Fibromyalgia - a sentence for life? Muscular non-inflammatory tissue damage involving the nervous system or fibromyalgia: symptoms and home treatment, useful recommendations.

Fibromyalgia is a condition of the body caused by constant and sometimes debilitating pain in the muscles, which is accompanied by fatigue of the whole body. No one knows exactly what causes it, but fibromyalgia can be the result of both physical and emotional trauma, as well as viral infections. Fibromyalgia is also known as fibrosis or fibromyositis.

Causes of fibromyalgia

The underlying cause of fibromyalgia is not known. Physical or emotional trauma, as well as viral infections, can cause a general breakdown of the body, but so far it has not been proven that they are the primary causative agents of fibromyalgia.

Many experts believe that fibromyalgia is not a disease, but rather chronic condition pain caused by several abnormal body responses to stress. The areas of the brain that are responsible for the sensation of pain in healthy people and patients with fibromyalgia react differently in the same areas.
People with fibromyalgia have a decrease in opioid receptor activity in parts of the brain that affect mood and the emotional aspect of pain. This explains why patients with fibromyalgia are more likely to be depressed and less responsive to opioid pain medication.

Some research has helped elucidate the main possible causes of fibromyalgia:

- Hormonal disturbances in brain chemicals. Many hormonal, metabolic, and chemical brain abnormalities have been described in studies of fibromyalgia patients. The changes mainly occur in a few brain chemicals. Fibromyalgia may be the result of pain and stress affecting the central nervous system, leading to changes in the brain, but not to the brain disease itself.

- Serotonin. Of particular interest to researchers is serotonin, an important nervous system chemical messenger in the brain, gut, and other areas of the body. Serotonin helps create a sense of well-being, regulates pain levels and promotes deep sleep. Lower levels of serotonin have been noted in some patients with fibromyalgia.

- Stress hormones. The researchers also found irregularities in hormonal system known as the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis controls important functions, including sleep, responses to stress, and depression. Changes in HRA are characterized by lower levels of the stress hormones norepinephrine and cortisol. Lower levels of stress hormones lead to disruptions in psychological or physical exertion. Some factors may inappropriately cause stress response human and contribute to the development of fibromyalgia, including:

Infections (Epstein-Barr virus, Lyme disease);
- physical injury (eg. car accident) ;
- emotional stress;
- hormonal changes (such as thyroid disease);
- taking medications.

- Low levels of the hormone IGF-1. Some studies have shown that approximately one third of patients with fibromyalgia have low levels of insulin-like growth factor-1 (IGF-1). IGF-1 is a hormone that promotes bone and muscle growth. Low levels of growth hormone can lead to impaired thinking, lack of energy, muscle weakness, and cold intolerance. Studies show that changes in growth hormone likely originate from the hypothalamus in the brain. Although researchers have not found an association between IGF-1 levels and fibromyalgia, blood levels of growth hormone may be a marker of the disease.

- Abnormal perception of pain. Some research has shown that people with fibromyalgia may perceive pain differently than healthy people. Fibromyalgia can cause too much activity in the parts of the central nervous system that process pain (the nociceptive system). Brain scans of fibromyalgia patients found abnormalities in pain processing. Some fibromyalgia patients may be hypersensitive to external stimulation and worry too much about pain. This increase in awareness is called generalized hypervigilance. Fibromyalgia patients are also more sensitive to sounds and lights.

- Immune disorders. Fibromyalgia has symptoms similar to some rheumatic diseases, including rheumatoid arthritis and lupus (systemic lupus erythematosus). These are autoimmune diseases in which the immune system mistakenly attacks the body's own healthy tissues, creating inflammation and damage. However, fibromyalgia pain is not associated with autoimmune factors, and there is no evidence to support a role for the inflammatory response in the study of fibromyalgia.

Psychological and social factors are not the main causes of fibromyalgia, but they can contribute to the condition in three ways:

They make people more susceptible to fibromyalgia;
- they may play some role in initiating the onset of the condition;
- they can perpetuate the fortune.

Risk Factors for Fibromyalgia

Some evidence suggests that certain factors may make people more susceptible to fibromyalgia. These risk factors are:

Female. Nine out of 10 patients with fibromyalgia are women. Women may be especially prone to developing fibromyalgia during menopause;

Tense cultural or social environment;

Increased psychological vulnerability;

Physical and emotional trauma of childhood. Studies have reported that physical and emotional abuse of people exposes them to fibromyalgia more often than other people. Most often, family members or partners are the perpetrators. sexual abuse, in general, is not a risk factor for fibromyalgia, however, women who have been victims of rape may face an increased risk of developing the disease.

Age. The disorder usually occurs in people between 20 and 60 years of age. Some studies note peaks of disease outbreaks around the age of 35 years. Others point out that fibromyalgia is most common in middle-aged women. In one study, cases of fibromyalgia increase with age, reaching rates of over 7% among people aged 60 to 70. There is such a thing as juvenile primary fibromyalgia. This type of fibromyalgia appears in teenagers, more often in girls. The disease usually manifests itself after the age of 13 and reaches its peak at the age of 14 years. Cases of primary fibromyalgia are rare, but studies show that the incidence may be increasing. The symptoms are similar to those of adult fibromyalgia, but treatment outcomes are much better in adolescents.

hereditary factors. Studies report an increased prevalence of fibromyalgia among family members. Children and siblings of people with fibromyalgia are eight times more likely to develop the disease than the rest of the population. Family members are also more sensitive to pain and are more likely to have similar conditions and the same syndromes.

Fibromyalgia Symptoms

The main symptom of fibromyalgia is pain. It can focus in one place or throughout the body. The exact locations of the pain are called tender points. People diagnosed with fibromyalgia are very sensitive to pain, with at least 18 specific tender points able to identify about 11.

Basically, the pain starts in the muscles, usually in the neck and shoulders, and then spreads further out of these areas. Usually it does not affect the joints, although many patients feel it in the joints. The skin becomes more sensitive to touch.
Pain can be aching, causing burning and fatigue of the whole body. In this case, the intensity of pain may increase or decrease. It can change depending on the time of day, changes in the weather, physical activity or inactivity. The most intense pain becomes when sleep is disturbed.

- Fatigue and sleep disturbance are also common symptoms in patients with fibromyalgia. It feels like a syndrome restless legs(RLS) and periodic limb disorders (PLMD).

Many patients complain that they cannot fall asleep or stay asleep, and as a result they feel tired when they wake up. Some report that fatigue bothers them more than pain because it interferes with enjoying life, the body does not relax during sleep. Some experts believe that if a person does not experience sleep problems, then their risk of developing fibromyalgia is significantly reduced.

- Depression and bad mood. About a third of fibromyalgia patients suffer from depression. Impairments in memory and concentration are also very common. These symptoms are very often diagnosed.

Other symptoms. Fibromyalgia can also cause the following symptoms:

Digestive problems, including irritable bowel syndrome with excessive gas formation, constipation often replaces diarrhea;
- Dizziness;
- Dry mouth;
- Painful menstruation;
- Problems with balance in the body;
- Migraine;
- Tingling or numbness in the hands and feet;
- Frequent urination due to bladder spasms.

Symptoms of fibromyalgia in children

Children with fibromyalgia often have sleep disturbances and severe pain. They may also experience fatigue, stress, depression, and headaches.

Several studies have shown muscle abnormalities in fibromyalgia patients, including:

- Biochemical disorders: fibromyalgia patients may have more low level phosphocreatine of muscle cells and adenosine triphosphate (ATP). These chemicals regulate calcium levels in muscle cells. Calcium is important component the ability of muscles to contract and relax. If the ATP level is low, calcium is not released into the cells and the muscle weakens.

- Functional disorders: the pain and stress caused by fibromyalgia can themselves be detrimental to muscle function.

- Structural and circulatory anomalies: Some researchers have seen overly thickened capillaries (tiny blood vessels) in the muscles of fibromyalgia patients. Abnormal capillaries can produce lower levels of compounds needed for muscle function and also reduce the flow of oxygen-rich blood to the muscles.
To date, none of these anomalies has a clear certain attitude with fibromyalgia.

It is important to diagnose fibromyalgia early and start treatment as soon as possible. But since there are no clear methods for diagnosing it (for example, laboratory tests or special examinations), three out of every four patients with fibromyalgia go undiagnosed. It can take an average of 5 years to receive a diagnosis.

The symptoms of fibromyalgia can be helpful in making a diagnosis, but if the patient does not have an overt disorder such as depression or arthritis, the diagnosis can be difficult. However, the absence of any symptoms does not exclude the course of the disease. Fibromyalgia should be suspected in any person who has muscle and joint pain without a specific cause.
The American College of Rheumatology (ACR) has proposed a new set of diagnostic criteria that take into account symptoms such as fatigue, sleep disturbances, and cognitive problems, in addition to pain.

