Fibromyalgia is a disease characterized by chronic diffuse musculoskeletal pain in various parts body, stiffness of movement, fatigue and weakness, depressive disorders, sleep disorders. In recent years, interest in this neurological disease has increased due to an increase in incidence of approximately 5%. If left untreated, fibromyalgia significantly reduces the patient’s ability to work and his quality of life, leading to deterioration in adaptability to life. external conditions, especially in society.
This disease has characteristic feature: objective research methods (blood tests, urine tests, x-rays, computed tomography, etc.) do not reveal any pathological changes. This aspect makes the diagnosis of this disease very difficult. But, nevertheless, an experienced doctor, when comparing all the manifestations, may suspect a diagnosis of fibromyalgia. In no case should the process be left to chance; patients should trust the doctor and the treatment he prescribes for this pathology.
The diagnosis of fibromyalgia is made based on a thorough interview and examination of the patient. Additional Methods studies are ordered to exclude all others possible diseases which can cause chronic pain.
For a long time, there were no clear criteria for diagnosing fibromyalgia in medicine. It cannot be reliably stated that they have been identified even now, but still today there is a scale of criteria for the possible presence of fibromyalgia. This scale was developed in 1990 by the College of American Rheumatologists. It is not intended for full use in the clinic, mostly as part of research, but clearer diagnostic criteria have not yet been developed.
Currently, the disease is diagnosed based on several factors. Let's list them.
One of the most common reasons for visiting a rheumatologist is fibromyalgia. It occurs in 2% of the population, mainly in women. The disease begins at 30–35 years of age, and the incidence increases with age.
Content:
Literally this term translates as “pain in muscle fibers.” The disease is accompanied by various disorders of the nervous and muscular systems. Patients are concerned about pain in different areas muscles. When visiting a doctor, patients complain of soreness in a certain muscle group (for example, in the neck), but upon questioning it turns out that the muscles “hurt everywhere.” Many patients are concerned about stiffness of the limbs in the morning, fatigue, insomnia, and apathy. A third of fibromyalgia patients do not work because they feel unwell.
The disease has characteristic feature– the presence of pain points, the action of which causes or intensifies discomfort.
Fibromyalgia is a syndrome chronic pain and more often than other diseases in this group leads to depression and maladaptation of patients. It significantly reduces a person's quality of life.
Many patients are treated for a long time and unsuccessfully by therapists and neurologists, while they need consultation with a competent rheumatologist.
Fibromyalgia - hereditary disease which can manifest itself under stress
The disease is not associated with damage to skeletal muscles or peripheral nerves. It has been proven that pain in fibromyalgia occurs due to increased stimulation of nerve cells spinal cord– the phenomenon of “central sensitization”. At the same time, there are no objective signs of muscle or nerve damage, so patients’ complaints are often attributed to manifestations of neurosis, hysteria, or even simulation. Often this disease is hidden under the diagnosis of “NCD” or “somatoform dysfunction of the autonomic nervous system.”
In fact, central sensitization (the cause of fibromyalgia) occurs in people with a hereditary predisposition under the influence of unfavorable factors:
Patients are characterized by wariness, suspiciousness, fear serious illnesses. These disorders are associated with changes in the balance in the brain and blood biologically active substances, like norepinephrine and serotonin. The concentration of these neurotransmitters in the brain is increased by certain drugs, such as tricyclic antidepressants, tramadol and duloxetine. At the same time, the well-being of patients improves.
Fibromyalgia is accompanied by an abnormally high sensitivity to pain and changes in its perception and evaluation. The neurobiological basis of the disease has been confirmed using modern diagnostic methods.
Leading clinical sign Fibromyalgia is a common symmetrical muscle pain. This feeling is constant, monotonous. The pain intensifies after stress, with physical fatigue, with prolonged work in one position and long periods of immobility, as well as after hypothermia. The pain subsides after warming, resting, and massaging the muscles.
The severity of this symptom may change during the day, but pain of one degree or another accompanies the person constantly. The patient complains of a feeling of a “long cold.” Constant discomfort leads to maladjustment of the patient - he cannot work or lead an active life.
Sometimes patients note ankle, wrist and other joints. Paresthesia, tingling, burning, numbness of the skin on the arms or legs, and a crawling sensation often appear.
Symptoms of fibromyalgia
Upon external examination, no changes in muscles, joints, or peripheral nerves are noted. Only pain in certain points of the body is detected. This is an important part of diagnosing fibromyalgia. However, the study of such points can only be carried out by an experienced specialist who knows exactly their location and the strength of the desired impact.
For fibromyalgia, 18 paired sensitive points are examined, and the diagnosis is considered definite when at least 11 of these areas are painful. are located symmetrically in the following areas:
For control, points are felt in the middle of the forehead, on the back of the forearm and in the area thumb brushes
The doctor performs quite strong stimulation of these points. It is very difficult for an untrained specialist to conduct research correctly and evaluate its results.
