doctor’s office. Therefore, research related to fibromyalgia seeks to understand and deepen this pathology, so that the most adequate understanding can be drawn, in order to provide quality of life.
“The pain seems an offense to our physical integrity.” Clarice Lispector
A body will always be to the subject a “thing” of his. Thus, to live each being depends to inhabit a body. In this way, passions, affects, ideas are considered by the principle of classical philosophy, the location of human ills – mentioned from a body – as a necessary support function. The analysis of the body constitutes a relation of pertinence between the existing and its materiality. This is the heart of great questions that go beyond time, culture, life, birth, death, and also a theme intrinsic to psychoanalysis: sexuality.
In this article we will address physical and psychic pain without organic cause. We will enunciate here, a syndrome that does not find specific organic cause – we will call “disease of the soul”. The syndrome, whose chronic pain with no known organic causality, is a source of suffering for patients and a challenge for medical professionals. This syndrome is located at the border between rheumatology and psychosomatic pathology, with comorbidities of disorders and a deterioration of the professional, social and family life quality.
Fibromyalgia is a clinical syndrome that manifests with pain in the whole body, mainly in the musculature. The syndrome has symptoms of fatigue, exercise intolerance and non-restful sleep – the person always wakes up tired. Doctors classify fibromyalgia as a syndrome because it characterizes a group of symptoms without a specific cause being identified.
There is no single known cause for fibromyalgia, but there are some signs to identify it. More recent studies have shown that fibromyalgia patients are more sensitive to pain than others who do not have the disease. This is not related to being “strong” or “weak” in relation to pain. In fact, it works as if the fibromyalgic brains were a deregulated compass that would activate the entire nervous system to make the person feel more pain. Thus, nerves, medulla and brain would be causing any painful stimulus to be increased in intensity.
The pain of fibromyalgia is real. There are advanced experimental studies showing the brain functioning and patients with fibromyalgia feeling pain. Studies have also been done with the liquid that bathes the spinal cord and the brain (CSF) and it has been seen that substances that lead to the sensation of pain for the brain are three to four times increased in fibromyalgic patients compared to people without the problem.
Both patients and doctors seem to better understand the causes of pain when there is an inflammation, a bruise, a tumor, that are there, visible, causing the pain. In fibromyalgia it is different; if we take a piece of muscle that is aching and look under the microscope, we will find nothing – because the problem is only in the perception of pain.
Epidemiological data point to a higher incidence of this clinical entity in young women, but we can not fail to approach men, with great sensitivity to pain. Society and many scholars insist on proclaiming that women are more suffering than men, however, under the eyes of a psychoanalyst, the male suffers as much as they point out the suffering of the female sex. We can not generalize and rationalize that the female sex is more susceptible than the male sex. Men still need to omit their feelings so that they do not appear weak. This is a precarious condition of human observation.
Regardless of sex, there is an absence of evidence in the body’s materiality and the presence of psychopathological factors makes diagnosis and treatment difficult. Facing the diversity and factors involved in certain syndromes. It is necessary to indicate a multidisciplinary approach for a treatment with more effective results.
In this context, while professionals seek a cure for their pain, patients cry out for recognition of this syndrome that causes a lot of suffering.
The suggestion is to consider the possible function of fibromyalgia in psychic structuring as a subjective solution. For the theoretical-clinical reference of psychoanalysis. Psychoanalysis provides elements for reflections on pain in the body and its place in the psyche.
From the current state of research on the subject – considering the scarcity of studies in the field of psychoanalysis, the neuralgic point for us psychoanalysts is that we can contribute to a fibromyalgia approach that supports the report of the pain experience. We do not pretend to put fibromyalgia into any psychopathological picture, such as hysteria or depression – the focus of psychoanalysis is to emphasize the subjective position – of those who suffer in their bodies this “unbearable” pain for then, we have a diagnosis with professionals doctors in the treatment of fibromyalgia.
O que a fibromialgia pode ensinar ao psicanalista? Acreditamos que, para além da doença, há um sujeito em questão e que o diagnóstico em psicanálise se produz a partir da posição que este ocupa frente ao seu sintoma. O que, para além da dor, do que o analisando diz, comporta um falar singular. Se na medicina o diagnóstico se alicerça nos fenômenos comprovados e numa probabilidade estatística, a psicanálise avança, para além dos fenômenos, os modos de enfrentar a singularidade do sofrimento. Da forma como a dor psíquica, implicada na dor física, faz com que a psicanálise avance na subjetividade dos casos sob o olhar clínico. A fibromialgia não pode ser igual para todos, mesmo que haja uma tipologia, uma peculiaridade sintomatológica na doença, o traço único dirá mais sobre aquele que sofre e sobre o uso que faz de sua dor.
