Fibromyalgia: causes, diagnosis and treatment

Fibromyalgia is a complex disorder characterized by diffuse musculoskeletal pain, the presence of specific painful points, insomnia, depression, a feeling of fatigue and stiffness. This disease is difficult to diagnose due to pain throughout the body. Statistically, the disease affects about 4% of the population. Such patients do not live their usual life, since its quality is significantly reduced. These are mostly middle-aged women.

If you don't know what fibromyalgia is or how to treat it, but the symptoms you are experiencing are similar to those described in this article, contact the CELT Pain Clinic. Treatment of fibromyalgia in Moscow is one of our areas of activity, and in it we have achieved significant success.

Causes

The reasons why fibromyalgia occurs are currently not clearly established. Previously, this disease was classified as inflammatory or psychiatric, but modern research has revealed that there is no reason to say this: inflammatory processes have not been detected in fibromyalgia, and depressive states can appear as a result of it.

Modern research has revealed increased levels of neurotransmitter and nerve growth factor in the cerebrospinal fluid of patients who suffer from this disease. In addition, there are prerequisites to assume that they have hypersensitivity of the central nervous system and impaired pain perception.

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Diagnosis and treatment of fibromyalgia

Fibromyalgia is a complex disorder with widespread musculoskeletal pain, depression, sleep disturbances, morning stiffness, and fatigue. The disease is also characterized by the presence of painful areas on the body - so-called “pain points”. Women are more susceptible to developing this disease than men. Among all forms of chronic pain syndromes, fibromyalgia is the leader in terms of the prevalence of depression, the degree of maladaptation of patients suffering from this disease, i.e., the degree of reduction in their quality of life. Fibromyalgia is a disease that comes to the attention of not only rheumatologists, neurologists, pain specialists, but also general practitioners. According to statistics, fibromyalgia affects 2–4% of the population. However, despite its prevalence, the diagnosis of fibromyalgia in the world, particularly in Russia, is extremely rare. This is due to unusual manifestations of the disease, insufficient awareness of doctors and the lack of clear diagnostic criteria.

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 twentieth 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 rheumatology community did not consider this pathology at all. The modern concept of fibromyalgia was created by Smythe and Moldofsky in the mid-1970s. They coined a new term, fibromyalgia. The authors identified the presence of local hypersensitivity, so-called “tender points,” as a characteristic symptom of fibromyalgia. They also found that patients with fibromyalgia often experience sleep disturbances. The next stage in fibromyalgia research was the development of the American College of Rheumatology (ACR) diagnostic criteria for fibromyalgia, which were published in 1990 [3]. 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.

Etiology and pathogenesis

One of the most important mechanisms for the formation of chronic pain in fibromyalgia is the phenomenon of central sensitization (CS). It is characterized by the fact that after prolonged peripheral nociceptive stimulation, a certain level of excitation remains in the central sensory neurons of the dorsal horn, which maintains pain even in the absence of further peripheral pathology. However, numerous studies have demonstrated that CS can develop in the presence of disorders in the central nervous system without peripheral damage. Fibromyalgia is such an example. That pain can be the result of changes in the central nervous system and a “real” neurobiological phenomenon that contributes to the formation of pain seems unlikely to many. Often, patients with fibromyalgia who do not show peripheral changes are considered by doctors as malingerers or patients with hysteria. Some doctors, in situations where they cannot find an organic cause of pain, prefer to use diagnostic labels such as psychosomatic and somatoform disorders.

However, today it has been convincingly shown that CS, as well as a violation of the descending (noradrenergic and serotonergic) inhibitory control of pain, arise in fibromyalgia not as a result of peripheral changes in muscles, fascia, ligaments or connective tissue, but as a result of neurodynamic disturbances in the central nervous system in individuals with a genetic predisposition to this disease. exposure to a large number of stressful (physical and mental) events (Table 1).

Research into fibromyalgia over the past two decades has shown that the pain threshold varies 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 patients with fibromyalgia have decreased levels 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 evidence is supported by the fact that drugs that simultaneously increase serotonin and norepinephrine levels (tricyclic antidepressants, duloxetine, milnacipram and tramadol) are effective in treating fibromyalgia. Neurobiological evidence that fibromyalgia is a condition with increased pain sensitivity (PS) and impaired perception processes is confirmed by the results of hardware diagnostic methods: single-photon emission computed tomography and functional magnetic resonance imaging [1, 2].