Fibromyalgia Classification Criteria

In 1990, the ACR established the following classification criteria for fibromyalgia:

Severe pain must be present for at least 3 months. This pain should appear in all of the following places:
- both sides of the body;
- above and below the belt;
- along the entire length of the spine;
- Pain should be felt in at least 11 out of 18 specific areas called sensitive points on the body. When the doctor presses on the tender point, the pain is very palpable and localized. Tender points can be located in the following locations:
- on the left or right side of the back of the neck, just below the hairline;
- in the left or right side of the front of the neck, above the collarbone (collarbone);
- in the left or right side of the chest, just below the collarbone;
- on the left or right side of the upper back, near where the neck and shoulders join;
- on the left or right side of the spine in the upper back between the shoulder blades (shoulder blades);
- inside any arm, where it bends at the elbow;
- in the left or right side of the lower back, right below the belt;
- on both sides of the lower pelvic bones (buttocks);
- in the kneecaps.

The physician should always take a close look at personal and family medical history, which includes a psychological portrait and a history of any factors disease-causing, such as:

Infectious diseases;
- muscle weakness;
- physical injuries;
- rash;
- recent weight changes;
- sexual or physical disorders, as well as the abuse of psychoactive substances or alcohol.

Patients should tell their doctor about any medications they are taking, including vitamins and herbal medicines.

Methods for diagnosing fibromyalgia

- Medical checkup. The physical examination cannot provide much information about the disease, other than sensitive points that are included in the diagnostic criteria. These points should be painful when pressed. When diagnosing fibromyalgia, they should not show signs of inflammation (redness, swelling, or damage to the joints and soft tissues are not relevant). The health care provider should also examine the nails, skin, mucous membranes, joints, spine, muscles, and bones to rule out arthritis, thyroid disease, and other conditions.

- Analyzes. Blood, urine or other test laboratory research cannot definitively diagnose fibromyalgia. If these tests show incorrect results, the doctor should look for other methods. To detect fibromyalgia, you can do following tests and analyses:

Antibody tests;
- general blood analysis;
- C-reactive protein;
- erythrocyte sedimentation rate (ESR).

- Studies of thyroid and liver function. In cases where previous laboratory results do not indicate a specific disease, the doctor may suggest this study to make a diagnosis.

- Exclusion of diseases with similar symptoms. Approximately 10%-30% of patients visit doctors with symptoms that resemble fibromyalgia, including fatigue, malaise, and widespread muscle pain. Because no laboratory test can confirm a diagnosis of fibromyalgia, doctors usually first look for a disease with similar symptoms.

Initiating a diagnosis of a condition from one of the conditions listed below does not always rule out fibromyalgia, as several conditions can overlap or coexist with fibromyalgia, and moreover have similar symptoms. Like fibromyalgia, a number of these diseases are not easy to diagnose. It is not yet clear whether these symptoms cause fibromyalgia, are risk factors for its disorder, or have nothing to do with it at all.

List of diseases with similar symptoms to fibromyalgia

- Syndrome chronic fatigue. There are significant similarities between fibromyalgia and chronic fatigue syndrome (CFS). As with fibromyalgia, the causes of CFS are unknown. A doctor can only diagnose a disorder based on the patient's symptoms. Fibromyalgia and CFS experience and treat most of the same symptoms. However, there is some difference between them:

Painful points are the main symptom in fibromyalgia. Some CFS patients have similar pressure points, but their muscle pain is less severe.
Fatigue is the main symptom of CFS. It is not caused by excessive physical exertion, and it does not go away even after sleep and rest.

Some doctors believe that fibromyalgia is just extreme point chronic fatigue syndrome. However, the data shows that the two diseases are different and each has its own symptoms.

- Myofascial pain syndrome. Myofascial pain syndrome can be easily confused with fibromyalgia. However, unlike fibromyalgia, myofascial pain tends to be concentrated at trigger points and generally does not spread widely. Trigger point is pain in tight muscles, and when the doctor presses on these points, the patient may experience muscle twitching. Unlike pain points, trigger points are most often small lumps about the size of a pencil eraser.

- Depression. The link between psychological disorders and fibromyalgia is very strong. Studies report that 50 to 70% of fibromyalgia patients experience lifelong depression. However, only 18 to 36% of fibromyalgia patients experience major depression.

Some studies have shown that people who have both psychological disorders and other symptoms of fibromyalgia seek medical help more quickly than patients who simply have fibromyalgia symptoms. If this is the case, then the results of the study may be inaccurate, so we need to look for something more serious than just the link between depression and fibromyalgia.

The suppressed feelings in people with fibromyalgia may be a normal response to pain and fatigue caused by the syndrome. Such emotions, unfortunately, are often accompanied by this disease. However, they are not considered a disorder or depression. Unlike normal periods of sadness, depression can last for many months.

Symptoms of severe depression include the following:

Depressed mood every day;
- inability to concentrate or make decisions;
- insomnia or excessive sleepiness;
- reduced energy every day;
- anxiety or feeling of fear;
- significant weight gain or loss (10% or more of a person's habitual body weight);
- suicidal thoughts.

If some of the above signs are present, and none of the physical symptoms of fibromyalgia exist, the diagnosis is most likely prolonged depression.

- Chronic headache and migraine. Chronic headaches such as migraine are common in patients with fibromyalgia. Some experts believe that headaches in both migraine and fibromyalgia are due to defects in the system that regulates certain chemical composition in the brain, including levels of serotonin and adrenaline. Also, patients with both fibromyalgia and migraine have low magnesium levels. Symptoms of a migraine attack may include increased sensitivity to light and sound, nausea, problems with vision (aura), difficulty speaking, severe pain, which is mainly concentrated in one part of the head.

- Some chemical sensitivity. Some chemical sensitivity (MCS) is a term for situations in which certain chemicals cause symptoms that are similar to CFS or fibromyalgia. Like CFS and fibromyalgia, MCS can be medical or psychological problem. Each of us is exposed to many chemicals on a daily basis, so it is very difficult to determine whether chemicals are causing specific symptoms. Experts have come up with several criteria to help recognize MCS:

Symptoms can be caused by several substances that are chemically related;
- symptoms affect many organs and systems;
- symptoms always recur upon repeated contact with the chemical;
- symptoms disappear when Chemical substance removed.

- Restless legs syndrome. About 15% of people with fibromyalgia have Restless Leg Syndrome (RLS). RLS brings anxiety and worsens physical activity which is sometimes described as a feeling of restlessness and fatigue in the lower leg.

- Lyme disease. Lyme disease is a bacterial disease transmitted by ticks. Healthcare professionals typically (but not always) diagnose Lyme disease using blood tests that identify antibodies directed at the bacteria that caused the disease. But if the disorder is not diagnosed right away and the symptoms return, then Lyme disease can be mistaken for fibromyalgia. Some experts believe that 15 - 50% of patients referred to the clinic for Lyme disease actually have fibromyalgia. If patients with fibromyalgia are misdiagnosed and treated for Lyme disease with long courses of antibiotics, the drugs can have serious side effects.

- Drugs and alcohol. Fatigue is a side effect of many prescription and over-the-counter medications, such as antihistamines. Constant fatigue is also a symptom of drug and alcohol addiction or abuse. Health care providers should consider the medications the patient is taking as a possible cause of fatigue. Withdrawal from caffeine can also produce depression, fatigue, and headaches.

- Polymyalgia rheumatica. Polymyalgia rheumatica is a condition that causes pain and discomfort. It usually occurs in older women. In this disorder, tender points are also present, although they are almost always located in the hip and shoulder joint. Morning stiffness is a common symptom, some patients may also experience fever, weight loss and fatigue. It is important to diagnose symptoms of polymyalgia rheumatica early because some PMR patients have associated conditions (giant cell arteritis) that can lead to blindness if left untreated. Polymyalgia rheumatica is usually treated with small doses of steroid drugs such as prednisone.

Treatment fibromyalgia

Fibromyalgia is not yet a fully understood condition of the body. What are its causes, and how does it hurt human body, is still largely unknown. Its treatment usually includes not only relieving symptoms, but also changing people's attitudes towards their illness, which helps them cope with their illness more quickly.

The Fibromyalgia Society of America recommends a combined treatment approach using cognitive behavioral therapy and exercise. A combination of non-drug therapies works in the same way as drug therapy to reduce pain, depression and disability. This method includes exercise, stress management, massage, and diet.

If this set of treatments fails to improve symptoms, antidepressants or muscle relaxants may be added to the treatment. Doctors usually prescribe these drugs to lower the pain threshold.

Patients should have realistic expectations about the long-term outlook for their condition. It is important to understand that fibromyalgia can be managed so that people can live fulfilling lives.

Many studies have shown that exercise is the most effective part fibromyalgia management. Physical activity prevents muscle wasting, improves emotional well-being, and, over time, reduces fatigue and pain. Fibromyalgia exercise programs often combine aerobic and strength training with calisthenics. Some studies have shown that improvement in body condition can last up to 9 months after the end of an exercise program.

- Adapted exercises. The main approach that is used in the treatment of fibromyalgia is called graduated exercises. According to these exercises, the patient gradually increases the amount of physical activity. Enough effective exercises stretching before work. Doing them daily helps to relax tense muscles and prevent soreness. Very good swimming and water procedures, they do not contribute to the distribution of the load on the joints. swimming, walking, physical activities using equipment such as Treadmills or exercise bikes render positive action for people with fibromyalgia.

