What Are the Best Treatments for Fibromyalgia and Chronic Pain?

Fibromyalgia syndrome (FS) is a non-articular rheumatism with clinical manifestations of multiple pains and stiffness in the musculoskeletal system, and tender points in specific locations. Fibromyalgia syndrome can be secondary to trauma, various rheumatic diseases, such as osteoarthritis (OA), rheumatoid arthritis (RA), and various non-rheumatic diseases (such as hypothyroidism, malignant Tumor) and so on. This type of fibromyalgia syndrome is called secondary fibromyalgia syndrome, and if it is not accompanied by other diseases, it is called primary fibromyagia syndrome.

Fibromyalgia syndrome

Fibromyalgia syndrome (FS) is a non-articular rheumatism with clinical manifestations of multiple pains and stiffness in the musculoskeletal system, and tender points in specific locations. Fibromyalgia syndrome can be secondary to trauma, various rheumatic diseases, such as osteoarthritis (OA), rheumatoid arthritis (RA), and various non-rheumatic diseases (such as hypothyroidism, malignant Tumor) and so on. This type of fibromyalgia syndrome is called secondary fibromyalgia syndrome, and if it is not accompanied by other diseases, it is called primary fibromyagia syndrome.

Western Medicine Name

Fibromyalgia syndrome

English name

fibromyalgia syndrome, FS

Other name

Non-articular rheumatism

The main symptoms

Multiple musculoskeletal pains and stiffness

The mechanism of this disease is not yet

Regarding the epidemiological situation of the fibrous muscle comprehensive film, no reports have been reported in China and accurate statistics are not available abroad. However, from some preliminary data, the disease is not uncommon. According to a survey in the United Kingdom, 10.9% of people who cannot work due to illness are caused by rheumatism, and about half of them are fibromyalgia syndrome. The American Rheumatology Association has pointed out that rheumatism is one of the most common rheumatic diseases of primary fibromyalgia syndrome, second only to RA and OA. Yunus et al. Treated and treated 285 patients with musculoskeletal diseases within one year, of which 29% were OA, 20% were primary fibromyalgia syndrome, and 16% were RA. Among Asian countries, Japan has a report explaining that 182 rheumatic patients were treated in connective tissue disease clinics within 2 years, of which 11 were fibromyalgia syndrome, accounting for 6% of the total. It ranked seventh after wind-induced arthritis (27.5%), systemic lupus erythematosus (16%), systemic sclerosis (10.4%), and Sjögren's syndrome (7.7%).

Fibromyalgia syndrome is more common in women, and the most common age of onset is 25-45 years. The clinical manifestations are diverse, but mainly have the following 4 groups of symptoms:

1. Main symptoms: Extensive generalized pain is a symptom in all patients with fibromyalgia syndrome. Although some patients complain only of one or more pain points, a quarter of the patients may have more than 24 pain points. The disease spreads throughout the body, especially in the central axis bones (neck, thoracic spine, lower back), scapular belt, and pelvic belt. Other common parts are knee, head, elbow, ankle, foot, upper back, mid back, wrist, hip, thigh and calf. Most patients describe this pain as stinging, which is disturbing.

All other patients have widespread tenderness points that are present in tendons, muscles, and other tissues, and are often distributed symmetrically. At the site of the tenderness point, the patient and the normal person respond differently to "pressing", but there is no difference in other parts.

2. Characteristic diseases: This group of symptoms includes sleep disturbance, fatigue and morning stiffness. About 90% of patients have sleep disorders, manifested as insomnia, easy to wake up, more dreams, and loss of energy. Nocturnal EEG showed alpha waves intervening in non-fast branch ocular rhythms, suggesting a lack of deep sleep. Fifty to 90% of patients have a feeling of fatigue, and about half of the patients have more severe fatigue symptoms, so that they feel "too tired to work". Morning stiffness was seen in 76-91% of patients, and its severity was related to sleep and disease activity.

3. Common symptoms: The most common symptoms in this group are numbness and swelling. Patients often complain of swelling in the joints and around the joints, but there are no objective signs. Followed by headache, irritable bowel syndrome. Headaches can be classified as migraines or non-migraine headaches, the latter of which is a compressive dull pain in the occipital area or the entire head. Psychological abnormalities including depression and anxiety are also more common. In addition, the patient's labor capacity has declined, and about one-third of the patients need to change jobs, and a small number of people cannot adhere to daily work. The above symptoms are often exacerbated by cold weather, mental stress, and overwork. Local heat, mental relaxation, good sleep, and moderate activity can alleviate the symptoms.