Clinical picture and diagnosis

In 1990, the American College of Rheumatology developed guidelines for the diagnosis of fibromyalgia (ACR criteria) (Table 2) [3]. Although these criteria are not intended for use in clinical settings, but only in research settings, they are nevertheless more than 85% accurate in differentiating patients with fibromyalgia from similar conditions.

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 three 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 for fibromyalgia have been identified (Fig.).

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. Painful points reflect areas of increased sensitivity to painful stimuli, and are not a consequence of local inflammation or tissue damage.

The presence of a positive reaction in more than 11 of 18 painful points was determined by the diagnostic criterion based on the analysis of statistical data from large populations of patients. However, not all patients with fibromyalgia will have 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. However, 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 the ACR criteria show, fibromyalgia is not just 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.

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: “No matter how long I slept, I feel like I was run over by a truck.”

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 from 30% to 60%, and the frequency of mental disorders is even higher. Depression and anxiety disorders are the most common conditions. In addition, most patients experience cognitive impairment. For example, patients typically describe their problems with concentration or attention as “brain fog.”

Recently, the FiRST (Fibromyalgia Rapid Screening Tool) questionnaire has been proposed to screen for fibromyalgia (Table 3). The advantages of the questionnaire are its brevity and ease of completion. It should be emphasized its high sensitivity (90.5%) and specificity (85.7%). It is important to note that the questionnaire is intended for screening and a diagnosis cannot be made using it alone. Patients who score 5 or more on the FiRST questionnaire should be carefully evaluated to make a definitive diagnosis of fibromyalgia.

Fibromyalgia Treatment

Non-drug treatment

A specially conducted analysis of various non-drug methods of treating fibromyalgia showed that two methods have significant effectiveness - cognitive behavioral therapy and physical education (Table 4) [4]. Both treatment methods showed sustained improvement in fibromyalgia symptoms for one year or more.

Drug treatment

Antidepressants

Among the medications, tricyclic antidepressants (TCAs) were among the first to be used to treat pain in fibromyalgia. Amitriptyline has been shown to be able to relieve pain, promote sleep, and reduce fatigue in patients with fibromyalgia [5]. At the same time, antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs) (fluoxetine, sertraline, citalopram, paroxetine) showed low effectiveness in randomized, placebo-controlled trials for fibromyalgia [5].

Serotonin norepinephrine reuptake inhibitors (SNRIs) (venlafaxine, duloxetine, milnacipran) have been shown to be more effective than SSRIs. These drugs, like TCAs, inhibit the reuptake of serotonin and norepinephrine, however, unlike TCAs, they have virtually no effect on other receptors. This selectivity leads to fewer side effects and better tolerability. Data on venlafaxine indicate its successful use in the treatment of neuropathic pain and fibromyalgia [6].

In studies using duloxetine, there was a greater reduction in total Fibromyalgia Impact Questionnaire (FIQ) scores [7] and a 30% reduction in pain in 54% of those taking the drug compared with 33% of those taking placebo [8, 9]. Duloxetine is approved by the US Food and Drug Administration (FDA) as an SNRI for the treatment of major depressive disorder, neuropathic pain in diabetes mellitus and fibromyalgia.

Milnacipran, which is widely used as an antidepressant, is approved by the FDA for the treatment of fibromyalgia. In a 12-week randomized clinical trial (RCT), 125 patients with fibromyalgia received either milnacipran once or twice daily (at doses up to 200 mg/day) or placebo [10]. In total, 37% of patients with fibromyalgia achieved a 50% reduction in pain with a double dose, 22% with a single dose, and 14% with a placebo. In a 27-week study of milnacipran in 888 patients with fibromyalgia, 56% of patients experienced at least a 30% reduction in pain intensity, compared with 40% of those in the placebo group [11]. Side effects were generally mild and the most common symptoms were nausea and headache.

Despite the fact that many chronic pain syndromes, including fibromyalgia, are accompanied by depression, some studies have shown that the analgesic activity of antidepressants does not depend on their effect on the emotional status of patients [7–11].

A recent meta-analysis of 18 RCTs confirmed that antidepressants can reduce pain in fibromyalgia, reduce depression, fatigue, restore sleep and improve quality of life [5].