To screen for fibromyalgia, you can use the following questionnaire:
With 5–6 affirmative answers, the patient should be specifically examined to identify fibromyalgia.
Diagnostic criteria to make this diagnosis with confidence have not been developed. The disease does not manifest itself as structural changes in nerves or muscles that could be detected using diagnostic techniques. Therefore, a clinical approach is taken.
Diagnostic criteria have been developed for scientific research this problem, however, they are widely used in clinical practice.
The diagnosis is made based on a complex of such signs:
A patient with fibromyalgia must follow general recommendations home therapy, as well as taking medications and using non-drug treatments.
Methods non-drug treatment fibromyalgia through sports, the effectiveness of which has been proven in scientific research:
Both medicinal and non-medicinal treatment methods are used to treat the disease.
One of the most effective ways to treat fibromyalgia is cognitive behavioral therapy, preferably relaxation training. This method is taught by a psychotherapist. The biofeedback method is also used.
An alternative method that improves the production of serotonin and norepinephrine, restores sleep and eliminates depression is phototherapy.
Non-drug treatment for fibromyalgia
For fibromyalgia, it is necessary to use several medications that affect different parts of the disease. Standard treatment includes:
New drugs with good effect:
Officially, only Lyrica is approved for the treatment of fibromyalgia in Russia. This remedy reduces pain and fatigue, improves sleep, has a positive effect on quality of life, but does not reduce symptoms of depression.
Treating fibromyalgia is a complex task that requires ongoing medications, non-drug treatments, and lifestyle changes.
Main directions of therapy:
Without following the rules of behavior at home, it is impossible to get rid of pain.
Worsening of the course of the disease in many patients is observed with sleep disturbances. Therefore, it is necessary to observe the sleep schedule and conditions. The bed should be comfortable and familiar to the patient. It is recommended to place it in a room well isolated from light sources and the slightest noise (even the ticking of a clock). An individual comfortable temperature for the patient should be created. Before going to bed, it is recommended to do a calming favorite activity (knitting, reading, etc.), take a warm bath.
You need to go to bed in the evening and get up in the morning at the same time every day, regardless of whether the patient needs to go to work or on a day off. You should not take liquid in the evening. Drinking alcohol and smoking cause intermittent, shallow sleep that is not restorative.
Additionally you can take herbal preparations– motherwort, valerian. If they are ineffective, you should visit a specialist to get a prescription for sleeping pills. The possible risk of taking these drugs is much lower than the beneficial effects of deep sleep.
The patient's condition can improve significantly if the balanced diet, which includes proteins, carbohydrates, vegetable oils.
The patient's condition improves significantly by following a balanced diet rich in healthy carbohydrates(porridges, cereals), proteins and vegetable oils. You should take 7 glasses of caffeine-free liquid per day.
Magnesium and calcium are of particular importance in the diet of patients with this disease. Normal quantity calcium per day is 1000 mg in men, 1200 mg in young women, 1500 mg in patients after the cessation of the menstrual cycle. This is also necessary because it helps strengthen bones and eliminate pain, which can also cause bone pain. Required dose magnesium is 420 mg for men and 320 mg for women per day. These micronutrients should be consumed together.
Other measures that can help relieve fibromyalgia at home:
Recipes alternative medicine for fibromyalgia, they can relieve a person from feeling tired, restore strength, and improve sleep. Therefore they are used medicinal plants and natural products with different actions, depending on the predominant symptom.
Oil massage will relieve muscle tension
The honey-lemon mixture increases vitality, improves mood, and reduces muscle pain. To prepare it, take half a kilogram of lemons and grind them in a meat grinder or blender without removing the peel. Mix with 500 ml of flower honey, add a couple of spoons of good butter and a pinch of grated almonds. Mix well and place the mixture in a cool place. Take 1 spoon of the medicine before meals, twice a day for 30 days.
Oil massage is good for relieving pain in tense muscles of the back, neck, and limbs. To prepare massage oil, take a quarter cup of thyme herb (you can buy it at the pharmacy) and grind it in a coffee grinder. Pour 1 liter of high-quality olive oil into a saucepan, bring to 40° in a water bath, add mashed thyme and keep on low heat for 2 hours. In the evening for 2 weeks, rub the oil with chopped thyme into the area of the hands, forearm, foot, and shin. Let your family apply this mixture to your spine from neck to sacrum.
Dandelion-based products help with emotional disorders, deterioration of memory and attention, and difficulty concentrating. The plant is pulled out entirely with flowers and roots and collected from May to July. Rinse the dandelions thoroughly, dry them a little on a towel and grind them in a meat grinder or blender, then, using a gauze pad, squeeze out the milky juice. Keep the product in a glass container with a lid in a cool place and use 30 drops 3 times a day for 6 months.