OF THE PSYCHOANALYST’S FUNCTION AND / OR PSYCHOLOGIST IN THE CLINIC:
To work in the clinical area, the psychoanalyst and / or psychologist usually complement their training with courses: lato sensu specialization – and, above all, psychoanalysis. The psychoanalyst, however, will only become a psychoanalyst after having completed a higher education in any area and doing the training in psychoanalysis. This implies that a psychoanalyst has continuous training. Both professionals also use psychotherapy to analyze and intervene in emotional, behavioral and / or mental disorders problems. In psychotherapy, the psychoanalyst and / or psychologist, through verbal mediation, conducts his analysis to a process in which the latter becomes more aware of what he does, thinks and feels. Seeking to provide the analysand with the knowledge of himself and new behaviors to deal with his feelings.
OF FIBROMYALGIA TREATMENT:
It is important to note that we as psychoanalysts and / or psychologists can not diagnose any type of disease and / or pathology. The diagnosis of any disease is exclusively of the doctor. Psychoanalysts and / or psychologists are not medical professionals. Therefore, the diagnosis of fibromyalgia is solely and exclusively under the eyes of the medical professional. That is, the most common specialty for the diagnosis of fibromyalgia is rheumatology.
“The threshold of stimulation required to transform a sensory stimulus into a potential threat is significantly lowered in Fibromyalgia, being one of the main features of the neurobiological process, which extensively affects every system and can convert subclinical information into unpleasant sensations in different body parts. “(Collado, A., 2008, pp. 517-518).
OF THE EXISTENCE OF CHRONIC PAINFUL STATES:
The existence of chronic pain states without organic substrate, pain diseases, has been reported since the 19th century. Among them, fibromyalgia (FM), known as fibrositis since 1904 (Gowers, 1904), has a rather recent name (Smythe and Moldofsky, 1977). Recognized by WHO in 1992, under the identification M 79.7 in the International Classification of Diseases (ICD), this syndrome is defined as composed of musculoskeletal pain, often accompanied by sleep disorders and fatigue. From this classification, which gives it a status of disease, the increased interest in fibromyalgia has repercussions in numerous studies (Kahn, 1989; Kochman, 2002; Heymann, 2006; Saltareli, Pedrosa, Hortense and Sousa, 2008). However, its etiology remains obscure and seems to refer to a multifactorial origin,
Most of the texts and studies on the subject indicate the possibility of a psychiatric comorbidities regarding the presence of anxiety disorders and depression. Thus, they point out the adequacy of the use of drug treatments as each case is their comorbidities. Of note, the indication of psychotherapeutic treatment is mentioned in the recent Brazilian study on the subject at the same time as the stretching and assimilated exercises (Heyman et al., Idem). However, the indication of a multidisciplinary approach for the treatment of fibromyalgia cases seems to be consensual in most of the medical studies, appearing in both the recent Brazilian Consensus study of the treatment of fibromyalgia (Heyman et al., Ibid) and the report of the Academie Française de Médecine (Menkès and Godeaul, 2007).
Numerous authors recognize the important and even preponderant role of psychic factors in the onset of fibromyalgia. At the same time, most of them reject their assimilation to any psychiatric illness and only the psychosomatic component is evoked in some cases. A psychological vulnerability marked by stress (Boureau, 2000), the tendency to “catastrophism”, to “victimization”, sometimes a previous hyperactivity, a context of constant emotional tension, anxiety and depressive affections come to sketch a psychological picture of the fibromyalgic patient. However, it is emphasized that the causal relationships between psychiatric symptoms and fibromyalgia are difficult to confirm. (Menkès, Godeaul, 2007).
It is possible that the disorders found in fibromyalgia (fatigue, sleep disorders, headaches, decreased cognitive activity) make the signs of depression appear, adding to a painful syndrome. However, there are neither suicidal ideals nor elements of devaluation and self-accusation. Similarly, if the authors emphasize the undeniable links between fibromyalgia and an extensive list of psychological disorders, including hypochondriasis, functional and somatoform disorders, the main criterion for diffuse pain seems to separate them (Kochman, Hatron , 2003). Only comorbidities between the states of post-traumatic stress disorder (PTSD) and fibromyalgia, both in terms of symptomatic expression and anamnesis (traumatic events, violence, sexual abuse, etc.) appear to be confirmed clinically. Usually,
In many cases, the evidence of the disease through diagnosis may allow the subject some relief. In reality, the recognition of pain opens the possibility of having, as a prêt-à-porter, a cause that provides some sense to the somatic but also to the psychic ones. Thanks to this adopted identity and characterized by the fibromyalgia seal, there is the displeasure of feeling bodily pain, but it does not need to be hidden or omitted.
However, to attempts always without definitions and / or an accurate diagnosis to describe a typical profile of the fibromyalgic patient – correct will be to obtain references to a psychopathology sustained in the consideration of the subject. Thus, we can not proclaim that there is “cure at any price”, but we can consider the possible function of fibromyalgia in psychic structuring as a subjective solution. In this “hopeful” action (the specialist physician along with other professionals) can keep the subject’s saying in his attempt to outline a personal theory of his illness. It is a first step, a way to allow the subject to change or at least understand their position in the face of suffering and power in time to leave the remedy. In some cases, this may be a path to true subjective change,
Rev. Mal-Estar Subj. vol.10 no.4 Fortaleza dez.