4. Mixed Symptoms: Primary fibromyalgia syndrome is rare, and most patients with fibromyalgia syndrome also suffer from some type of rheumatism. At this time, the clinical symptoms are the overlap and overlap of the two symptoms. Fibromyalgia syndrome often makes the symptoms of rheumatism coexist with it appear more serious. Failure to recognize this condition often leads to overtreatment and examination of the latter.

Unless concomitant with other diseases, fibromuscular syndrome is generally free of laboratory abnormalities. However, it has been reported that patients with fibromyalgia syndrome have increased IL-1 levels, reduced natural killer cells and serotonin activity, and increased substance P concentrations in the cerebrospinal fluid. One third of the patients had Raynaud's phenomenon. In this group of patients, antinuclear antibodies were positive and C3 levels were reduced.

Since Smythe first proposed diagnostic criteria for fibromyalgia syndrome in the 1970s, many diagnostic criteria have come out. However, these standards are different in methodology and content, which brings some difficulties to epidemiological and clinical research. For this reason, foreign scholars studied the clinical symptoms and tenderness points of a large number of patients based on previous standards through multi-center collaboration, and screened out the most distinguishing clinical symptoms and 18 tenderness points. Classification criteria for pain syndrome.

1. Systemic pain that lasts for more than 3 months: Systemic pain is considered when the left, right, upper, lower, and central bones of the body (cervical or prothoracic or thoracic or lower back) are pained at the same time .

2. Press with your thumb (pressing pressure is about 4kg) and at least 11 of the 18 tender points are painful. The 18 (9 pairs) tender points are: the attachment of the suboccipital muscle; the midpoint of the upper edge of the trapezius; the front of the 5th to 7th cervical transverse process; Margin; 2cm at the distal end of the lateral epicondyle of the humerus; the junction of the second rib and cartilage, just above the outer edge of the junction; the upper gluteal quadrant, the anterior gluteal fold; the posterior tuberosity; Near side. Those who are satisfied with the above two conditions can be diagnosed with fibromyalgia syndrome.

The application of this criterion will lead to a more consistent definition of fibromyalgia syndrome. This standard emphasizes the difference between fibromyalgia syndrome and other similar diseases, so it does not include the characteristic manifestations of the syndrome, such as fatigue, sleep disorders, morning stiffness, and so on. When applying this standard, taking into account the above characteristics, will increase the reliability and accuracy of the diagnosis. However, this criterion cannot distinguish between primary fibromyalgia syndrome and secondary fibromyalgia syndrome. Therefore, after the diagnosis of fibromyalgia syndrome is established, it must also be checked for other concomitant diseases to distinguish between primary and secondary fibromyalgia syndrome. This distinction is clearly necessary in clinical research and efficacy observation.

Fibromyalgia syndrome symptoms such as fatigue and pain are common clinical symptoms. It requires the identification of the following diseases.

1. Psychic rheumatic pain: Fibromyalgia comprehensive film is easy to be confused with mental rheumatism, but the two are significantly different. Mental rheumatism has emotional symptoms. Such as pain described as scalpel inflammation, severe pain, or numbness, tightness, needle-like or compression pain. These symptoms are often blurred. There are many changes, no anatomical basis, and they are not affected by weather or activities. Patients often have mental or emotional disorders, such as neuropathy, depression, schizophrenia or other mental illnesses. It is important to distinguish between the two, as the former is more difficult to handle and often requires treatment by a psychiatrist.

2. Chronic fatigue syndrome: Chronic fatigue syndrome includes chronic active EB virus infection and idiopathic chronic fatigue syndrome. Presented as fatigue, weakness, but lack of underlying causes. Check the patient for low fever, pharyngitis, and cervical or axillary lymphadenopathy and determine anti-EB

Fibromyalgia syndrome is an idiopathic disease whose pathophysiology is unknown until now, so there are not many treatment methods for it. Its main clinical manifestations are diffuse chronic pain, and there are no objective signs other than the "tenderness point". So not only is it difficult to choose a treatment, it is also quite difficult to evaluate the effect. Current treatments are focused on improving sleep, reducing the sensitivity of pain sensors, and improving muscle blood flow. These aspects are thought to be related to the causes of fibromyalgia syndrome. The curative effect is mainly determined by the number of tender points and symptoms before and after treatment.

One of the more important aspects of treatment is comforting and explaining. Inform patients that it is not a life-threatening disease and does not cause lifelong disability to relieve patients' anxiety and depression.

Chinese medicine believes that the body is weak, the internal organs are deficient, and the righteousness is insufficient. The yin and yang disorders are the main internal causes of the disease. Among them, liver, spleen and kidney deficiency are the main causes. Yin and Yang disorders, lack of qi and blood, disagreement between camp and guards, or liver depression and spleen deficiency cause the evil of wind, cold, dampness and heat to invade and cause disease. ^[1]