In treatment, herbal tinctures containing alcohol from spicy plants are widely used.
If you are worried about interrupted sleep or don't feel rested enough in the morning, use herbal remedies. Take equal parts of lemon balm herb and peppermint, half the amount of valerian root and elecampane rhizomes, chop well. Add grated lemon peel, cinnamon sticks, a few cloves, a pinch of nutmeg and cumin. Pour the resulting spicy mixture with 1 liter of high-quality vodka and place in a cool place. Take one spoon morning and evening, adding to tea or other drinks.
If you do not want to take tinctures with alcohol, spicy plants will help you in this case too. Take some black pepper, cinnamon powder or sticks, cardamom, cloves and grind in a coffee grinder. Pour 300 ml of water into a saucepan, add the spice mixture and simmer over low heat for a quarter of an hour. Remove from heat, add a pinch of loose leaf black tea and leave for 10 minutes. After this, strain, pour in the milk, add a little honey. This aromatic and beneficial drink for fibromyalgia can be drunk in the morning and evening for 10 days.
Take rose hips and dry lingonberries in a ratio of 3:1, chop and pour boiling water (500 ml), boil over low heat for a quarter of an hour, let cool, strain. Drink half a glass of the drink in the morning and evening for 30 days.
Take equal quantities of oregano leaves, thyme and motherwort herb, as well as crushed valerian rhizomes. Pour a tablespoon of the resulting mixture into a thermos and pour 2 cups of boiling water. Leave for 2 - 3 hours, pour the infusion into a jar. Drink on an empty stomach 3 times a day according to the following scheme: on the 1st day - a tablespoon, on the 2nd - two, on the 3rd - three and so on until the dosage is half a glass (100 ml) 3 times a day. Then gradually reduce the dosage. The mixture is useful for bad sleep, muscle soreness, low mood.
Take 200 ml of vodka and add a teaspoon of sage herb, eucalyptus leaves and flowers to it pharmaceutical chamomile. Leave for 7 days, then strain and drink one teaspoon at a time. spoon 3 times a day for 2 weeks. The collection has a calming and at the same time tonic effect, restores the activity of the nervous system.
Take equal parts of cucumber, sage, sweet clover, plantain, birch and lingonberry leaves, marigold flowers (calendula) and oat straw. Add a quarter cup of the mixture to a saucepan, pour 1 liter of water and boil, leave until cool, then strain. Drink half a glass of infusion in the morning and evening after meals, with the addition of honey. This collection will restore strength and reduce the severity of muscle pain.
Various compresses and rubbing help against muscle pain
A tincture of lilac flowers in alcohol will help relieve pain in muscles and joints. In the spring, take a three-liter jar of flowers, when they settle a little, fill them with alcohol or vodka, add liquid if necessary. Leave in a dark place for 2 weeks. The liquid can be used for rubbing and compresses.
Compresses made from cabbage, burdock and lilac leaves help against muscle and joint pain. You can alternate them. The leaves are kneaded, applied to the skin and secured with a bandage or gauze and leave the compress overnight.
You can make an alcohol compress from flowers horse chestnut. A liter of vodka requires 100 grams of raw material; infuse the product in a dark place for a week, and then rub it on painful muscles and joints.
Fibromyalgia is a fairly common disease caused by a disruption of the nervous system and manifests itself mainly as long-term, widespread muscle pain. Structural changes there are no peripheral tissues. The diagnosis is made based on examination of painful points located at the attachment points of muscles and tendons. Treatment includes lifestyle changes, physical activity, psychotherapy, as well as medications from the group of antidepressants, anti-inflammatory drugs and others. They can only be taken as prescribed by a doctor.
What is spondylosis of the lumbar, cervical and thoracic spine: signs, symptoms and treatment
Ankylosing spondylitis - what it is, how to treat it and identify the symptoms
Neurology", 2010, No. 5, p. 6-12
Doctor of Medical Sciences, Professor, A.B. Danilov
Department of Nervous Diseases FPPO, First Moscow State Medical University named after. THEM. Sechenov
Fibromyalgia is a disease characterized by chronic diffuse pain accompanied by symptoms such as increased fatigue, sleep disorders, cognitive impairment and bouts of depression. Fibromyalgia is characterized by increased sensitivity and pain in certain points of the body. Women are more susceptible to this disease than men. Just about 10 years ago, the scientific basis for the pathogenesis of fibromyalgia and other idiopathic pain disorders was very tentative. However, during recent years advances in instrumental diagnostics and genetics have led to significant progress in the understanding of fibromyalgia.