Adding cognitive behavioral therapy (CBT) to an exercise program may also help people with fibromyalgia feel better.

It is important to start your exercise program gradually. Patients who attempt compound exercises early experience only increased pain, become discouraged, and quit. Each patient should be prepared for relapses and failures, but do not give up. Exercise can help relieve fibromyalgia. Studies show that adding small amounts of physical activity daily improves pain and reduces fatigue in patients.

- Physiotherapy can also be very helpful. Research shows that physical therapy can not only reduce muscle overload and fatigue, but also strengthen weak muscles.

- Tai Chi program. There is an ancient Chinese Tai Chi exercise program that combines slow movements, correct breathing and meditation. It can also help people with fibromyalgia by reducing pain, fatigue, physical functioning, insomnia, and depression.

- Sleep normalization. When treating fibromyalgia, it is also important to maintain normal sleep. . Sleep is essential, in part, because sleep disturbance exacerbates pain. Many fibromyalgia patients suffer from insomnia, which prevents the body from resting at night. To normalize sleep you need:

Avoid caffeine or alcohol 4 to 6 hours before bedtime;
- avoid drinking liquids immediately before bedtime so that you do not have to wake up at night to urinate;
- Avoid large meals before bed. You can be quite satisfied with light snacks;
- avoid drowsiness, especially in the evening or late afternoon;
- set the bedtime and wake up hours in the morning. Maintain this schedule even on weekends and during holidays;
- if you can't fall asleep within 15 - 20 minutes, go to another room and start a quiet activity. Return to bed when you feel sleepy;
Minimize light and maintain a comfortable, moderate temperature in the bedroom. Keep the bedroom well ventilated;
- use the bed only for sleeping and sexual relations.

- Proper nutrition. While being treated for fibromyalgia, patients should also maintain a healthy diet that is low in animal fats and high content fiber. The diet should include a large number of whole grains, fresh fruits and vegetables. However, despite this, patients are still allowed to consume certain types of fats belonging to the Omega-3 group. fatty acid. The fact is that oils containing these acids are of particular interest for reducing joint pain. These oils can be found in cold water fish species or purchased as supplements called EPA-DHA or omega-3s.
Omega-3 fatty acids are a form of polyunsaturated fats that are ingested through food. Omega-3s are known as essential fatty acids (EFAs) because they cannot be produced by the body. These healthy fatty acids can be found in some fish, canola oil, flax seeds, and walnuts. Omega-3 fatty acids have anti-inflammatory properties that help prevent blood clots, lower cholesterol and triglycerides, and lower blood pressure. Omega-3s may also reduce the risks and symptoms of diabetes, stroke, rheumatoid arthritis, asthma, inflammatory bowel disease, ulcerative colitis, and even some cancers.
Actual benefit vegetarian diet for people with fibromyalgia remains unproven.

- Getting rid of stress. Experience shows that people with fibromyalgia have a more stressful response to daily conflicts and confrontations than healthy people. Some stress reduction techniques may be helpful for chronic pain management, including:

- Biofeedback. During a biofeedback session, electrical wires are glued to a person's head. The patient is encouraged to relax using whatever method works. Brain waves are measured and a beep sounds when alpha waves are detected. Alpha waves are brain waves that occur in a state of deep relaxation. By repeating the process, people who use biofeedback learn to relax on their own over time. These studies do not prove that biofeedback is a very useful method for treating fibromyalgia patients.

- Hypnosis. One small study found that hypnosis was even more effective in improving body condition and reducing pain than physical therapy.

- Massotherapy. Massage helps to slow down the heartbeat and relax the body. In one study, patients who received 30-minute massage sessions twice a week experienced a reduction in tension and anxiety.

- Meditation. Meditation, which has been used for many years in Eastern cultures, is now widely used throughout the world as an effective form of relaxation. A number of studies prove certain benefits of meditation in the treatment of fibromyalgia. Meditation provides the following physical benefits:

Decreased heart rate, blood pressure, adrenaline levels and skin temperature;
- improvement of well-being;
- improved sleep - melatonin helps regulate the sleep-wake cycle;
Reducing pain, possibly from lower levels of cortisol, the stress hormone.

The main purpose of meditation is to calm the mind - basically to let the thoughts relax. This redirection of brain activity away from thoughts and worries into the self disrupts the stress response, providing rest and renewable energy.
People who are trying to meditate for the first time should understand that it will be difficult to get their thoughts in order initially, so they should not be discouraged by the lack of immediate results. Some experts recommend meditating for no more than 20 minutes in the morning after waking up, and then again in the early evening before dinner. Meditating only once a day is helpful. It is not recommended to meditate before going to bed because some people wake up in the middle of the night after meditation with a feeling of anxiety and are unable to sleep.

Medical treatment fibromyalgia

In combination with exercise and behavioral therapy, patients may receive medication. The main treatments for fibromyalgia are pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella). However, many other drugs, including antidepressants, sleeping pills, pain relievers, and muscle relaxants, are also widely used in the treatment of this condition. The main purpose of using medications is to improve sleep and lower the pain threshold. Brief description of medicines:

- Anticonvulsants. Pregabalin is a medical anti-epileptic. Anticonvulsants affect the chemical composition of gamma aminobutyric acid(GABA), which helps prevent nerve cells from being overheated.
Studies show that pregabalin can improve sleep quality, relieve symptoms of fatigue and pain. Its most common side effects consist of mild dizziness and drowsiness. Pregabalin may also impair motor function and cause problems with concentration and attention. Patients should consult their physician about whether pregabalin may affect their ability to drive.

Studies have shown that another anticonvulsant, gabapentin (Neurontin), is similar to pregabalin in relieving pain in some people with fibromyalgia. Patients reported that after taking this drug they began to sleep better and feel less tired. However, gabapentin may cause side effects such as dizziness, drowsiness, and swelling.

- Antidepressants. The main antidepressants used in the treatment of fibromyalgia include tricyclic, selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine serotonin reuptake inhibitors (SNRIs). Although these drugs are antidepressants, doctors prescribe them even to non-depressed patients with fibromyalgia to improve sleep and relieve pain. The doses used to treat fibromyalgia are usually lower than the doses prescribed to treat depression.

- Tricyclics. Tricyclic antidepressants are among the first drugs that have been well studied for the treatment of fibromyalgia. In some cases, they may be more effective than SSRIs and SNRIs, although all three of these drug classes show some efficacy. Tricyclics cause drowsiness, which can improve the patient's sleep. Studies have shown that they are also effective in reducing pain and improving depressed mood and quality of life. The most commonly used tricyclic drug for fibromyalgia is amitriptyline (Elavil, Endep), which significantly reduces pain and improves sleep, but may lose its effectiveness over time. Other tricyclics are also used: nortriptyline (Pamelor, Aventyl), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), and amoxapine (Asendin).

- Selective serotonin reuptake inhibitor. Selective serotonin reuptake inhibitors (SSRIs) increase the level of serotonin in the brain, which is very important for patients with fibromyalgia. Commonly prescribed drugs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and fluvoxamine. Studies show that they can improve sleep, fatigue, and mood in many patients. These drugs should be taken in the morning as they can cause insomnia. Common side effects are manifested through agitation, nausea, and sexual dysfunction.

- Serotonin and norepinephrine reuptake inhibitors (SNRIs), also known as dual inhibitors, they act directly on two chemical messengers in the brain, serotonin and norepinephrine. These drugs in the treatment of fibromyalgia are more effective than SSRI drugs. They also have fewer side effects than tricyclic antidepressants and are very well tolerated. The most common SNRIs in the treatment of fibromyalgia is Duloxetine (Cymbalta), which reduces fibromyalgia pain by more than 30%. The most common side effects after taking this drug are nausea, dry mouth, constipation, decreased appetite, drowsiness, increased sweating, and agitation. Duloxetine may also increase the risk of bleeding in patients. The drug milnacipran (Savella) can significantly improve pain and physical function in patients with fibromyalgia. Milnacipran should not be given to children. It is also not suitable for patients who are taking monoamine oxidase inhibitors. Venlafaxine (Effexor) is similar in efficacy and tolerability to fluoxetine (Prozac). Venlafaxine impairs sexual function and some patients experience changes in blood pressure.

- Muscle relaxers. Cyclobenzaprine (Flexeril) relaxes muscle spasms in specific areas without affecting its overall muscle function. It helps relieve the symptoms of fibromyalgia. Cyclobenzaprine is similar to tricyclic antidepressants and has similar side effects, including drowsiness, dry mouth, and dizziness.

- Medicines to improve sleep. Zolpidem (Ambien) or other newer sleep medicines such as zaleplon (Sonata) and Eszopiclone (Lunesta) may improve sleep in patients with insomnia.