Anticonvulsants

Pregabalin

Pregabalin, an alpha-2-delta 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 alpha-2-delta region 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 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 general well-being [12]. 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. A follow-up 6-month placebo-controlled study included 566 patients with fibromyalgia who completed a 6-week open-label study and responded to treatment (responders) [13]. Monotherapy with pregabalin 300, 450 or 600 mg/day (twice daily) was administered. The results show that the response to pregabalin treatment is prolonged over time. The time to decline in therapeutic response was significantly shorter in those receiving placebo than in those receiving pregabalin. 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 RCTs, 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 [14, 15]. The effectiveness of pregabalin in the treatment of fibromyalgia was assessed in a meta-analysis of six RCTs involving more than 2000 patients with fibromyalgia [16, 17]. Pregabalin was shown to reduce pain in fibromyalgia, improve sleep and improve quality of life, but did not affect the severity of depressive mood. In addition, patients with fibromyalgia treated with pregabalin experienced improvements in fatigue and anxiety.

Gabapentin

Gabapentin, whose pharmacological properties are similar to pregabalin, was used in a 12-week RCT of 150 patients with fibromyalgia [18]. 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 Global Impression of Change (PGIC) scale, and the sleep quality scale. Compared with placebo, gabapentin resulted in a significant increase in the incidence of sedation, lightheadedness, and dizziness.

Tramadol

Tramadol is a centrally acting analgesic that binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin. The combination of paracetamol (Acetaminophen) with tramadol in a ratio of 8:1 has shown synergy between both drugs in preclinical pain models. In a 13-week multicenter RCT, tramadol/paracetamol 37.5 mg/325 mg relieved fibromyalgia pain more effectively than placebo [21]. All adverse events recorded in this study (transient and non-serious adverse events) were well-known complications of tramadol: dizziness (vertigo), nausea, vomiting, constipation, drowsiness, 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 pain in fibromyalgia, but clonazepam was quite effective in relieving temporomandibular joint pain, which is often observed in fibromyalgia [22, 23]. In addition, this drug was quite effective in stopping restless legs syndrome, which is a common cause of restless and interrupted sleep in patients with fibromyalgia.

Local anesthetics

Systemic administration 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 [24]. In a recent RCT of 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 observed, but also a general analgesic effect [25]. 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 5): 1) reduction of peripheral pain, in particular muscle pain; 2) prevention of central sensitization; 3) normalization of sleep disorders; 4) treatment of concomitant pathology, in particular depression. The first approach is more aimed at relieving the acute pain of 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 exercise and gamma-aminobutyric acid (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. All experts emphasize the need for a comprehensive multimodal approach in the treatment of fibromyalgia, including both pharmacological and non-drug methods.

Literature

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A. B. Danilov, Doctor of Medical Sciences, Professor

GBOU VPO First Moscow State Medical University named after. I. M. Sechenova Ministry of Health and Social Development of Russia, Moscow

Contact information about the author for correspondence

Symptoms of fibromyalgia

Manifestations of fibromyalgia include the following:

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• widespread pain throughout the body, often symmetrical;
• sleep disturbances, lack of feeling of freshness after recovery;
• feeling of stiffness in the morning;
• changes in body temperature;
• the occurrence of cramps and spasms;
• difficulties with concentration and memory;
• mental disorders, sudden changes in mood.

Causes of fibromyalgia

Currently, there is no exact list of reasons that could trigger the development of this disease. However, several factors can be noted that are a prerequisite for the occurrence of the disease:

• Long-term sleep disturbances (in particular, disturbance of the deep sleep phase). In this phase, the pituitary gland releases the hormone somatropin into the body. A decrease in somatropin levels as a result of long-term sleep disturbances leads to brain wave pathologies, which is a prerequisite for the development of fibromyalgia.
• The presence of infectious processes in the body (herpes virus, cytomegalovirus).
• Injuries that can be either acute or chronic.
• Disorders of the thyroid gland, leading to hormonal imbalance in the body.
• Chronic depression and frequent stress.
• Prolonged pain caused by a particular disease.
• It is believed that a genetic predisposition may also be the cause of the development of fibromyalgia, however, this has not yet been proven.

Diagnosis of fibromyalgia

If you don’t know which doctor to contact for fibromyalgia, come to the CELT Pain Clinic. We employ algologists who have extensive experience in treating various pain syndromes, including this disease. They will make a diagnosis and propose a treatment plan. If necessary, specialists from related specialties will be involved - neurologists and rheumatologists, immunologists, as well as psychotherapists and psychiatrists.