Story
Although the term “fibromyalgia” was coined relatively recently, this condition has long been described in the scientific literature. In 1904, William Gowers coined the term fibrositis. In the second half of the 20th century, some doctors believed that fibrositis was a typical cause of muscle pain, others believed that fibrositis was a consequence of “stress” or “psychogenic rheumatism,” and the rheumatological community did not consider this pathology. Modern concept Fibromyalgia was created by Smythe and Moldofsky in the mid-1970s. They coined a new term, fibromyalgia. The ending -algia suggests that this condition is more due to pain than inflammation connective tissue(-itis). The authors determined the presence of local increased sensitivity - the so-called tender points, as characteristic symptom fibromyalgia. They also found that patients with fibromyalgia often experience sleep disturbances.
The next stage in the study of the disease was the development of the American College of Rheumatology (ACR) diagnostic criteria for fibromyalgia, which were published in 1990. . According to this classification, the patient must have a history of chronic diffuse pain and more than 11 of 18 possible painful points must be identified. Significant progress in the study of fibromyalgia has been made after researchers concluded that the condition is not caused by damage or inflammation of peripheral tissues. Therefore, all efforts were aimed at studying the central mechanisms of pathogenesis. According to most experts, fibromyalgia is a multisymptom disease characterized by central disturbances in pain perception.
Etiology
Researchers have found that heredity plays an important role in the development of fibromyalgia. First-degree relatives of people with fibromyalgia have an 8-fold higher risk of developing fibromyalgia compared to the general population. Twin studies have shown that approximately half the risk of developing chronic diffuse pain is due to genetic factors, and the other half is due to factors external environment. As with most diseases that have a genetic basis, factors environment play an important role in the “trigger” of fibromyalgia and related pathologies. Factors that trigger the development of fibromyalgia include physical trauma (especially trauma to the torso), certain infections (for example, hepatitis C, Epstein-Barr virus, parvovirus and tick-borne borreliosis), and emotional stress etc. It is noteworthy that each of these factors leads to the development of chronic diffuse pain or fibromyalgia in approximately 5-10% of cases.
In other words, these factors in themselves are not the trigger mechanism that includes the development of pathology in patients against the background infectious process or after injury.
Possible factors triggering the development of fibromyalgia and associated pathologies:
Pathogenesis and pathophysiology
The mechanisms responsible for the clinical manifestation of fibromyalgia and related disorders are likely to be highly complex and multifactorial. The factor of chronic emotional stress plays a significant role. Research into the relationship between stress and the development of fibromyalgia has identified changes in the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. Research into fibromyalgia over the past two decades has provided greater insight into the pathophysiology of pain and perception processes, showing that pain thresholds vary with the degree of distress. Many psychological factors, such as hypervigilance, suspiciousness, catastrophizing, and external locus of pain control may play an important role in the severity of fibromyalgia symptoms. Special studies have shown that patients with fibromyalgia have reduced serotonergic and noradrenergic activity. It was also found that in patients with fibromyalgia there is a decrease in the level of serum serotonin and its precursor L-tryptophan and a decrease in the main metabolite of serotonin in the cerebrospinal fluid (5-hydroxyindole acetate). This data is supported by the fact that drugs that increase serotonin and norepinephrine levels (tricyclic antidepressants, duloxetine, milnacipram and tramadol) are simultaneously effective in treating fibromyalgia. Neurobiological evidence that fibromyalgia is a condition with increased pain sensitivity and disturbances in perception processes are confirmed by the results of hardware diagnostic methods: single-photon emission computed tomography and functional magnetic resonance imaging. Although sleep disturbances are quite common in patients with fibromyalgia, they rarely correlate with other fibromyalgia symptoms. Many clinicians have found that identifying and treating specific sleep disorders (eg, obstructive sleep apnea, increased upper resistance respiratory tract or disturbances in limb movement during sleep) will not necessarily improve the underlying symptoms of fibromyalgia.
Behavioral and psychological factors play a role in the development of the clinical picture of fibromyalgia. It has been established that the prevalence of psychiatric comorbidities in patients with fibromyalgia can reach 30-60%, and the frequency of mental disorders is even higher. Depression and anxiety disorders- These are the most common conditions.
Clinical picture and diagnosis
Some doctors consider the diagnosis of fibromyalgia to be highly controversial and controversial. Others see no problem in making a diagnosis. Controversy in the diagnosis of fibromyalgia arises from the lack of a clearly defined pathology. Fibromyalgia is classified as a functional disorder, which means there is no organic pathology. There are no specific diagnostic tests laboratory tests, radiological or other criteria for this pathology. The only symptom that a doctor can detect is increased sensitivity or tenderness of soft tissues upon palpation.
In 1990, the American College of Rheumatology developed guidelines for the diagnosis of fibromyalgia - ACR criteria (Table 1). Although these criteria are not intended for use in clinical settings, but only in research settings, they nevertheless provide more than 85% accuracy in differentiating patients with fibromyalgia from similar diseases.