- Painkillers. Pain management is of great concern in patients with fibromyalgia. Pain relievers for fibromyalgia include:

Tramadol (Ultram), used alone or in combination with acetaminophen (Tylenol), is often prescribed for pain relief. Its most common side effects are drowsiness, dizziness, constipation, and nausea. Tramadol should not be used with tricyclic antidepressants. Patients can become addicted to this drug and potentially abuse it. For mild pain relief, acetaminophen is most commonly recommended. Anti-inflammatory drugs that are commonly used for arthritis are less helpful for treating fibromyalgia. These include corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil). For older people with chronic pain, the use of NSAIDs is not recommended, as the risks of cardiovascular and gastrointestinal diseases are increased.

Capsaicin (Zostrix) is an ointment derived from the active ingredient - hot pepper Chile. Capsaicin is an effective pain reliever. It may also be helpful for patients with fibromyalgia.

Pramipexole, a drug used to treat Parkinson's disease and restless leg syndrome, may help relieve pain and fatigue in people with fibromyalgia. Pramipexole stimulates the production of dopamine, a chemical messenger in the brain.

- Other drugs. Nabilone, a synthetic drug derived from marijuana, may be another effective addition to fibromyalgia treatment. In one study, the drug nabilone (Cesamet), which is also used to treat nausea and vomiting in patients using chemotherapy, significantly improved the pain associated with fibromyalgia. There are some problems with using nabilone to treat fibromyalgia: firstly, this substance is under control and can be addictive, and secondly, the cost of the drug is quite expensive, so it is not appropriate to use it for a chronic disease such as fibromyalgia.

There is no consensus on which treatment method is most beneficial, or which combination of treatments works best. Patients may receive drug treatment in combination with exercise, patient education, and behavioral therapy.

Alternative treatments fibromyalgia

Due to the difficulties in treating fibromyalgia, many patients seek alternative methods treatment. The effectiveness of these treatments has not been proven, so doctors do not particularly recommend them. These methods include:

Research continues to report conflicting results about acupuncture's ability to relieve pain. Several small studies show that acupuncture has some results, especially for people who cannot take medication due to side effects. Acupuncture also helps to relieve pain in combination with tricyclic antidepressants and exercise, and improvements are observed for several months after the end of treatment. Other studies have not found enough evidence to support the use of acupuncture for the treatment of fibromyalgia.

- Chiropractic or manual therapy. Chiropractic or chiropractic may also help some patients. Osteopathic methods include various actions with the spine or muscles. Some studies have shown that osteopathic manipulation relieves pain and improves sleep. Larger and better studies are needed to clearly determine whether this is an effective treatment. There is always a very small risk of side effects from any of these methods. For example, in rare cases, massaging the neck can cause a stroke or damage to the major blood vessels in the neck area.

- Herbs and supplements. Some alternative means are in development for the treatment of fibromyalgia. Examples include: melatonin, a natural hormone associated with the sleep-wake cycle, and S-adenosylmethionine, a natural substance with antidepressant, anti-inflammatory, and analgesic properties. According to studies, there are small positive results in treatment for some patients with fibromyalgia, but all these trials have not been well thought out so far.

Here, it is extremely important for patients to understand that any herbal remedy, while having a positive effect, is likely to have negative side effects and toxic reactions, like any conventional drug. A significant number of cases have been reported with serious and even fatal side effects from herbal products. Before using any herbal preparations or food additives it is necessary to consult with a doctor. Potential interactions between existing medications and herbal and supplement supplements should also be discussed with them.

- Behavioral therapy. Cognitive behavioral therapy (CBT) is an effective way to help patients cope with chronic pain and stressful situations. Experience shows that CBT may help some patients with fibromyalgia.

Although the effects of CBT and other non-drug treatments for fibromyalgia do not always last long, they may help certain groups of people, especially those with high levels. psychological stress. Cognitive behavioral therapy may be especially helpful for insomnia, one of the main symptoms of fibromyalgia.

Goals of Cognitive Behavioral Therapy . The main tasks of CBT are to change the erroneous ideas of patients and their doom to failure. Patients learn to think of pain as something other than a negative factor that rules their lives. Over time, the idea that they are helpless goes away and they realize that they can control the pain. Patients learn to prioritize their responsibilities, they learn to prioritize less important tasks or delegate them to others. Learning these skills can ultimately lead to greater control over your life.

How does cognitive behavioral therapy work. CBT usually consists of 6 to 20 hour sessions. Patients also receive homework, which typically includes keeping a diary and doing things they have avoided in the past.
A typical CBT program may include the following measures:

Keeping a diary. Patients are usually asked to keep a diary. The diary serves as a guide for setting limits and planning activities. Patients use a diary to keep track of any stress, such as work or relationships, that may worsen their pain.
- Confronting negative or discouraging thoughts. Patients challenge all their negative thoughts by making a reverse belief. For example, "I'm not good enough to control this disease, I can't do anything," the reverse belief is "I can learn to control this disease."
- Setting limits. Restrictions are designed to keep both mental and physical activity within reasonable levels. For example, tasks are broken down into sequential steps and patients focus on completing one step at a time.
- Search for enjoyable activities. Patients are enumerated a number of pleasant low-energy activities where they can express themselves.
- Setting priorities. Patients learn to give up a number of less important tasks or delegate them to others.
Patients must learn to accept that relapses may occur over time. They must be prepared for this, so they must not feel that they have failed.

Research also suggests that patient education programs should be effective in treating fibromyalgia, especially when combined with cognitive behavioral therapy, exercise, and other therapies. Educational programs may take the form of group discussions, lectures, or printed materials, although there is no clear evidence that any particular type of education works better.

Treatment of fibromyalgia in children

Experts say treatment for fibromyalgia in children should start with non-drug treatment, including with exercise and cognitive behavioral therapy. Medications such as pregabalin and milnacipran are recommended for adults but have not been shown to perform well in trials to see if they can be used in children. Analgesics and NSAIDs are not very effective in treating children. Psychological methods treatments can help control pain in children, although there is no evidence that they improve physical activity or mood.

Complications of fibromyalgia

Fibromyalgia can be both mild and severe, with significant emotional losses. People with fibromyalgia experience a great psychological shock, pain has a significant impact on their quality of life, they bring more inconvenience to the patient than, for example, pain such as pain during chronic disease back.
About half of all patients experience difficulty in normal Everyday life. The constant pain, lack of sleep, distraction, nervousness associated with fibromyalgia prevents people from doing their usual activities, they lose their ability to function in the usual mode at home and at work, therefore they become irritable, restless, depression and a feeling of dissatisfaction with life appear. According to experts, about 30 - 40% of patients diagnosed with fibromyalgia were forced to quit or change jobs.

All this leads to the fact that patients suffering from fibromyalgia often self-medicate, while abusing sleeping pills, alcohol, drugs or caffeine, which in turn has adverse effect on the body. Such self-treatment can also lead to the emergence of other diseases, which can be eliminated only with the help of a qualified specialist.

- Outlook in adults. Although fibromyalgia is a lifelong condition, it is not fatal. Some studies show that fibromyalgia symptoms remain stable in the long term, while others report that more than a quarter of patients experience improvement in symptoms over time. Research also shows that regular exercise improves prognosis.

- Outlook in children. Children with fibromyalgia tend to have a better prognosis than adults. Some studies have shown that more than half of children with fibromyalgia recover in 2-3 years.

One of the most common reasons for visiting a rheumatologist is fibromyalgia. It occurs in 2% of the population, predominantly in women. The disease begins at the age of 30 - 35 years, the incidence increases with age.
Content:

What it is

Literally, this term is translated as "pain in the muscle fibers." The disease is accompanied by various disorders of the nervous and muscular systems. Patients are concerned about pain in different parts of the muscles. When contacting 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 "ache everywhere." Many patients are concerned about the stiffness of the limbs in the morning, fast fatiguability, insomnia, apathy. A third of patients with fibromyalgia do not work due to poor health.

The disease has a characteristic feature - the presence of pain points, the action on which causes or enhances discomfort.

Fibromyalgia refers to chronic pain syndromes and, more often than other diseases of this group, leads to depression and maladjustment of patients. It significantly reduces the quality of human life.

Many patients are treated for a long time and unsuccessfully by therapists and neurologists, while they need the advice of a competent rheumatologist.

Causes

Fibromyalgia is a hereditary disease that can manifest itself under the influence of stress.

The disease is not associated with damage to skeletal muscles or peripheral nerves. Fibromyalgia pain has been proven to be due to increased arousal nerve cells spinal cord - the phenomenon of "central sensitization". At the same time, there are no objective signs of damage to muscles or nerves, so patients' complaints are often referred to as 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 adverse factors:

• peripheral pain, for example, with neuritis or;
• infectious diseases caused by parvovirus, Epstein-Barr virus, tick-borne borreliosis);
• injury in a traffic accident and other severe physical damage;
• mental overwork and chronic stress;
• hypothyroidism (lack of thyroid hormones);
• long-term medication.

Patients are characterized by alertness, suspiciousness, fear of serious illnesses. These disorders are associated with a change in the balance in the brain and blood of biologically active substances such as 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 abnormal high sensitivity to pain and a change in its perception and evaluation. The neurobiological basis of the disease has been confirmed using modern diagnostic methods.