Unfortunately, to date, no special diagnostic methods have been developed that allow one to immediately diagnose fibromyalgia. Therefore, our specialists conduct a series of studies that allow us to exclude other diseases that are characterized by similar symptoms. For this purpose, laboratory tests are carried out, direction to determine:

• glucose level;
• red blood cell level;
• rheumatoid factor;
• erythrocyte sedimentation rate;
• prolactin and calcium levels.

Manifestations of fibromyalgia

The main manifestation of fibromyalgia is increased sensitivity of the body (even pain). People may complain of musculoskeletal pain, tenderness and stiffness in various parts of the body, as well as sleep disturbances and fatigue. Some patients report that fatigue is the most frustrating aspect of fibromyalgia, as it can affect mood, concentration, memory and the ability to think clearly.

The full list of possible fibromyalgia symptoms also includes:

• headache;
• joint disorders;
• irritable bowel syndrome;
• poor circulation and tingling in the periphery;
• urgent urge to urinate;
• allergic reactions.

The pain of fibromyalgia tends to spread and usually feels like an aching or burning sensation. It varies in severity, but is generally more severe on the most frequently used areas of the body. Fatigue also varies in severity - up to complete exhaustion.

Many people may experience periodic flare-ups, where symptoms suddenly become worse. Some people with fibromyalgia report that their pain gets worse in very damp, cold or hot weather.

With mild or moderate symptoms, people can continue to live their lives as normal. However, when severe, fibromyalgia can affect people to such an extent that maintaining a job or having a normal social life seems impossible.

Treatment

Since the symptoms of fibromyalgia are highly variable between patients, treatment programs must be personalized for each patient. Fibromyalgia treatment programs are most effective when drug and non-drug treatment methods are combined.

Stress Reduction

It is almost impossible to measure stress levels in different patients. For some people, spilled milk on the table is almost a tragedy. But for others, even if a tank enters the room, there will be no concern. Biofeedback and relaxation techniques have a good effect on reducing stress. Sometimes changes in environmental factors (such as noise, temperature, weather changes) are enough to increase the symptoms of fibromyalgia. And influencing these factors can have a positive impact. Getting the optimal amount of sleep is very helpful.

Exercise therapy

Low-intensity physical activity such as swimming, cycling, walking. Exercise in the morning is especially beneficial. The mechanism by which exercise affects fibromyalgia is unknown. One factor may be improved sleep (extension of REM sleep).

Diet

There is no specific diet to treat fibromyalgia. It is recommended to avoid drinking alcohol and coffee in the evening to improve sleep. If you have irritable bowel syndrome, it is necessary to avoid foods that provoke disturbances in the gastrointestinal tract.

Drug treatment

Traditionally, tricyclic antidepressants, commonly used to treat depression, have been considered the most effective. In the treatment of fibromyalgia, tricyclic antidepressants are used in dosages several times lower than in the treatment of depression. Tricyclic antidepressants relieve fatigue to some extent, reduce muscle pain, and improve sleep. Science believes this is due to changes in levels of a neurotransmitter called serotonin. A tricyclic antidepressant is, for example, amitriptyline or doxepin. Practice has shown that the combination of drugs such as fluoxetine (Prozac) with a reduced dose of amitriptyline increases the reduction of symptoms, improves sleep and well-being. But these drugs, unfortunately, have side effects. In 2007, a drug called Lyrica (pregabalin) was synthesized and was the first drug developed specifically for fibromyalgia. Lyrica significantly reduces pain in patients with fibromyalgia. Moreover, the drug has a wide therapeutic range (allows you to select the dosage depending on the symptoms). Another drug called Neurontin (gabapentin) has a similar effect. And more recently, drugs have been synthesized that instantly increase the level of two neurotransmitters in the brain (serotonin and norepinephrine). These drugs are duloxetine (Cymbalta) and milnacipran (Savella).

In addition to antidepressants, NSAIDs are often prescribed for fibromyalgia. But their effectiveness is not as obvious as for rheumatological conditions.

Massage and acupuncture often have some effect in the treatment of fibromyalgia.