Table 1. Diagnostic criteria and clinical characteristics of fibromyalgia (American College of Rheumatology, 1990)
| AKR criterion | Definition |
| History of diffuse pain (more than 3 months) | Pain is considered diffuse if it is present in 4 quadrants of the body (left and right, above and below the waist). There should be pain in the axial skeleton ( cervical region spine, or front part chest, or thoracic region spine, or lower back). Pain in the shoulders and buttocks is considered pain for each affected side. Sciatica is regarded as pain in the lower body |
| Pain in 11 of 18 tender points on palpation | Occiput: bilateral, in the area of the occipital muscles |
| Lower neck: bilateral, anterior to C5-C7 | |
| Trapezoid: bilateral, in the middle part of the upper border | |
| Supraspinatus: bilateral, above the spine of the scapula from the medial edge | |
| Second rib: bilateral, in the area of the second osteochondral joint slightly lateral | |
| Lateral epicondyle: bilateral, 2 cm distal to the epicondyles | |
| Gluteal: bilateral, upper outer quadrant of the buttocks | |
| Greater trochanter: bilateral, posterior to the acetabular tubercle | |
| Knee: bilateral, medial to the knee joint | |
| Clinical symptoms | Description from the patient's words |
| Increased fatigue | Lethargy, lack of motivation, difficulty moving or exercising |
| Quality of life | Impact on the ability to make plans, achieve goals, or complete tasks |
| General Features | Reduced daily household activities |
| Soreness | Soreness to touch |
| Dream | Has trouble falling asleep, shallow sleep, sluggish awakening |
| Cognitive impairment | Difficulty concentrating, lethargy |
| Rigidity | Stiffness in the morning |
| Depression/Anxiety | Feeling tired, frustrated, sad |
The main symptom of fibromyalgia is chronic diffuse pain, not caused by any pathology of the musculoskeletal system, which bothers the patient for at least 3 months. The pain is diffuse, spreading throughout the body above and below the waist. Typically, patients describe their condition as “I feel like I have pain everywhere” or “I always feel like I have a cold.” Patients usually describe pain that spreads throughout the muscles, but sometimes also report pain and swelling in the joints. In addition, patients often complain of paresthesia, numbness, tingling, burning, and a crawling sensation on the skin, especially in the legs and arms. In patients with fibromyalgia, physical examination reveals only increased sensitivity or tenderness in certain points of the body. Examining painful spots requires experience. The doctor must know exactly where to palpate and with what force. According to the ACR criteria, 9 pairs of painful points were identified (see figure).
Rice. 1. Examination of tender points
The pressure applied at these points should be 4 kg/cm (the pressure at which the examiner's nail beds turn white). When palpating 18 painful points, it is recommended to apply even pressure on paired points and, with the same force, palpate other areas of the body to compare sensitivity. Patients with fibromyalgia experience increased sensitivity in tender spots compared to other areas of the body. In addition, it is necessary to examine the joints, exclude the presence of synovitis and determine the sensitivity of the supra-articular areas. Painful points reflect areas of increased sensitivity to painful stimuli, and are not a consequence of local inflammation or tissue damage. Availability positive reaction in more than 11 out of 18 painful points identified diagnostic criterion based on the analysis of statistical data from large populations of patients. However, not all patients with fibromyalgia will experience increased sensitivity in more than 11 points. Once again, we note that the ACR criteria for fibromyalgia are intended for research purposes and not for making diagnoses for specific patients. Nevertheless, examination of tender points is considered an important part of studying the functioning of the musculoskeletal system in patients with generalized pain syndrome. Palpation of soft tissues and joints allows you to identify areas of increased sensitivity. This examination allows you to exclude synovitis or myositis and is very important in the diagnosis of fibromyalgia. As can be seen from the ACR criteria, fibromyalgia is not only a pain syndrome. This condition includes a whole range of symptoms that bother the patient. Along with chronic diffuse pain, another typical symptom of fibromyalgia is fatigue. This symptom is most pronounced upon awakening, but also occurs in the afternoon. Minor physical activity can dramatically increase pain and fatigue, although prolonged rest and inactivity can also aggravate symptoms. Since diffuse pain and fatigue can occur in the early stages of a flu, cold or overexertion, it should be noted that for fibromyalgia to be diagnosed, these symptoms must last for more than 3 months.
Patients with fibromyalgia feel stiff in the morning and feel sleepy, even if they have slept for 8-10 hours. Such patients usually sleep lightly, often wake up and have difficulty falling asleep. Patients usually say, “It doesn’t matter how long I’ve slept, but I feel like I’ve been run over by a truck.” In addition, most patients experience cognitive impairment and mood pathology. They most often describe their problems concentrating as “brain fog.” Negatively affects the patient’s well-being and many others clinical symptoms: headache (more than 50% of cases), dizziness, muscle spasms, tinnitus, leg cramps, restless legs syndrome, Raynaud's disease, chest, lower back and jaw pain. As a result of the described disorders, patients' quality of life usually decreases.