Symptoms

The leading clinical sign of fibromyalgia is widespread symmetrical muscle pain. This feeling is constant, monotonous. Soreness is aggravated after stress, with physical fatigue, with prolonged work in one position and long immobility, and also after hypothermia. The pain subsides after warming, resting, massaging the muscles.

The severity of this symptom may vary throughout the day, but the pain of one force or another accompanies a person constantly. The patient complains of a feeling of "prolonged cold". Constant discomfort leads to maladjustment of the patient - he cannot work and lead an active life.

Sometimes patients note ankle, wrist and other joints. Often there are paresthesias, tingling, burning, numbness of the skin on the arms or legs, a feeling of crawling.

Fibromyalgia Symptoms

During external examination, no changes in muscles, joints, peripheral nerves are noted. Only soreness of certain points of the body is found. 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.

In fibromyalgia, 18 paired sensitive points are examined, and the diagnosis is considered certain if at least 11 such areas are sore. located symmetrically in the following zones:

• neck area;
• posterolateral surface between the 5th and 7th cervical vertebrae;
• the middle of the upper edge of the trapezius muscle lying on the shoulder girdle;
• the area above the upper edge of the scapula;
• articulation of the II rib and sternum;
• olecranon;
• upper outer portion of the buttock;
• ledge in upper section femur under the hip joint;
• inner surface of the knee joint.

For control, points are probed in the middle of the forehead, on the back of the forearm and in the area thumb brushes.

The doctor provides a fairly strong stimulation of these points. It is very difficult for an unprepared specialist to correctly conduct a study and evaluate its results.

To screen for fibromyalgia, you can use the following questionnaire:

• there is pain all over the body;
• a combination of pain with constant fatigue up to exhaustion;
• pain resembles burns or electric shock;
• pain is associated with numbness, goosebumps, or other unpleasant sensations throughout the body;
• pain associated with constipation, digestive problems, painful or frequent urination, headache, restlessness in the legs before going to bed;
• the pain is combined with lethargy and superficial sleep.

With 5 - 6 affirmative answers, the patient should be purposefully examined to detect fibromyalgia.

Diagnostics

Diagnostic criteria to make this diagnosis with certainty have not been developed. The disease is not manifested by structural changes in the nerves or muscles that could be detected using diagnostic methods. Therefore, a clinical approach is taken.

Diagnostic criteria have been developed for scientific research this problem, but they are widely used in clinical practice.

The diagnosis is made on the basis of a complex of such signs:

1. Diffuse pain for 3 months or longer. Painful sensations are considered diffuse if they are present in all 4 conditional quadrants of the body (from the left and from right side, above and below the lumbar region). Additionally, pain in the skeleton (neck, sternum, lower back, back) is determined.
2. Soreness in at least 11 of 18 tender points.
3. Patient complaints.
4. Fatigue, lethargy, unwillingness to move.
5. Inability to make a plan for the future, set a goal or complete some task.
6. Decreased normal household activities.
7. Pain when touching the skin.
8. Poor sleep, shallow sleep, lethargy on waking.
9. Lethargy, "fog in the head", difficulty concentrating.
10. Morning stiffness in the body.
11. Frustration, sadness, anxiety, depression.

Treatment

A patient with fibromyalgia should follow the general recommendations for home therapy, as well as take medications and use non-drug methods of treatment.

Ways of non-drug treatment of fibromyalgia with the help of sports, the effectiveness of which has been proven in scientific studies:

• aerobics for 20 minutes twice a week;
• bike rides;
• walking;
• dancing;
• classes in the pool for 2 - 6 months, which has a lasting therapeutic effect.

For the treatment of the disease, both medical and non-medical methods of treatment are used.

One of the most effective ways to treat fibromyalgia is cognitive behavioral therapy, best of all relaxation training. Training in this method is carried out by a psychotherapist. A biofeedback method is also used.

An alternative method that improves the production of serotonin and norepinephrine, restoring sleep and eliminating depression is phototherapy.

Non-drug treatment of fibromyalgia

With fibromyalgia, it is necessary to use several drugs that affect different parts of the disease. Standard treatment includes:

• anti-inflammatory drugs (ibuprofen);
• opioids (codeine);
• tramadol;
• amitriptyline;
• fluoxetine,
• gabapentin.

New drugs with good effect:

• the anticonvulsant pregabalin (Lyrica);
• duloxetine;
• antidepressant milnacipran.

Officially in Russia, only Lyrica is approved for the treatment of fibromyalgia. This remedy reduces pain and fatigue, improves sleep, positively affects the quality of life, but does not reduce the symptoms of depression.

The treatment of fibromyalgia is a complex task requiring permanent reception medications, non-pharmacological methods and lifestyle changes.

The main directions of therapy:

1. Reducing muscle pain: for this, injections into sensitive points of the local anesthetic lidocaine are used.
2. Treatment or prevention of central sensitization: Anticonvulsants and antidepressants are used.
3. Sleep restoration: gamma-hydroxybutyric acid agonists are prescribed.
4. Eliminate depression with antidepressants.

Treatment at home

Without following the rules of behavior at home, it is impossible to get rid of the pain syndrome.

The worsening of the course of the disease in many patients is observed with sleep disturbances. Therefore, it is necessary to observe the mode and conditions of sleep. The bed should be comfortable, familiar to the patient. It is recommended to put it in a room well isolated from light sources and the slightest noise (even the ticking of a clock). It is necessary to create an individual comfortable temperature for the patient. Before going to bed, it is recommended to do a soothing favorite activity (knitting, reading, and so on), 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. Do not take liquid in the evening. Drinking alcohol and smoking cause intermittent, shallow sleep that does not restore strength.

Additionally, you can take herbal preparations - motherwort, valerian. If they are ineffective, you should visit a specialist for a prescription for sleeping pills. Possible risk from taking these drugs is significantly lower than the beneficial effects of deep sleep.

The patient's condition can improve significantly if a balanced diet is followed, which includes proteins, carbohydrates, and vegetable oils.

The patient's condition improves significantly with a balanced diet rich in healthy carbohydrates (cereals, cereals), proteins and vegetable oils. You need to take 7 glasses of liquid without caffeine per day.

Of particular importance in the diet of patients with this disease are magnesium and calcium. The normal amount of 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 to strengthen bones and eliminate, which can also be the cause of bone pain. The required dose of magnesium is 420 mg for men and 320 mg for women per day. These trace elements should be consumed together.

• peanuts;
• soy cheese;
• broccoli, soybeans, spinach greens;
• any kind of beans;
• tomatoes and tomato paste;
• pumpkin seeds;
• muesli from whole grains;
• milk and yogurt.

Other home remedies to help relieve fibromyalgia include:

• constant physical activity, including any available, even minor loads; it is advisable to perform it in the morning after a shower with a warming effect and increase the intensity by 10% every week;
• activity during the daytime, despite the desire to go to bed and do nothing;
• giving up alcohol and smoking;
• planning the day so that the most important things fall on the period of the best state of health;
• regular alternation of rest and activity;
• setting only achievable goals, without mental and physical overstrain;
• comfortable organization of life, convenience in everything that surrounds the patient;
• participation in various fields activities - work, communication with family and friends, the allocation of time for personal hobbies and leisure.

Treatment with folk remedies

Alternative medicine recipes for fibromyalgia can relieve a person from feeling tired, restore strength, and improve sleep. Therefore, medicinal plants and natural products with different effects are used, depending on the predominant symptom.

Oil massage relieves muscle tension

Honey-lemon mixture increases vitality, improves mood, reduces muscle pain. To prepare it, take half a kilogram of lemons and grind them in a meat grinder or in a blender without removing the peel. Mix with 500 ml of flower honey, put a couple of spoons of good butter and a pinch of grated almond nuts. Mix well and put the mixture in a cold place. Take the medicine 1 spoon before meals twice a day for 30 days.

Oil massage well relieves pain in tense muscles of the back, neck, limbs. To prepare massage oil, take a quarter cup of thyme herb (you can buy it at a pharmacy) and grind it in a coffee grinder. Pour 1 liter of quality olive oil, bring in a water bath to 40 °, add crushed thyme and keep on low heat for 2 hours. In the evening for 2 weeks, rub oil with chopped thyme in the area of ​​​​the hands, forearm, foot, lower leg. Have your family apply this mixture to your spine from neck to sacrum.

Beverages

With emotional disorders, deterioration of memory and attention, difficulties in concentration, dandelion-based remedies help. The plant is pulled out entirely with flowers and roots, it is harvested from May to July. Rinse the dandelions thoroughly, dry a little on a towel and grind in a meat grinder or blender, then, using a gauze napkin, squeeze out the milky juice. Keep the product in a glass container with a lid in a cold place and use 30 drops 3 times a day for 6 months.

In the treatment, herbal tinctures on alcohol from spicy plants are widely used.

