Fibromyalgia is a form of lesions of extra-articular soft tissue, characterized by diffuse musculoskeletal pain and the presence of specific painful points or hypersensitivity points, determined by palpation.
The disease affects predominantly middle-aged women.
A characteristic feature of fibromyalgia is the abundance and variety of complaints and subjective sensations of the patient with very scarce objective signs of the disease.
The main symptom of fibromyalgia is diffuse musculoskeletal pain. Pain is considered spilled if it is present in various anatomical areas of the right and left half of the body above and below the belt, as well as in the projection of the spine.
The pain is usually combined with a feeling of morning stiffness, a sensation of swelling of the extremities, muscle fatigue and goosebumps or tingling sensations. Characteristic strengthening of these signs when changing weather, fatigue, stress.
In accordance with the diagnostic criteria of the American College of Rheumatology, the duration of fibromyalgic symptoms should exceed 3 months, since the appearance of diffuse muscle pain and fatigue can be caused by a viral infection, temporary sleep disturbance and stressful situations.
Significant psychological disorders largely determine the manifestations of fibromyalgia and bring this disease closer to chronic fatigue syndrome.
One of the most typical complaints is fatigue, which marks 87% of patients. Sleep disturbance , manifested by difficulty in falling asleep, intermittent restless sleep and lack of recovery from sleep, is observed in 79% of patients. More than half of patients with fibromyalgia report frequent migraine- type headaches.
150 shades of PMS: symptoms, causes and treatment
PMS is far from a homogeneous phenomenon: someone today is crying over trifles, someone is suffering from pain, and someone does not recognize himself in the mirror because of edema. Symptoms of PMS, known to doctors, are estimated in dozens (there are about 150 of them) and only detailed …
Patients are characterized by emotional disorders, which can vary from a slight decrease in mood to severe depression and anxiety and anxiety state.
Along with psychological disorders, a number of disorders can be detected in patients with fibromyalgia.
These disorders include manifestations such as irritable bowel syndrome , premenstrual syndrome , primary dysmenorrhea , vestibular disorders, joint hypermobility syndrome, irritable bladder syndrome, fluid retention syndrome, Raynaud’s syndrome and shegren-like syndrome, mitral valve prolapse , dysfunction of the temporomandibular joint syndrome , detection of mesh livedo.
Great importance is attached to the search for specific painful points, the presence of which distinguishes fibromyalgia from other diseases accompanied by chronic musculoskeletal pain.
When determining painful points, the finger pressure should be considered the most optimal with a force not exceeding 4 kg. The point is counted as positive if the subject notes pain. According to the criteria of the American College of Rheumatology, the presence of 11 painful out of 18 possible points is necessary for the diagnosis of fibromyalgia. Their localization predominates in the muscles of the shoulder girdle, back, lumbosacral and gluteal region.
The essential point in the diagnosis of fibromyalgia is the search for painful points. To eliminate the factor of subjectivity, it is necessary to re-determine the number of painful points by different persons. In addition, the determination of pain sensitivity in the control points (in the frontal, above the fibula head) is necessary.
The presence of pronounced psychological disorders dictates the need to include antidepressants in the treatment of fibromyalgia. The most commonly used amitriptyline, melipramine at a dose of 10-25 mg 1 time per night. The course of treatment is 4-6 weeks. Fluoxetine administered 20 mg 1 time in the first half of the day.
Non-steroidal anti-inflammatory drugs have found widespread use in the treatment of fibromyalgia. Prolonged ingestion of nonsteroidal anti-inflammatory drugs is undesirable due to possible side effects. Recently, preference has been given to local therapy in the form of ointments, gels, as well as local injections in combination with painkillers, in particular with lidocaine.
It is considered expedient to include muscle relaxants of the so-called local action: baclofen at a dose of 15-30 mg per day or dantrolene at a dose of 25-75 mg per day contribute to a decrease in muscle tone, have an analgesic effect.
There are reports on the effectiveness of antioxidants (ascorbic acid, alpha-tocopherol).
Of the non-drug treatments, various physiotherapeutic procedures are widely used, in particular, massage, balneotherapy, cryotherapy.
Much attention in recent years has been paid to physical exercise, namely aerobics, as an effective way to eliminate chronic muscle pain and fatigue. The importance is also attached to the methods of psychological rehabilitation of patients with fibromyalgia – psychotherapy and autogenic training.