Non-drug treatment
A special analysis of various non-drug methods of treating fibromyalgia showed that two methods have significant effectiveness - cognitive behavioral therapy and physical education (Table 2). Both treatment methods showed sustained improvement in fibromyalgia symptoms for 1 year or more.
Table 2. Non-drug methods fibromyalgia treatment
Drug treatment
Antidepressants. Among the medications, tricyclic antidepressants (TCAs) were among the first to be used to treat pain syndrome in fibromyalgia. Amitriptyline has been shown to be able to relieve pain, promote sleep, and reduce fatigue in patients with fibromyalgia. At the same time, antidepressants from the group selective inhibitors Serotonin reuptake drugs (SSRIs) (fluoxetine, sertraline, citalopram, paroxetine) have shown low efficacy in randomized, placebo-controlled trials.
Serotonin norepinephrine reuptake inhibitors (SNRIs) (venlafaxine, duloxetine, milnacipran) were more effective than SSRIs. These drugs, like TCAs, inhibit the reuptake of serotonin and norepinephrine, but unlike TCAs, they have virtually no effect on other receptors. This selectivity leads to fewer side effects and better tolerability. Data on venlafaxine indicate that it successful application for the treatment of neuropathic pain and fibromyalgia.
In studies using duloxetine, there was a greater reduction in Fibromyalgia Questionnaire (FIQ) total score and a 30% reduction in pain in 54% of those taking the drug compared to 33% of those taking placebo. The most common adverse events were: nausea (29.3%), headache (20.0%), dry mouth (18.2%), insomnia (14.5%), fatigue (13.5%), constipation (14.5%), diarrhea (11.6%) and dizziness (11.0%). Duloxetine is approved by the FDA as an SNRI for the treatment of major depressive disorder, neuropathic pain and diabetes mellitus and fibromyalgia.
Milnacipran, which is widely used as an antidepressant, is also approved by the FDA for the treatment of fibromyalgia. In a 12-week randomized clinical trial, 125 patients with fibromyalgia received either milnacipran once or twice daily (at doses up to 200 mg/day) or placebo (10). It was possible to achieve a 50% reduction in pain in 37% of patients with fibromyalgia after taking it twice a day, in 22% -in the background single dose and 14% in the placebo group. Only milnacipran twice a day showed a statistical advantage over placebo. Only minor side effects were reported. In a 27-week study of milnacipran in 888 patients with fibromyalgia, 56% had at least a 30% reduction in pain intensity, compared with 40% of those in the placebo group. Side effects were generally mild, with nausea and headache being the most common.
Despite the fact that many chronic pain syndromes, including fibromyalgia, are accompanied by depression, some studies have shown that the analgesic activity of antidepressants is independent of their effect on the emotional status of patients. A recent meta-analysis of 18 RCTs confirmed that antidepressants can reduce fibromyalgia pain, depression, fatigue, sleep, and quality of life. Anticonvulsants. Pregabalin, an a2-a calcium channel ligand, is approved for the treatment of neuropathic pain and was the first drug approved by the FDA for the treatment of fibromyalgia.
Pregabalin (Lyrica) is the first and so far the only drug in Russia officially registered for the treatment of fibromyalgia. Pregabalin binds to the α2-σ site of voltage-gated calcium channels in the central nervous system. Due to a decrease in the influx of calcium into neurons, the release of substance P, glutamate and norepinephrine is reduced, providing the analgesic and anxiolytic (anti-anxiety) effect of pregabalin. The activity of this drug is limited to neurons and does not affect vascular calcium channels. In a large RCT of 528 patients with fibromyalgia, Pregabalin was shown to significantly reduce pain scores, improve sleep quality, reduce fatigue, and improve overall well-being. Study participants received placebo or one dose of pregabalin (150, 300, or 450 mg/day) for 8 weeks. All patients taking the drug showed improvement within 2 weeks, which persisted until the end of the study. Treatment with Pregabalin resulted in moderate but statistically significant dose-dependent reductions in pain, improved sleep, and decreased fatigue. Adverse events were quite common, but were mild and short-lived: dizziness (49%), drowsiness (28%), dry mouth (13%), peripheral edema (11%) and weight gain (7%). A follow-up 6-month placebo-controlled study included 566 patients with fibromyalgia who completed the 6-week open-label study and responded to treatment (responders). Pregabalin monotherapy was carried out in doses of 300, 450 or 600 mg/day (2 times a day). The primary objective of this study was to evaluate the duration of effect of Pregabalin therapy compared with placebo in the treatment of fibromyalgia pain in patients who responded to Pregabalin. In addition, the effectiveness of Pregabalin compared with placebo was assessed in terms of analgesia, overall patient well-being, treatment of sleep disorders, fatigue and safety. The results show that the response to treatment with Pregabalin is prolonged over time. The time to decline in therapeutic response was significantly shorter in those receiving placebo than in those receiving Pregabalin. At doses of 300, 450 and 600 mg/day, Pregabalin was superior to placebo in time to loss of response. Pregabalin with long-term therapy led to a later deterioration in parameters such as sleep disturbance, fatigue and general well-being of the patient.
