How Effective Is Amitriptyline for Fibromyalgia?

Fibromyalgia syndrome is a type of rheumatism, which is characterized by diffuse muscle pain, often accompanied by a variety of non-specific symptoms; typically, patients have tenderness in certain specific parts of the body, and do not require a specific laboratory or disease. Physical examination to help diagnosis.

Basic Information

English name

Fibramyalgia syndrome

Visiting department

Internal medicine

Multiple groups

25 to 60 year old women

Common symptoms

Insomnia, awakening, dreaming, loss of energy; pain and swelling around joints and joints; abdominal pain, diarrhea and constipation alternately, etc.

Causes of fibromyalgia syndrome

The cause of fibromyalgia syndrome is unknown, but the patient may have a previous history of physical or trauma. The most prominent symptom of fibromyalgia syndrome is generalized diffuse pain, which lasts for more than 3 months, and will be combined with some other clinical manifestations, including sleep disorders, physical stiffness, fatigue, and cognitive dysfunction. Fibromyalgia syndrome is difficult to treat and is still an incurable chronic painful disease.

Central nervous system

Central nerve sensitization is one of the most important causes of fibromyalgia syndrome. Chronic chronic pain can lead to "central sensitization", which is manifested in patients with increased levels of serotonin (5-HT) and substance P in the cerebrospinal fluid of patients. In addition, functional magnetic resonance imaging technology also shows Related regional functional activities are enhanced.

2. Immune disorders

Some studies have reported the presence of antithyroid antibodies in the serum of patients, and the levels of interleukin (IL) -1, interleukin-6 (IL-6), and tumor necrosis factor in some patients have increased.

3. infection

Some people think that FS is related to infection, especially Epstein-Barr virus, parvovirus, and Burgdorferi infection.

4. Genetics

The prevalence of first-degree relatives in patients with fibromyalgia is significantly increased, suggesting that heredity plays a role in the pathogenesis.

Clinical manifestations of fibromyalgia syndrome

Fibromyalgia syndrome is more common in women, and the most common age of onset is 25 to 60 years. The clinical manifestations are diverse, but mainly have the following four symptoms.

Main symptoms

Generalized generalized muscle pain and widespread tenderness points are symptoms common to all patients with fibromyalgia syndrome. Pain is found throughout the body, especially in the central axis bones (neck, thoracic spine, lower back), shoulder straps, and pelvic straps. The other common parts are knee, hand, elbow, ankle, foot, upper back, mid back, wrist, hip, thigh and calf. Most patients describe this pain as dull pain, which is distracting. Patients often report joint pain but no joint swelling.

Another phenomenon is tender points in some special places. These tender points exist in tendons, muscles and other tissues, and they are often distributed symmetrically. When these tender points are pressed with a certain force, the patient will feel pain, but normal people will not have pain.

2. Common symptoms

Symptoms in this group include sleep disorders, morning stiffness, and cognitive dysfunction. About 90% of patients have sleep disorders, which are manifested as insomnia, awakening, dreaming, and lack of energy. However, there are two important characteristics of sleep disorders in patients with fibromyalgia. The first is that even when the sleep time can reach the normal age Sleep time, but the patient's mental and physical strength will not be restored. Some patients even complain that they are tired after sleep than when they are not asleep. Another feature is that they have difficulty falling asleep. 50% to 90% of patients have a sense of fatigue, and about half of the patients have more severe symptoms of fatigue. This fatigue has nothing to do with the amount of exercise. Morning stiffness occurs in 76% to 91% of patients. Most patients also suffer from cognitive dysfunction, which is manifested by memory loss, difficulty in concentrating, fluency in speech, such as before, and decreased computing ability; some patients also experience general stiffness.