If you are worried about interrupted sleep, you do not feel sufficiently rested in the morning, use herbal products. Take equal parts of lemon balm herb and peppermint, half the valerian root and elecampane rhizomes, grind 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, put in a cold place. Consume one spoonful in the morning and evening, adding to tea or other drinks.

If you do not want to take tinctures for 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 a mixture of spices and boil over low heat for a quarter of an hour. Remove from heat, add a pinch of loose leaf black tea and let sit for 10 minutes. After that, strain, pour in milk, add a little honey. Such a fragrant and useful 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 drink in the morning and evening for 30 days.

Herbal Blends

Take equal amounts of oregano leaves, thyme and motherwort herb, as well as crushed valerian rhizomes. Pour a tablespoon of the resulting collection into a thermos and pour 2 cups of boiling water. Leave for 2 - 3 hours, pour the infusion into a jar. Use on an empty stomach 3 times a day according to the following scheme: on the 1st day - a tablespoon, on the 2nd day - two times a day, on the 3rd day - three times a day, and so on, until the dosage is half a glass (100 ml) 3 times a day. Then gradually reduce the dosage as well. The mixture is useful for poor sleep, muscle soreness, low mood.

Take 200 ml of vodka and add a teaspoon of sage herb, eucalyptus leaves and flowers to it chamomile. Insist for 7 days, then strain and drink tea. 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 cudweed, sage, sweet clover, plantain, birch and lingonberry leaves, marigold flowers (calendula) and oat straw. Add a quarter cup of the collection to a saucepan, pour 1 liter of water and boil, leave to cool, then strain. Drink half a glass of infusion in the morning and evening after meals, with the addition of honey. Such a collection will restore strength and reduce the severity of pain in the muscles.

Compresses and rubbing

Good help against muscle pain various compresses and rubbing

To relieve pain in muscles and joints will help tincture of lilac flowers in alcohol. In the spring, collect a three-liter jar of flowers, when they settle a little, fill 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 from cabbage leaves, burdock and lilac help against pain in muscles and joints. You can alternate them. The leaves are kneaded, applied to the skin and secured with a bandage or gauze, and the compress is left overnight.

You can make an alcohol compress from flowers horse chestnut. A liter of vodka requires 100 grams of raw materials, leave the product in a dark place for a week, and then rub the painful muscles and joints.

Fibromyalgia is quite frequent illness caused by a malfunction of the nervous system and manifested mainly by prolonged widespread pain in the muscles. There are no structural changes in peripheral tissues. The diagnosis is made on the basis of an examination of painful points located at the points of attachment of muscles and tendons. Treatment includes lifestyle changes, physical activity, psychotherapy, and antidepressant, anti-inflammatory, and other medications. They can only be taken with a doctor's prescription.

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Fibromyalgia is a disease characterized by chronic diffuse musculoskeletal pain in various parts of the body, stiffness of movements, fatigue and weakness, depressive disorders, and sleep disturbances. In recent years, interest in this neurological disease has increased due to an increase in the incidence of approximately 5%. If untreated, fibromyalgia significantly reduces the patient's ability to work and quality of life, leads to a deterioration in adaptability to external conditions, especially in society.

This disease has salient feature: objective research methods (blood, urine, 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 the diagnosis of fibromyalgia. In no case should the process be left to chance, patients should trust the doctor and the treatment of this pathology prescribed by him.

The diagnosis of "fibromyalgia" is made on the basis of a thorough questioning of the patient and his examination. Additional Methods studies are prescribed to exclude all other possible diseases that can give chronic pain.

For a long time in medicine there were no clear criteria for the diagnosis of fibromyalgia. 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, for the most part as part of research, but clearer diagnostic criteria have not yet been developed.

At the moment, the disease is diagnosed based on several factors. Let's list them.

Fibromyalgia is a pathology that manifests itself as chronic pain in the muscles and joints. This disease is also called fibrositis. It is characterized by anxiety and depression, poor sleep, feeling constant fatigue and intestinal disorders.

Etiology

Fibromyalgia syndrome is recorded most often among women 40-55 years old. In men, this pathology is diagnosed much less frequently - only in 16% of cases. Pain in fibromyalgia has the ability to disappear and reappear, migrating throughout the body, so diagnosis is difficult. At the same time, fibromyalgia in adults is a common occurrence, since adolescents and children suffer from this disease very rarely, although they may experience periodic muscle or joint pain.

The reasons for the development of this disease are unknown. Often it develops in patients with concomitant rheumatoid arthritis. Provoking factors are constant stressful situations, overwork and depressive states. In some cases, there is genetic predisposition to fibromyalgia.

Features of fibrositis

It was previously believed that fibromyalgia is a pathological condition of inflammatory etiology, but today these assumptions have been refuted, since neither signs of inflammation nor manifestations of arthritis are observed. A feature of this disease is that patients have a low level of growth hormone. This can be attributed to the fact that with fibromyalgia, the deep sleep phase is disturbed, namely, during this period, the pituitary gland is able to synthesize this hormonal compound.

It is also worth noting that patients with fibromyalgia experience pain even in response to stimuli that usually cannot be perceived as pain. In addition, patients have high levels of neurotransmitters (the so-called substance P), as well as growth factors in the CSF (cerebrospinal fluid). If we examine the nature of the pain, we can assume the presence of CNS hypersensitivity, as well as pathological perception of pain stimuli.

Also, patients who are diagnosed with fibromyalgia, the causes of which are unknown, have a history of severe physical or psychological trauma or a complex infection. They also have a small amount of slow movements. eyeballs during sleep, which leads to a feeling of weakness or to frequent night awakenings.

Clinic

When fibromyalgia develops, symptoms of the disease include the following:

Rapid muscle fatigue;

. "goosebumps";

Sleep disturbance;

General fatigue;

Frequent headaches;

Temporomandibular disorders in the form of pain in the region of the face and jaw, as well as resonance in the ears.

Patients also have an imbalance in the mental sphere. So, when fibromyalgia is present, the symptoms of this pathology may include poor attention and emotional disturbances which are quite often defined as depression.

Patients also complain of dizziness, pain in the abdomen, especially during palpation. Sometimes prolonged hyperthermia can be observed for no apparent reason. In addition, patients with fibromyalgia are prone to colds and are noted in the morning (after waking up).

It should be noted that the course of the disease is stationary. Manifestations of fibromyalgia can be observed for many years, changing slightly under the influence of certain external factors. Pain sensations, as a rule, are permanent, asymmetric or generalized. If the pain reaches a critical level, then they speak of a “fibrositis storm”.

Features of the pain syndrome in fibromyalgia

When fibromyalgia is diagnosed, the symptoms of this disease in 100% of cases include pain. It has certain features:

Pain in musculoskeletal system are widespread and can last more than six months;

Quite often, chronic pain syndrome in fibromyalgia is combined with symptoms of other diseases;

The pain is accompanied by autonomic disorders and changes in the psychological sphere.

When fibromyalgia develops, symptoms can also include fluid retention, intestinal irritation, vestibular disorders, osteoporosis, and other disorders. Clinical manifestations in each case are individual and require careful diagnosis.

It should be noted that the pain occurs in different parts of the body and can be concentrated on both sides. Most often, pain is localized in the neck, shoulders and chest, that is, in the upper body. Zones that have increased sensitivity are characterized by a clear location. So, when fibromyalgia occurs, points of tenderness can act as a certain diagnostic criterion.

Tender Points (TP) - pain points for fibromyalgia

TR are important modern criteria in the detection of fibromyalgia, although patients are not even aware of their existence. These points have the following properties:

To have pain, you need a slight pressure;

On palpation, pain is observed that occurs spontaneously in the patient;

TRs are placed in strictly defined places, so there are specific maps of these areas.

It should be noted that the exact amount of TR is unknown, although it correlates with the intensity of clinical manifestations. The most common localization of pain points is the area of ​​the nape, neck, the area of ​​​​the trapezius muscle, the place of attachment of the second rib to the sternum, the lateral section of the shoulder, buttocks, as well as the medial fat pad in the area of ​​the knee joint.

Despite the presence of TR, patients with fibromyalgia develop various algic syndromes with different localization. So, pain can be observed not only in the muscles, but also in abdominal cavity or heart, making diagnosis difficult. In addition, panic attacks, loss of consciousness, tunnel neuropathy are characteristic.

Features of the diagnosis of fibromyalgia

To date, there are no specific tests or examinations that would help identify this disease. They are prescribed only to exclude other pathologies. Diagnosis is based on history and physical examination. It is when specific pain points are identified and in the absence of other diseases that fibromyalgia can be detected.

It is worth remembering that many pathologies have clinical course resembling fibromyalgia syndrome:

Hypothyroidism;

Vitamin D deficiency;

Hyperfunction of the parathyroid glands, which is accompanied by an increase in the level of calcium;

Polymyositis or other lesions of muscle fibers;

bone diseases;

Oncopathology;

Infectious diseases.

As a rule, to rule out other lesions, the level of thyroid hormones, creatine phosphokinase, as well as ESR, C-reactive protein, antinuclear factor, and sialic acid are determined. With fibromyalgia, these indicators are within the normal range.