Two other large randomized clinical trials, where treatment lasted 13-14 weeks, showed that Pregabalin monotherapy was effective in reducing pain in fibromyalgia at dosages of 300, 450 and 600 mg/day. The effect occurred quickly and persisted with continued treatment. In addition, Pregabalin therapy resulted in significant and consistent improvements in self-report measures across all doses in both studies and, in one study, a significant reduction in fibromyalgia severity at 450 and 600 mg/day. There was an improvement in the quality and quantitative characteristics sleep. Finally, the effectiveness of Pregabalin in the treatment of fibromyalgia was assessed in a meta-analysis of 6 RCTs involving more than 2000 patients with fibromyalgia. This analysis showed that Pregabalin reduced fibromyalgia pain, improved sleep, and improved quality of life, but did not affect the severity of depressive mood. In addition, patients receiving Pregabalin experienced a decrease in fatigue and anxiety.
Gabapentin, whose pharmacological properties are similar to Pregabalin, was used in a 12-week randomized clinical trial in 150 patients with fibromyalgia. There was a significant decrease in the mean pain intensity score in the Gabapentin group than in the placebo group. In addition, Gabapentin significantly improved scores on the Fibromyalgia Severity Scale (FIQ), the Patient Intervention Inventory (PGIC), and the Sleep Quality Scale. Compared with placebo, Gabapentin resulted in a significant increase in the incidence of sedative effect, lightheadedness and dizziness.
Muscle relaxants. Currently, doctors use muscle relaxants (cyclobenzaprine, tizanidine) in the treatment of fibromyalgia, despite the lack of results from relevant clinical studies. Tizanidine is FDA-registered as a muscle relaxant for the relief of spasticity in multiple sclerosis and disorders cerebral circulation. It belongs to the group of α2-adrenergic receptor agonists. A study of Tizanidine in fibromyalgia (4-24 mg/day) showed a decrease in the concentration of neuroamines and substance P in the cerebrospinal fluid. Tramadol - analgesic central action, which binds to μ-opioid receptors and inhibits the reuptake of norepinephrine and serotonin. An 8:1 combination of paracetamol (acetaminophen) and tramadol has shown synergism between both drugs in preclinical pain models. In a 13-week multicenter randomized clinical trial, Tramadol/paracetamol 37.5 mg/325 mg relieved fibromyalgia pain more effectively than placebo. All adverse events The adverse events reported in this study (transient and non-serious adverse events) were the well-known complications of tramadol: dizziness/vertigo, nausea, vomiting, constipation, somnolence, headache and weakness.
Benzodiazepines. The effectiveness of benzodiazepines in the treatment of fibromyalgia has not been fully studied. Many studies have produced conflicting results. For example, benzodiazepines, including alprazolam (0.5–3.0 mg at bedtime), did not show superiority over placebo for the treatment of fibromyalgia pain, but clonazepam was quite effective in treating the temporomandibular joint pain syndrome that is often seen in fibromyalgia. In addition, this drug quite effectively relieved restless legs syndrome, which is common cause restless and interrupted sleep in patients with fibromyalgia.
Local anesthetics. Systemic use of lidocaine has been used to treat patients with fibromyalgia: single and course infusions of lidocaine in doses of 5-7 mg/kg led to a fairly noticeable reduction in pain in patients with fibromyalgia. In a recent randomized clinical trial in patients with fibromyalgia, lidocaine 50 mg was injected into a painful point in the trapezius muscle. As a result, not only a local reduction in pain at the injection site was noticed, but also a general analgesic effect. This study demonstrated the important role of peripheral tissues in the development of hyperalgesia in fibromyalgia and demonstrated the clinical utility of local anesthetic injections for the management of pain in fibromyalgia.
Conclusion
Thus, today there are four main directions in the treatment of fibromyalgia (Table 3):
The first approach is more aimed at stopping acute pain for fibromyalgia and includes the use of physical therapy, muscle relaxants, muscle injections and analgesics. Central sensitization is successfully treated with cognitive behavioral therapy, sleep correction, antidepressants and anticonvulsants. Sleep disturbances are corrected by reducing stress exposure, aerobic physical activity and GABA agonists. Drug and behavioral therapy for secondary pain affect (anxiety, depression, fear) are among the most promising treatment strategies for fibromyalgia. Although any combination of these approaches can be very beneficial for patients with fibromyalgia, only comparative studies can provide reliable data on the effectiveness of a particular treatment method.
