With ‘diffuse’ pain, i.e. affecting the entire body or certain parts, various diseases can be detected.
By definition, diffuse pain affects the whole body or several parts. Maybe acute or chronic, when it lasts longer than three months. “Pain is defined as an unpleasant sensory experiencewithout necessarily having an anatomical link“explains Professor Thomas Hügle, head of the department of rheumatology at the Vaud University Hospital of Lausanne. The medical endpoint for pain is -algia, this is why professionals may use the term diffuse polyalgia syndrome in diffuse pain. fibromyalgia is one of the leading causes of widespread pain, but it is certainly not the only reason. The pain may be difficult for the patient to place or localize. “The causes are very broadsays Professor Hügle. Our task is to exclude various diseases such as rheumatism, spondylitis, psoriasis, rheumatoid arthritis or lupus, which are common causes of diffuse pain. However, they are very rarely caused by a serious disease such as cancer“.
Fibromyalgia: Pain “Anywhere, Anytime”
When a patient suffers from fibromyalgia (pain in the muscles and fibrous tissues – tendons, ligaments -), we often say that he“He is in pain everywhere and all the time.” Pain is the main symptom, which may decrease with rest and intensify after exercise. Fibromyalgia is associated with significant fatigue related to sleep disturbances and non-restorative sleep. “Other body systems are disrupted, such as the digestive system. The patient may have abdominal cramps or constipation. On a neurological level, dizziness can be like migraines“, continues our interlocutor. The precise cause of fibromyalgia is not yet well defined and several hypotheses exist.
The pain can differ from person to person: difficulty concentrating, light sensitivity, etc.
“is the most accepted a problem with the central nervous system, spinal cord or brain, explaining the different types of pain and symptoms. Moreover, there is no single clinical picture of fibromyalgia, but there are several subtypes depending on the symptoms.“, describes the rheumatologist. Indeed, the pain can differ from person to person: problems with concentration, light sensitivity (discomfort with light), discomfort with sound, etc.
Neurological diseases: Parkinson’s, Lyme, Multiple Sclerosis
Lyme borreliosis, Parkinson’s disease or multiple sclerosis are neurological diseases that can cause pain in the body. They can also be toxic neuropathies, related to certain medications or the consumption of certain medications.
Psoriatic arthritis: pain mainly in the joints
Psoriatic arthritis is an inflammatory joint disease caused by psoriasis. The pain mainly affects damaged skin and nails, joints and the spine.
Rheumatoid arthritis: swollen wrists and hands
This disease is manifested by pain in various joints, often swollen in the wrists and hands. Affected joints feel stiff, especially at night and in the morning.
Ankylosing spondylitis: flaring pain
Ankylosing spondylitis is a chronic inflammatory joint disease. The pain is mainly lumbar and sacroiliac (pelvic). This disease causes painful flare-ups, alternating with periods of rest.
Vitamin D deficiency can lead to bone pain
Certain metabolic diseases, for example caused by a vitamin D deficiency, can be the cause of chronic diffuse pain in the muscles or bones.
A muscle disease
Inflammatory or congenital muscle diseases or myopathies can cause widespread pain throughout the body. Myositis manifests itself very differently from one form to another and, for the same form, from one person to another.
Somatoform disorders after trauma
Somatoform disorders are not defined as persistent physical complaints caused by pain of psychosomatic origin. “We understand the somatoform part of pain better and better. They can occur years after the trauma, psychological post-traumatic stress or even sexual abuse. The functional link has been proven in several studies. Traumas that occurred during childhood and adolescence can lead to the appearance of physical pain, like an imprint left on brain activity.”, describes the rheumatologist.
Pre-menopause: 1 in 2 women have joint pain
Peri or pre-menopause is another common cause of diffuse pain, but underestimated. The period before menopause can last several years. “With the decrease in estrogen, the body begins to ache. These hormones are natural anti-inflammatorieswomen gradually lose their protection against inflammation. Losteoarthritis of the back, of the heel pain (talalgia) or epicondylitis are all types of pain that can occur during perimenopause. We qualify them as pseudorheumatism. This is a common phenomenon in the rheumatologist profession: 50% of women may have joint pain during this period. The women most often affected are women between 50 and 53 years old. quite obese and sedentary”, describes Professor Thomas Hügle.
Which doctor to consult for diffuse pain?
In case of persistent diffuse pain: the doctor can already offer the patient many therapeutic solutions. The treating physician can take the anamnesis and prescribe medical examinations. If necessary, the doctor refers the patient to a specialist in the field of pain and musculoskeletal disorders, such as the rheumatologist. The diagnosis is a diagnosis of exclusion. Diseases are ruled out one after another to find the one causing the pain.
“We may evaluate muscles and vitamin D”
“The medical history is essential, as is the clinical examination. A blood test is prescribed to rule out inflammation. We assess the muscles and possibly vitamin D. An ultrasound of the joints is prescribed to rule out arthritis.” Classic, for fibromyalgia, Nothing is visible on medical imaging studies. The diagnosis for this disease is mainly made retrospectively a full and rigorous investigation as well as negative test results.
How to relieve diffuse pain?
Treatment depends on the etiology of the diffuse pain, which is difficult to assess. “Medications can improve the pain of fibromyalgia by about 20-30%, often not anymore. Support must be multidisciplinaryincluding medication, physiotherapy and psychological treatment, the rheumatologist indicates. Fibromyalgia is treated with antidepressants or anticonvulsants, such as Gabapentin or anti-inflammatory medications. At the same time, exercise with a physical therapist can relieve widespread pain.” Professor Hügle also recommends this fight against a sedentary lifestyle by exercising regularly. Weight loss in obesity also has benefits in combating chronic pain. Cognitive behavioral therapy (CBT) is also recommended to reduce the stress of living with this pain. Finally, improving sleep quality It is very important to avoid exhaustion, because the pain is already tiring for the patient. “What gives the best result is a multimodal treatment. In collaboration with the multidisciplinary team, we try out multiple therapies simultaneously, especially with a psychiatrist. Finally, patient care must be comprehensive to effectively reduce diffuse pain.“
With thanks to Professor Thomas Hügle, Head of Department of Rheumatology at the Vaud Lausanne University Hospital Center