What are the criteria for making the correct diagnosis?

Fibromyalgia can be suspected in the following cases:

1. The patient has diffuse and symmetrical pain that occurs spontaneously and wears chronic(observed for 6 months or longer).

2. The examination reveals 11 pain points out of 18 generally accepted, which are characteristic of fibromyalgia.

3. Absence of symptoms of any primary pathology.

It should be noted that in clinical practice it is not always possible to detect these criteria, but it is they that guide specialists in making a diagnosis. The combination of depressive disorders and chronic muscle pain is also taken into account. Often, psychological disorders are considered as a consequence of a constant pain syndrome.

When making a diagnosis of fibromyalgia, many other pathological conditions. As a rule, depression, bulimia nervosa and sleep disturbances, chronic illogical syndrome are observed simultaneously. Also pay attention to the level of serotonin, which in this disease is reduced.

Fibromyalgia and menopause

After 45 years in female body involutional changes begin, which consist in a decrease in the level of sex hormones, as well as in the suspension of the ovaries. During this period, the work of organs and systems functionally changes, and the relationship between the hypothalamus, pituitary gland and ovaries is disturbed.

As a rule, the manifestations of menopause are typical, although they may have individual characteristics because each body reacts to hormonal failure in its own way. The most common symptom of menopause is hot flashes. They are a sudden sensation of heat in the face, neck and chest, accompanied by palpitations, excessive sweating and redness of the skin.

It should be noted that there are no clear diagnostic methods by which it would be possible to detect the end reproductive period. Fibromyalgia with menopause - quite frequent occurrence as women suffer from insomnia and pain all over the body. In addition, they are emotionally unbalanced, so the symptoms of this disease during this period are more pronounced.

Fibromyalgia Therapy

When fibromyalgia develops, symptoms and treatment depend on the course of this pathology, but the most effective is therapy that combines pharmacological and non-drug methods.

As a rule, patients are prescribed tricyclic antidepressants, which improve sleep, relieve muscle pain and eliminate fatigue. Most often, Amitriptyline and Doxepin, as well as Lyrica or Neurontin, are used for therapeutic purposes. In addition, drugs that increase the concentration of serotonin and norepinephrine (Cymbalta, Savello), non-steroidal anti-inflammatory drugs, analgesics can be used.

Among non-drug methods of treatment, massage, acupuncture and exercise therapy are used. It is useful for patients to swim (hydrotherapy), walk, ride a bicycle, do aerobics. Focus on improving sleep. Patients should also avoid stressful situations that can provoke an aggravation of the clinic.

When fibromyalgia is diagnosed, treatment with folk remedies also gives good results. As a rule, natural adaptogens are used that activate the immune system and work. muscle tissue(infusion of Chinese magnolia vine, ginseng, St. John's wort).

Herbal medicine helps to neutralize intoxication, has antibacterial and antiviral effects, and also causes a calming effect. Herbs commonly used in the treatment of fibromyalgia oxidize pyruvic and lactic acid, the main fatigue toxins.

It is worth noting that herbal remedies should be taken under the strict supervision of a physician. Only the correct dosage can improve appetite, calm and mobilize the functional activity of the body.

diet for fibromyalgia

To date, there are no clearly established principles diet food with this disease, however, there are a number of substances that are recommended to be limited in the diet of patients:

Aspartame, which is often found in sweeteners. It has been found that this compound exacerbates the clinical manifestations of fibromyalgia, as it stimulates the response of pain receptors.

Dietary supplements, which include monosodium glutamine and nitrates, as they predetermine an increase in pain.

Caffeine. With fibromyalgia, you should not drink coffee, tea, a lot of chocolate. With their restriction, the condition of patients improves in just a week.

Various baked goods that contain yeast and gluten.

Scientists believe that dairy products of any fat content can negatively affect the dynamics of fibromyalgia.

Solanaceae - peppers, potatoes, tomatoes and eggplants. These products can exacerbate both arthritis and fibrositis.

If fibromyalgia develops, the symptoms and treatment of this pathology depend on the prescription pathological process and the presence of other comorbidities. With timely diagnosis and therapy, the prognosis is favorable.

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. THEM. Sechenov

Fibromyalgia is a disease characterized by chronic diffuse pain accompanied by symptoms such as fatigue, sleep disturbances, cognitive impairment and bouts of depression. Fibromyalgia is characterized by increased sensitivity and soreness in certain areas of the body. Women are more susceptible to this disease than men. Only about 10 years ago, the scientific basis for the pathogenesis of fibromyalgia and other idiopathic pain disorders was very arbitrary. However, during recent years advances in instrumental diagnostics and genetics have led to significant advances in the understanding of fibromyalgia.

Story

Although the term "fibromyalgia" is relatively recent, the 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 at all. The modern concept of 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 identified the presence of local hypersensitivity - the so-called pain points (tender points), as a characteristic symptom of fibromyalgia. In addition, they found that patients with fibromyalgia often had sleep disturbances.

The next step 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 out of 18 possible tender points should be identified. Significant progress in the study of fibromyalgia was made after researchers came to the conclusion that this condition is not caused by damage or inflammation of peripheral tissues. Therefore, all efforts were directed to the study of the central mechanisms of pathogenesis. According to most experts, fibromyalgia is a multisymptomatic disease characterized by central disturbances in pain perception.

Etiology

The researchers found that in the development of fibromyalgia important role plays heredity. First-line relatives of patients with fibromyalgia are 8 times more likely to develop fibromyalgia than the general population. Twin studies have shown that approximately half of 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, environmental factors play an important role in triggering fibromyalgia and concomitant pathology. Factors that provoke the development of fibromyalgia include physical trauma (especially injuries of the trunk), certain infections (for example, hepatitis C, Epstein-Barr virus, parvovirus and tick-borne borreliosis), as well as emotional stress, etc. It is noteworthy that each of these factors leads to 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 that includes the development of pathology in patients against the background of an infectious process or after injuries.

Possible factors triggering the development of fibromyalgia and associated pathology:

• peripheral pain syndromes;
• infections (parvovirus, Epstein-Barr virus, tick-borne borreliosis, Q fever);
• physical injury (for example, in a traffic accident);
• mental stress/distress;
• hormonal disorders (hypothyroidism);
• medicines;
• vaccines.

Pathogenesis and pathophysiology

The mechanisms responsible for the clinical manifestation of fibromyalgia and related disorders are likely to be highly complex and multifactorial. An essential role is played by the factor of chronic emotional stress. Studies of the relationship between stress and the development of fibromyalgia reveal changes in the hypothalamic-pituitary-adrenal system and the autonomic nervous system. Fibromyalgia research over the past two decades has provided a better understanding of the pathophysiology of pain and perception processes - they have shown that the pain threshold depends on the degree of distress. Many psychological factors, such as hypervigilance, suspiciousness, catastrophization, external locus of pain control may play an important role in the severity of fibromyalgia symptoms. Special Studies showed that serotonergic and noradrenergic activity is reduced in patients with fibromyalgia. 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 CSF (5-hydroxyindole acetate). Supporting this finding is 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 perceptual processes is supported by the results of instrumental 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 symptoms of fibromyalgia. Many clinicians have found that identifying and treating specific sleep disorders (eg, obstructive sleep apnea, upper respiratory tract or impaired movement of the limbs during sleep) will not necessarily lead to a reduction in the main 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 are the most common conditions.

Clinical picture and diagnosis

Some doctors consider the diagnosis of fibromyalgia highly controversial and controversial. Others see no problem in making a diagnosis. Controversy in the diagnosis of fibromyalgia arises from the lack of a well-defined pathology. Fibromyalgia is classified as functional impairment, which implies the absence of organic pathology. There are no specific diagnostic laboratory tests, radiological or other criteria of this pathology. The only symptom that a doctor can detect is increased sensitivity or tenderness of soft tissues during 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 to be used in a clinical setting, but only in research settings, they nonetheless provide over 85% accuracy in differentiating patients with fibromyalgia from similar conditions.

Table 1. Diagnostic criteria and clinical characteristics of fibromyalgia (American College of Rheumatology, 1990)

AKP 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 belt). There must be pain in the axial skeleton ( cervical region spine, or anterior chest, or thoracic region spine, or lower back). Pain in the shoulders and buttocks is treated as pain for each affected side. Sciatica is regarded as pain in the lower body
Pain in 11 of 18 tender points on palpation	Nape: bilateral, in the region of the occipital muscles
	Lower neck: bilateral, anterior to C5-C7
	Trapezoidal: bilaterally, in the middle part of the upper border
	Supraspinatus: bilaterally, above the spine of the scapula from the medial edge
	Second rib: bilaterally, slightly more lateral in the area of ​​the second osteochondral joint
	Lateral epicondyle: bilateral, 2 cm distal to the epicondyles
	Gluteal: bilateral, upper outer quadrant of the buttocks
	Greater trochanter: bilaterally, posterior to the acetabular tubercle
	Knee: bilateral, medial to the knee joint
Clinical symptoms	Description from the patient's words
Fatigue	Lethargy, lack of motivation, difficulty moving or exercising
The quality of life	Effects on the ability to make plans, achieve goals, or complete tasks
General Functions	Decreased daily household activity
Soreness	Pain when touched
Dream	Poor sleep, superficial 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. Pain wears diffuse character, extends throughout the body above and below the waist. Usually patients describe their condition as "I feel like I have pain everywhere" or "I feel like I have a cold all the time." Patients usually describe pain that radiates throughout the muscles, but sometimes pain and swelling in the joints is also noted. In addition, patients often complain of paresthesia, numbness, tingling, burning, 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 areas of the body. The study of painful points requires experience. The doctor must know exactly where to palpate and with what force. According to the AKP criteria, 9 pairs of tender points were identified (see figure).