Fibromyalgia (myofascial pain syndrome)- this is inflammation individual areas muscles and places of attachment of muscles to bones (tendons). The causes of fibromyalgia are related to stress, decreased immunity and infection. Most people who get sick are of a certain psychological make-up: emotional, but with well-developed self-control. Treatment of fibromyalgia should be aimed at simultaneously treating the infection, immune disorders and nervous exhaustion, as well as to relieve inflammation.Chronic fatigue is a common symptom of fibromyalgia. This is the state exhaustion of the nervous system against the background of chronic stress and chronic infection. The main signs are a feeling of fatigue starting in the morning, difficulties in performing usual work.
The disease begins with a long stay of the nervous system in a state of stress. It could be mental stress or overwork, surgery or injury. Normally, stress is a beneficial response of the nervous system. The purpose of stress is a short-term increase physical capabilities the body in response to danger. When stressed, the body releases accumulated “emergency resources” of hormones, immune factors, heat, and various biologically active substances.
If stress continues for too long, resources are depleted, and this primarily concerns the nervous and immune systems. Immunity decreases, and the body is attacked by infections that were previously present in the body in a “silent” carrier mode . These are usually typical “opportunistic” infections:
In response to infection activity exhausted immune system gives the answer that can. Or maybe she gives a strong, but not focused enough response. “Immune special forces” appear in the blood, i.e. large number killer cells, which attack not only infections, but, by misunderstanding, also some own fabrics body, primarily on muscles and tendons. That's when inflammation appears, and then pain.
Main characteristics of fibromyalgia:
Treatment for fibromyalgia should be aimed at simultaneously treating infection, immune disorders and nervous exhaustion, as well as relieving inflammation and pain.
What are the symptoms of muscle fibromyalgia? What are the causes of this complex pathology and what is the therapy based on?
Let's look at the topic: from diagnosis to possible procedures treatment.
Fibromyalgia is a rheumatic syndrome that affects the muscles and tendons. The disease was known in the early 1800s. However, we had to wait until the beginning of the 20th century to get its theoretical description. The English neurologist Govers in 1904 called the disease fibrositis, meaning inflammation of the muscles.
Only in 1940 was it possible to exclude the inflammatory nature of the disease, and it began to be considered as a pathology with a very strong psychological basis. Then we had to wait until 1978 to arrive at today’s interpretation of the cause of the disease, and only in 1994 was an accurate diagnostic protocol drawn up.
Fibromyalgia is characterized by a group of symptoms, of which the most common are:
The syndrome can be divided into 2 different types, each of which has several implications:
Generalized fibromyalgia, in which pain and muscle stiffness spreads throughout the body and, in turn, it can be:
Localized fibromyalgia, where pain and stiffness occurs in discrete locations such as the jaw, neck and shoulder, but often spreads throughout the body over time, becoming generalized fibromyalgia.
To date, the real etiology of the primary syndrome is still unknown. Several reasons can be assumed; below are the most reliable ones.
The causes of secondary fibromyalgia are well known; it is a complication of diseases such as:
Localized fibromyalgia is often the cause of muscle cramps.
The main symptom of all types of fibromyalgia is:
Pain points are located:
These typical symptoms Fibromyalgia syndrome is usually accompanied by other manifestations that may periodically disappear and reappear:
Diagnosis of fibromyalgia is very difficult and for many years this disease may remain undiagnosed, since patient complaints are attributed to psychosomatic disorders.
Moreover, there are no special research blood or other type of examination that could clearly confirm fibromyalgia. Therefore, the diagnosis is based solely on observations of the clinical picture, that is, on the analysis of symptoms and signs.
From the above, it is obvious that fibromyalgia syndrome is very difficult to diagnose. The situation is further complicated by the fact that many symptoms and signs are nonspecific in the sense that they are common to many other diseases, for example, they may indicate polymyalgia rheumatica, Sjogren's syndrome, polymyositis.
The specialist in charge of the diagnosis is a rheumatologist, who acts in accordance with the diagnostic protocol:
Anamnestic analysis with palpation of 18 “painful” points, 11 of which should be painful.
Often, to exclude other conditions, the rheumatologist prescribes additional tests: radiography, MRI, scintigraphy.
Considering the characteristics of the disease and the lack of a clear understanding of the causes of the disease, treatment is carried out individually (there is no specific treatment protocol) and quite often it turns out to be fruitless.
Most commonly used the following types therapy:
Despite the fact that fibromyalgia is burdensome for the patient and often has a very negative impact on the quality of life, however, this disease is not threatening general health patient. The only consequence that may occur is pathology gastrointestinal tract, in particular, irritable bowel syndrome.
Treatment for fibromyalgia is a long and the hard way, requiring persistence and cooperation with a specialist, even if it is not dangerous to health, with the exception of psychological consequences.
In our country, unlike some European ones, fibromyalgia is not a basis for disability, despite the severe limitations that the disease can lead to.
Muscular fibromyalgia much more common in women than in men (ratio 9 to 1). The prevalence of the disease in the world among females significantly exceeds 3% of the population. The disease most often manifests itself between 20 and 45 years of age.
