Fibromyalgia is a chronic pain syndrome of soft tissues such as tendons, ligaments, fascia, muscles, and adipose tissues that cause systemic musculoskeletal pain, stiffness, paresthesia, sleep disturbances, fatigue, and tender spots appearing throughout the body.
The main symptom of fibromyalgia is pain. It starts in any part of the body and eventually spreads throughout the body. Patients mainly complain of lower back pain or pain in the neck and shoulders. The patient feels tingly or stiff, or deeply painful, and complains of various other aspects. In addition, even light exercise can cause pain.
Some patients with fibromyalgia often complain of spasticity. Some muscles and joints become stiff when the patient wakes up in the morning, and usually improves during the day. However, in severe cases, these symptoms can be felt throughout the day. They also complain of abnormal sensations or Raynaud’s symptoms.
The second prominent feature of fibromyalgia is fatigue. People with fibromyalgia often feel tired. In particular, patients wake up frequently during sleep so that fatigue does not go away even after sleep. Due to these symptoms, patients may complain of memory impairment, cognitive impairment, headache, anxiety, and depression. In addition, patients have tender points that sensitively feel pain in areas where normal people do not feel much pain.
Such fibromyalgia is sometimes caused by mental stress or medical diseases such as infectious diseases, surgery, etc., and is often accompanied by irritable bowel syndrome, irritable bladder, migraine, menstrual pain, and non-cardiac chest pain.
The causes of fibromyalgia have not yet been identified, but it is thought to be due to an abnormal perception of pain. The following abnormalities have been found in the central nervous system of patients with fibromyalgia.
- Decrease in the metabolism of serotonin
- Decreased secretion of growth hormone
- Decreased secretion of corticosteroids in response to stress
- Increased P substance (pain-causing substance) in cerebrospinal fluid
- Dysfunction of the autonomic nervous system
Patients with fibromyalgia may feel pain as a stimulus that normal people do not feel as pain. This is thought to be because the body does not properly process stimuli that are not related to pain. It is also accompanied by various mental disorders such as depression, anxiety, and health anxiety. In addition, about 30% of fibromyalgia patients have symptoms of psychiatric disorders. On the other hand, no objective abnormalities are found in muscles, ligaments, or tendons.
The diagnosis is made when complaining of whole body musculoskeletal pain for more than 3 months and significant tenderness in 11 or more of 18 specific body parts during examination. However, not all fibromyalgia patients meet these criteria. Some people have fewer tender points and may have more pain in certain areas. Musculoskeletal examination and neurological examination showed no abnormal findings.
There is no test that can diagnose fibromyalgia. In addition, the musculoskeletal and neurological results of most fibromyalgia patients are normal. If there is an abnormality in the inflammatory level, muscle enzyme level, thyroid level, etc., other diseases such as polymyalgia rheumatica, inflammatory myopathy, hypothyroidism, etc. must be differentiated.
In the treatment of fibromyalgia, education and exercise about the disease, and medications for sleep and pain are important. The first step in medication treatment is to take drugs developed primarily as antidepressants, such as amitriptyline, nortriptyline, and doxepin, one to two hours before bedtime. Medication treatment begins with a low dose and increases until effective, and checks for side effects such as constipation, dry mouth, weight gain, and sleepiness. Similar antidepressants such as fluoxetine, paroxetine, and duloxetine are known to be effective. Recently, drugs such as pregabalin and milnacipran have been studied to be effective in clinical trials. Anti-inflammatory pain relievers are a little helpful, but steroids or narcotic pain relievers are rarely effective, so do not use them. Clinical trials have proven that tramadol is effective for severe pain.
Progress and complications
The prognosis is very different depending on the patient. Some patients control chronic pain thanks to constant treatment, but on the other hand, there are patients whose symptoms do not improve at all over time, making it impossible to even daily life. About 9-44% of patients with fibromyalgia show disability symptoms, which are closely related to pain, mood, depression, and job status.
The onset of fibromyalgia cannot be prevented. At the onset, it is necessary to be diagnosed by a specialist and to quickly improve symptoms through appropriate treatment.
Daily life tips
It should be noted that the disease itself does not cause disability or deformity, and there are many good treatment options. The course of the disease depends a lot on what the patient does. It is good for patients to develop the ability to manage stress well because the stress of daily life can worsen symptoms. In addition, it is desirable to receive appropriate help by consulting a specialist about biofeedback treatment, behavioral therapy, and physical therapy.
It’s a good idea to do aerobic exercise regularly. However, it is desirable to start when there are no problems with sleep, and when pain and fatigue improve. Slowly start the exercise at a low level where the patient does not feel pain in the body, and increase it to 3-4 times a week for 20-30 minutes at a time. In addition, exercises such as stretching are helpful.
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