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Tobacco. Several studies into the association between fibromyalgia and tobacco have concluded that, to some extent, smoking can have an influence on the pain and other symptoms (stiffness, physical disability, and depression). It is unknown whether smoking implies a greater risk of developing fibromyalgia.
Alcohol and caffeine. The same is true of caffeine and excessive alcohol, which may also interfere with the patient’s medication and other therapies (iontophoresis, TENS, etc.) as well as affecting other symptoms such as sleep disorders, obesity, and so on.
Overweight. Overweight is a risk factor for worsening the disease.
Diet. There is no evidence of a direct relationship between fibromyalgia and diet; furthermore, at present, there is not enough scientific data to establish specific dietary recommendations.
Dietary supplements. There is no consensus regarding dietary supplements and antioxidants. Unless the healthcare team diagnose a specific deficiency of a nutrient (e.g., iron in cases of anaemia), there is no need to take a dietary supplement to treat fibromyalgia.
Exercise. People with fibromyalgia tend to take part in physical activity on an irregular and inconsistent basis. Some patients perform no or very low levels of physical activity, while others do too much. This is because of the level of pain and fatigue each patient suffers at any given time.
Fibromyalgia and exercise – yes or no?
People with a sharp pain generally decrease their physical activity. The body’s automatic response to pain is to stop moving around in an attempt to reduce it. When the pain is more manageable thanks to rest, the person can perform their everyday routines once again, but in the case of people with almost constant pain (chronic pain), resting can prove detrimental to their problem. Therefore, constant inactivity means the body becomes unprepared for exertion. The body loses strength, muscle elasticity, resistance and develops joint stiffness because it needs to move.
Nevertheless, patients still have to respect the pain. After all, pain is a warning signal from the body and it must be heeded. But when the pain leads to a significant lack of physical activity, then it begins to propagate a vicious circle where the inactivity also causes more pain and more fatigue.
Recommendations for physical exercise must be indicated and monitored by a physiotherapist in order to establish the most appropriate intensity, duration and progression for each exercise. This will allow patients to introduce some lifestyle habits that include moderate and regular physical exercise which improves the symptoms of fibromyalgia.
Well-planned exercise that does not involve any overexertion can prove a very important ally rather than an enemy.
On the understanding that each patient must establish some personalised guidelines, and as a general recommendation, aerobic exercise is currently the foundation of any physical treatment: walking on level ground or in a heated swimming pool are two excellent activities to begin with. Patients are advised to:
Warm up their joints every day by completing some simple joint movements upon waking up or after a period of inactivity.
Complete muscle stretching and strengthening programmes, but these exercises will initially be monitored by a professional.
Take part in tolerable, moderate and progressive exercises. Therapeutic education is very important, so the patient can learn to manage their efforts and use physical exercise as a significant part of their treatment.
Initially, avoid exercising for more than 30 minutes at a time and divide the effort into 10‑minute periods until they reach their target. Rest for 5 minutes between each period. This schedule should be repeated 3–5 times a week.
Sleep. The pain can reduce quality of sleep, but sleep disorders can also worsen the pain. Too much daytime rest can reduce the feeling of waking up refreshed. It is important to sleep well, but it is not essential for maintaining an adequate level of activity. To improve the quality of sleep, patients must establish a suitable routine and increase their activity levels.
Sex. Several studies have shown that people with fibromyalgia have less desire, less excitation, more pain, fewer orgasms, and therefore less sexual activity than the general population. Patients are also known to have a worse perception of body image and therefore the intensity of the pain, overweight, and emotional state are factors that can have a clear influence on sexual relationships. Specialised healthcare professionals can provide either general or more specific indications such as psychological treatment, drug therapy and/or physiotherapy.
Travel. Travelling is not contraindicated, rather it is recommended; travelling can be a good form of medicine that helps manage the illness in environments and situations other than habitual ones. It is essential to prepare for the journey correctly.
Points to consider when travelling
Plan the trip in detail and well in advance taking into account the clinical situation and, if necessary, discuss it with the specialists and/or treatment monitoring team.
Calculate how many routine and rescue medications are required and bear in mind the legal regulations in the country of destination.
Use technical aids and travel assistance services.
The travel itinerary should include scheduled breaks and locations to rest. Include flexible activities to facilitate changing them, if necessary.
Social and emotional support. People close to patients with fibromyalgia play an important role in the condition; their understanding and support are vital to help improve their situation.
Advice for family and friends
Speak to the person with fibromyalgia about the best way to help them.
Learn about the syndrome and its treatment and, where necessary, accompany the patient to their therapy sessions.
Understand, share, support, and congratulate their efforts and achievements.
Accompany them and assume an active role throughout the disease process.
Adapt to any changes that may arise during the course of the illness.
Try to avoid being overprotective and allow the patient enough space to find their family, social and occupational roles once again.
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Substantiated information by:
Ana Arias GassolOccupational therapistRheumatology Service
Antonio Collado CruzRheumatologistRheumatology Department
José Pérez RuizRheumatologistRheumatology Department
Xavier Torres MataPsycologistService of Psychiatry and Psychology
Ángel Fernández LópezPhysiotherapistRheumatology Department
Published: 28 December 2018
Updated: 28 December 2018
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