Causes

The process of studying the causes of fibromyalgia is still ongoing. Some researchers are studying hormonal and biochemical disturbances that may affect receptor sensitivity. Other experts believe that fibromyalgia, with its characteristic deep muscle pain, is related to stress, illness or injury. Still others believe that there are hereditary reasons. But due to the fact that there is no clear explanation for the causes of this syndrome, all researchers agree that fibromyalgia occurs due to a combination of several factors, and not just one (physical and emotional stress). Recently, studies have appeared on the role of neurotransmitters such as serotonin (low levels in the brain reduce the threshold of pain sensitivity). A decrease in the threshold of pain sensitivity may also be due to the ineffectiveness of neuropeptides such as endorphins and, as a result, an increase in substance P, which enhances pain impulses. Perhaps because women have 7 times less serotonin in their brains than men, fibromyalgia is much more common in women than in men. It is also possible that hormonal factors play a role in women, especially during menopause.

Stress, as well as insufficient sleep, can lead to decreased serotonin levels, which leads to increased sensitivity to pain.

Genetic determination may have a role in the development of fibromyalgia, as pain sensitivity is determined by certain genes. But so far these genes have not been isolated or identified.

Types of fibromyalgia

Doctors distinguish several types of fibromyalgia.

• Rheumatic
  . With this type of fibromyalgia, the muscles and tendons become hard to the touch, their mobility decreases, the person feels constrained, unable to make wide, full-amplitude movements. Often the muscles cramp. The picture is very similar to rheumatism, but there are no inflammatory processes.
• Idiopathic
  . This is the primary form of the disease. Doctors speak about the causes of its occurrence in a speculative manner: it manifests itself in people with a genetic predisposition when they are under stress or in a state of extreme nervous tension. Fibromyalgia of the breast. The most common type of disease in women. It feels very similar to mastopathy. The difference is the absence of an inflammatory process. There is pain in the mammary gland itself and in the muscles surrounding it. Often accompanied by headache.
• Autoimmune
  fibromyalgia. The presumable reason is stress, a decrease in the body's production of substances useful for the proper functioning of the muscular and other systems. Sometimes, when you come out of stress, the symptoms of the disease decrease or disappear completely.

The main danger of the disease is directly related to its main symptom: constant aching, pulling, throbbing or stabbing pain. A person experiencing such sensations cannot live normally, becomes nervous, and falls into a state of depression. Efficiency drops, communication with others gradually fades away due to fears of experiencing a nervous breakdown at any moment. It has been established that when such a diagnosis appears in the body, the level of various substances beneficial to the immune system decreases. Immunity falls, the body becomes powerless against pathogenic bacteria and viruses. Consequences: constant exposure to colds. Therefore, when the first symptoms of the disease appear, you should consult a doctor and undergo a full course of diagnostics.

Features of the condition

As a specific condition, fibromyalgia has been included in medical theory and practice for quite a long time. This condition is known to occur in 4% of the population. The greatest likelihood of encountering it occurs in women aged 35-55 years. Since the disease does not have an organic basis, for many years it was considered a mental disorder. Such patients were given a wide variety of diagnoses, including hypochondria, hysteria, and psychogenic rheumatism.

The term itself originated in the 70s. last century, but diagnostic criteria were recorded only in 1990 by the American College of Rheumatology. And already in the 21st century, scientists have proven that this disease does not have background peripheral tissue disorders due to inflammatory processes, and therefore cannot be considered a rheumatic pathology. Since such patients had problems with the central mechanisms of pain, fibromyalgia was classified in the field of neurology.

Symptoms

The universal symptom of fibromyalgia is, of course, pain. As mentioned above, the pain of fibromyalgia is not caused by tissue inflammation. Instead, patients appear to have increased sensitivity to various sensory stimulants and an unusually low pain threshold. Minor sensory stimulations that usually do not cause significant distress to others can be significant and disabling in patients with fibromyalgia.

Fibromyalgia pain can occur in different parts of the body, on both sides. Most often, pain occurs in the neck, buttocks, shoulders, chest, and upper torso. Sensitive zones are limited areas where there is increased sensitivity.

Fatigue occurs in 90% of patients. Fatigue may be associated with pathological sleep phase disturbances, which is often observed in these patients. Normally, there are several levels of sleep depth. A person needs to be in the deep stage of sleep longer to restore the body's strength. Patients with fibromyalgia lack deep, restorative levels of sleep (called the non-rapid eye movement stage). As a result, patients wake up in the morning feeling tired and with heaviness in their muscles and a feeling of lack of sleep (even though the number of hours of sleep was sufficient).