3. Other symptoms

Some patients experience joint and peri-articular pain and swelling, but do not see significant joint swelling. Other symptoms include headache, irritable bowel or bladder syndrome. Patients with irritable bowel syndrome are prone to alternate abdominal pain, diarrhea, and constipation, but no abnormalities are found in gastrointestinal examinations; urinary bladder patients have frequent urination and urgency, but urine and bladder and kidney examinations are not abnormal. Some patients also experience pain. Patients with fibromyalgia often also experience some psychological abnormalities, including depression and anxiety. In addition, the patient's labor capacity has decreased, and about one-third of the patients need to change jobs, and a small number of people cannot persist in their daily work. The above symptoms are often exacerbated by cold weather, nervousness, and overwork.

4. Combining symptoms of other diseases

Some patients with fibromyalgia syndrome may also have some type of rheumatism. At this time, the clinical symptoms are the overlap and overlap of the two symptoms.

Diagnosis of fibromyalgia syndrome

There is no specific laboratory test and other auxiliary tests, and the diagnosis can be confirmed based on clinical characteristics and typical tenderness points.

1. Systemic pain lasting more than 3 months

When the left and right sides of the body, the upper and lower parts of the waist, and the bones of the central axis (cervical vertebrae or anterior chest or thoracic vertebrae or lower back) appear at the same time, it is called generalized pain.

2. Press the tender point with your thumb

The pressing pressure is about 4 kg, and at least 11 of the 18 tenderness points are painful. The 18 (9 pairs) tender points are: the suboccipital muscle attachment point; the midpoint of the upper edge of the trapezius muscle; the front of the 5-7th cervical spine transverse process; 2 cm from the distal end of the lateral epicondyle of the humerus; the junction of the second rib and cartilage; the outer upper quadrant of the gluteal region, the front of the gluteal muscle; the posterior part of the trochanter;

Fibromyalgia Syndrome Treatment

Fibromyalgia syndrome is an idiopathic disease whose pathophysiology is unknown until now. Therefore, treatment is difficult and requires the cooperation of doctors from multiple disciplines. Current treatments are focused on improving sleep and reducing the sensitivity of nociceptors.

Western medicine treatment

(1) Eliminate the causes of worsening symptoms Cold and humid environment. Physical or mental fatigue. Poor sleep. Excessive or too little physical activity. Anxiety and tension.

(2) Drug treatment Amitriptyline This medicine is an antidepressant, which is taken orally before bedtime, and has obvious improvement on pain, insomnia and morning stiffness. Patients with obvious anxiety can take oral eszolam (sulbutolam). Side effects of amitriptyline may include dry mouth, constipation, blurred vision, urinary retention, increased intraocular pressure, and tachycardia. Pregabalin has analgesic and anticonvulsant effects, and has a good effect on reducing pain and improving sleep. Duloxetine is a serotonin and epinephrine reuptake inhibitor. In addition to relieving pain, it has a better effect on patients with more anxiety and depression. Cyclobenzaprine (Amiphencycloheptene) This medicine has a certain effect on myalgia and insomnia in patients with FS. Chlorpromazine before bedtime can improve sleep and reduce myalgia and tenderness.

(3) Psychotherapy This disease is more common in young women with obvious neuropsychiatric symptoms, such as headache, insomnia, upset and anxiety. Therefore, there are obvious psychological disorders in the onset and clinical manifestations. Doctors should explain and guide patiently. Pay attention to psychotherapy.

(4) Other treatments such as local sympathetic nerve block, pain point closure, percutaneous nerve stimulation, interference electrical stimulation, acupuncture, massage, magnetic therapy, comprehensive electromagnetic heat therapy, far-infrared gyromagnetic therapy, etc. can be tried. The efficacy and mechanism of these treatments need further study.

2. Chinese medicine treatment

Fibromyalgia syndrome belongs to the category of TCM paralysis. Traditional Chinese medicine treatment of soothing and nourishing blood. Shujin Tongluo, promoting blood circulation and removing stasis, relieving qi and pain, in order to relieve the patient's pain and sleep disorders.

Fibromyalgia syndrome prevention

1. Avoid factors that worsen symptoms: such as avoiding cold and wetness, physical and nerve fatigue, sleep that cannot be recovered, excessive or too little physical activity.

2. Build confidence in overcoming illness, maintain balance, and overcome anxiety and tension.

3. Actively exercise and strengthen your physique.