Rice. 1. Study of painful points (tender points)

The pressure applied at these points should be 4 kg/cm2 (the pressure at which the examiner's nail beds turn white). When performing palpation of 18 painful points, it is recommended to exert uniform pressure on paired points and palpate other parts of the body with the same effort to compare sensitivity. In patients with fibromyalgia, there is increased sensitivity in painful points compared to other parts of the body. In addition, it is necessary to conduct an examination of 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 the result of local inflammation or tissue damage. Availability positive reaction more than 11 out of 18 tender points were identified as diagnostic criteria based on the analysis of statistical data from large populations of patients. However, not all patients with fibromyalgia will have hypersensitivity at more than 11 points. Again, the AKP criteria for fibromyalgia are intended for research purposes and not for diagnosing specific patients. Nevertheless, examination of painful points is considered an important part of the study of the functioning of the musculoskeletal system in patients with generalized pain syndrome. Palpation of soft tissues and joints reveals areas of hypersensitivity. This examination excludes 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 disturbing symptoms for the patient. Along with chronic diffuse pain, other typical symptom fibromyalgia is fatigue. This symptom is most pronounced on waking, but occurs in the afternoon. Minor physical activity can drastically increase pain and fatigue, although prolonged rest and inactivity can also exacerbate symptoms. Since diffuse pain and fatigue can occur during the initial stages of flu, colds, or overexertion, it should be noted that these symptoms must last more than 3 months to be diagnosed with fibromyalgia.

Patients with fibromyalgia in the morning feel stiff in the body and feel sleepy, even if they slept 8-10 hours. Such patients usually do not sleep soundly, often wake up and have difficulty falling asleep. Patients typically say, "It doesn't matter how much sleep I have, but I feel like I've been run over by a truck." In addition, most patients have cognitive impairment and mood pathology. Most often, they describe their problems with concentration as "fog in the head." Negatively affects the patient's well-being and many other clinical symptoms: headache (in more than 50% of cases), dizziness, muscle spasms, tinnitus, leg cramps, restless legs syndrome, Raynaud's disease, pain in the chest, lower back and jaw. As a result of the described disorders in patients, as a rule, the quality of life decreases.

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 2). Against the background of both methods of treatment, there was a persistent improvement in the symptoms of fibromyalgia for 1 year or more.

Table 2. Non-drug methods fibromyalgia treatment

Medical treatment

Antidepressants. Tricyclic antidepressants (TCAs) were among the first drugs to treat pain in fibromyalgia. It has been shown that amitriptyline is able to relieve pain intensity, improve sleep and reduce fatigue in patients with fibromyalgia. At the same time, antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs) (fluoxetine, sertraline, citalopram, paroxetine) showed low efficiency in randomized, placebo-controlled trials.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) (venlafaxine, duloxetine, milnacipran) were found to be more effective than SSRIs. These drugs, like TCAs, inhibit the reuptake of serotonin and norepinephrine, but unlike TCAs, they practically do not affect other receptors. This selectivity results in fewer side effects and better tolerability. Data on venlafaxine suggest that successful application for the treatment of neuropathic pain and fibromyalgia.

In studies using duloxetine, there was a greater reduction in total fibromyalgia severity score (FIQ) and a 30% reduction in pain in 54% of those taking the drug compared to 33% in the placebo group. 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 FDA-approved 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 also FDA approved 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). A 50% reduction in pain was achieved in 37% of patients with fibromyalgia on the background of a double dose, in 22% on the background of a single dose, and in 14% in the placebo group. Only milnacipran twice daily showed a statistical advantage over placebo. Only minor side effects have been reported. In a 27-week study of the use of milnacipran in 888 patients with fibromyalgia, 56% of the pain intensity decreased by at least 30%, while in the placebo group there were 40% of such cases. Side effects were usually 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 does not depend on their effect on the emotional status of patients. A recent meta-analysis of 18 RCTs confirmed that antidepressants can reduce fibromyalgia pain, reduce depression, reduce fatigue, restore sleep, and improve 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 (Lyric) is the first and so far the only drug in Russia officially registered for the treatment of fibromyalgia. Pregabalin binds to the α2-σ region of voltage-gated calcium channels in the CNS. Due to a decrease in the influx of calcium into neurons, the release of substance P, glutamate and norepinephrine decreases, providing analgesic and anxiolytic (anti-anxiety) effects 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 showed a significant reduction in pain score, improved sleep quality, decreased fatigue, and improved overall well-being. Study participants received a placebo or one of the doses of pregabalin (150, 300, or 450 mg/day) for 8 weeks. All patients treated with the drug showed improvement within 2 weeks, which persisted until the end of the study. Treatment with Pregabalin resulted in a mean but statistically significant reduction pain, depending on the dose of the drug, improve sleep and reduce 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 a 6-week open-label study and responded to treatment (responders). Pregabalin was monotherapy at 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 versus placebo in the treatment of fibromyalgia pain in patients responding to pregabalin. In addition, the effectiveness of pregabalin compared with placebo was assessed in terms of analgesic effect, general well-being of patients, treatment of sleep disorders, fatigue and safety. As a result, it is shown that the response to treatment with Pregabalin is extended in time. The time to decline in therapeutic response was significantly shorter in placebo-treated subjects than in those treated with pregabalin. At doses of 300, 450, and 600 mg/day, pregabalin was superior to placebo in terms of time to loss of response to treatment. 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 the intensity of pain in fibromyalgia at dosages of 300, 450 and 600 mg / day. The effect came quickly and persisted with continued treatment. In addition, Pregabalin therapy resulted in a significant and consistent improvement in patient self-report scores across all doses in both studies, and in one study a significant reduction in fibromyalgia severity at 450 and 600 mg/day. An improvement in the qualitative and quantitative characteristics of sleep was noted. Finally, the efficacy of Pregabalin in the treatment of fibromyalgia was evaluated in a meta-analysis of 6 RCTs of more than 2000 patients with fibromyalgia. This analysis showed that pregabalin reduced fibromyalgia pain, improved sleep and quality of life, but had no effect on the severity of depressed mood. In addition, patients treated with Pregabalin experienced a reduction in fatigue and anxiety.

Gabapentin, whose pharmacological properties similar to Pregabalin was used in a 12-week randomized clinical trial in 150 patients with fibromyalgia. In the Gabapentin group, there was a significant decrease in the mean pain intensity score than in the placebo group. In addition, Gabapentin significantly improved scores on the Fibromyalgia Severity Scale (FIQ), the Patient Self-Assessment Scale (PGIC), and the Sleep Quality Scale. Compared with placebo, Gabapentin resulted in a significant increase in the incidence of sedation, 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 approved as a muscle relaxant for the management of spasticity in multiple sclerosis and disorders cerebral circulation. It belongs to the group of a2-adrenergic receptor agonists. A study of Tizanidin in fibromyalgia (4-24 mg/day) showed a decrease in the concentration of neuroamines and substance P in the cerebrospinal fluid. Tramadol is a centrally acting analgesic that binds to μ-opioid receptors and inhibits the reuptake of norepinephrine and serotonin. The combination of paracetamol (acetaminophen) with tramadol in a ratio of 8:1 showed synergy of both drugs in preclinical pain models. In a 13-week, multicenter, randomized clinical trial, tramadol/paracetamol at doses of 37.5 mg/325 mg relieved fibromyalgia pain more effectively than placebo. All adverse events reported 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 is not fully understood. Many studies have produced conflicting results. For example, benzodiazepines, including alprazolam (0.5–3.0 mg at bedtime), have not been shown to be superior to placebo for the treatment of fibromyalgia pain, but clonazepam has been shown to be effective in managing temporomandibular joint pain, which is often seen in fibromyalgia. In addition, this drug effectively stopped 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 at 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 showed the important role of peripheral tissues in the development of hyperalgesia in fibromyalgia and proved the possibility of clinical application of local anesthetic injections for pain relief in fibromyalgia.

Conclusion

Thus, today there are four main directions in the treatment of fibromyalgia (table 3):

1. reduction of peripheral pain, in particular muscle pain;
2. prevention of central sensitization;
3. normalization of sleep disorders;
4. treatment of comorbidities, in particular depression.

The first approach is more focused on relieving acute pain in 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 stress reduction, aerobic exercise, and GABA agonists. Drug and behavioral therapies 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 one or another treatment method.