Mental or emotional disturbances occur in more than half of patients with fibromyalgia. These disorders include poor concentration, impaired fixation memory, irritability, and depressed mood. And due to the fact that the diagnosis of fibromyalgia is difficult to verify, such patients are often diagnosed with depression.

Other symptoms of fibromyalgia may include migraine or tension headaches and various numbness or tingling sensations in various areas of the body. In addition, there may be abdominal discomfort (spasmodic bowel) and irritable bladder (frequent and sometimes painful urination). But the examination shows no signs of inflammation in the intestines or bladder. Each patient with fibromyalgia is unique, and symptoms can occur in different combinations.

Basic treatment methods

Since there is no reliable data on the causes of fibromyalgia syndrome, during treatment doctors direct all their efforts to relieving symptoms and eliminating the consequences of the disease. Therapy is based on an individual principle. First of all, the severity of pain and the condition of trigger points on the patient’s body are taken into account.

Treatment includes several therapeutic areas:

1. Taking medications can eliminate pain and muscle stiffness, reduce irritability, normalize sleep and get rid of symptoms of depression, if present. The choice of medications must be approached with extreme caution, since the success of treatment largely depends on how much sleep disorders can be eliminated. And many of the drugs can cause insomnia.
2. Among non-drug methods of treating the syndrome, the most effective are cognitive-behavioral psychotherapy and physical therapy. The combination of only these two methods allows you to achieve sustainable results. Massage, oxygen therapy, hypnosis and autogenic training, yoga, meditation, etc. will be useful for fibromyalgia. Maintaining a sleep and rest schedule is also a necessary condition for recovery.
3. For fibromyalgia, non-traditional treatment methods can also be used. Some experts say that acupuncture can help reduce pain. Cryotherapy and a raw vegetarian diet can achieve similar results. There is also a method of treating the syndrome with popular cough tablets - guaifenesin. But in this case, the patient must completely avoid drinking tea, products containing plant oils and extracts, menthol, and bioflavonoids. You should not use cosmetics that contain salicylates, salicylic acid, disalcide and camphor. The list of substances prohibited for use and use is quite extensive, but many researchers are skeptical about this method.

It is not possible to completely get rid of the manifestations of fibromyalgia syndrome. With regular maintenance treatment, positive results can be achieved, but they do not last more than one year.

While working with the patient, the doctor supports his desire to actively resist the symptoms of the disease and develops positive thinking. The patient will be recommended to live in a dry, warm climate and be completely free from stressful situations.

Diagnostics

There are no tests or x-rays that confirm the diagnosis of fibromyalgia. Tests and examinations are prescribed to rule out other diseases. The diagnosis of fibromyalgia is made based on medical history and physical examination. In patients with chronic pain, the diagnosis of fibromyalgia can be made based on the detection of painful points (up to 80% of cases), the presence of tissue inflammation and the exclusion of other diseases. Many diseases have symptoms similar to fibromyalgia. For example, these are diseases such as:

• Low thyroid hormone levels (hypothyroidism),
• Vitamin D deficiency
• Increased function of the parathyroid glands (causes an increase in blood calcium levels),
• Muscle diseases accompanied by muscle pain (polymyositis),
• Bone diseases, with bone pain (Paget's disease),
• Increased levels of calcium in the blood (hypercalcemia),
• Infectious diseases (hepatitis, Epstein-Bar virus, AIDS),
• Oncological diseases.

And, although blood tests do not verify fibromyalgia, they are necessary for differential diagnosis. Therefore, it is necessary to do blood tests for thyroid hormones and calcium levels in the blood (to exclude hypercalcemia, hyperparathyroidism, and hypothyroidism). Alkaline phosphatase levels are often elevated in patients with Paget's disease. Creatine phosphokinase is often elevated in patients with polymyositis. A detailed blood test and blood biochemistry allows you to diagnose hepatitis.

Fibromyalgia can debut independently or in association with systemic rheumatological diseases. In systemic rheumatological diseases (SLE, rheumatoid polyarthritis, polymyositis), inflammation and damage to various tissues and organs occurs. For the diagnosis of these diseases, tests such as ROE, plasma protein levels, antinuclear factor, C reactive protein, and sialic acid are important. For fibromyalgia, these tests are within normal limits.