Fibromyalgia syndrome is an idiopathic disease, the pathophysiology of which is still unknown, and therefore there are few treatments for it. Its main clinical manifestation is diffuse chronic pain, with no objective signs other than “pressure points”. Therefore, it is not only difficult to choose the treatment, but also to evaluate the efficacy. The current treatment focuses on improving the sleep state, reducing the sensitivity of the nociceptive receptors, and improving the blood flow to the muscles. It is believed that these aspects are related to the causes of fibromyalgia syndrome. The efficacy of treatment is determined by the number of pressure points and the change in symptoms before and after treatment. One of the more important aspects of treatment is to provide comfort and explanation to the patient. The patient’s anxiety and depression can be relieved by telling the patient that it is not a life-threatening disease and that it does not cause lifelong disability. In terms of pharmacological treatment, most authors report that the tricyclic antidepressants amitriptyline and aminophenazone are currently the ideal drugs for the treatment of this disease. They improve sleep and reduce the amount of stiffness and pain by: (i) antidepressant; (ii) increasing non-passive eye sleep and reducing fast eye movement sleep; (iii) increasing serotonin content; and (iv) relieving muscle spasm. Amitriptyline 10mg, according to can be slowly increased to 20-30mg, or aminophene 10-40mg, both for a single dose before bedtime. The side effects are dry mouth, sore throat and constipation, which are mostly tolerated by patients due to the small dose. In recent years, S-adenosylmethionine has been found to be effective in the treatment of fibromyalgia syndrome. It is the methyl arch of many methylation reactions in brain tissue and has antidepressant effects. In terms of non-pharmacological treatment, cardiovascular fitness training and EMCbiofeedback training have been reported in the literature. 42 patients with primary fibromyalgia were divided into cardiovascular fitness training and flexibilty exercises groups by McCain et al. The patients were divided into cardiovascular adaptation and flexibilty exercises groups.) The patients in each group were trained three times a week for 60 minutes each time. Cardiovascular adaptation training pedal bicycle ergometer, exercise requires heart rate to be more than 150 beats/min and the duration is extended time by time. After 20 weeks, when comparing the two groups, the cardiovascular habilitation group showed significant improvements in the degree of pressure pain at pressure points and in overall patient and physician ratings.Furaccioli et al. performed 15 sessions of EMG biologic meal training over 5 weeks in 15 patients with primary fibromyalgia, 9 of whom showed improvements in morning stiffness, number of pressure pain points, and the degree of pressure pain were improved. This improvement persisted for 6 months after the end of treatment. The same results were obtained in a subsequent controlled study. Other treatments such as local sympathetic blockade, pain point closure, transcutaneous nerve stimulation, interferential electrical stimulation, acupuncture, and proximity massage may be tried. The efficacy and mechanism of these treatments have to be further studied. Pathogenesis】 The mechanism of this disease is still unclear. The literature reports that it is related to sleep disorders, abnormal neurotransmitter secretion and immune disorders. 1.Sleep disorder Sleep disorder involves 60-90% of patients. It is characterized by easy awakening, excessive dreaming, morning mental fatigue, generalized pain and morning stiffness. Nocturnal EEG recordings revealed alpha waves intervening in stage IV delta sleep waves. The above EEG patterns and clinical symptoms can also be induced by disturbing non-rapid eye movement (non rapid eyemovement) in volunteers with ringtones. Other factors affecting sleep, such as mental stress and environmental noise, can aggravate the symptoms of fibromyalgia syndrome. Therefore, it is speculated that this stage IV sleep abnormality plays an important role in the development of fibromyalgia syndrome. 2, abnormal neurotransmitter secretion The literature reports that neurotransmitters such as serotonin (serotonin, 5-HT) and substance P (substance P) play an important role in the development of this disease. The precursor of serotonin is tryptophan, a food protein that is absorbed in the intestine and is mostly bound to plasma proteins, with a small portion being free. The free tryptophan can be carried by carriers across the blood-brain barrier into brain tissue. 5-HT is then hydroxylated and decarboxylated in 5-HTergic neurons to produce 5-HT. 5-HT released into the synaptic gap is partially reuptaken by presynaptic nerve endings and partially produced by mitochondrial monoamine oxidase as inactive 5-hydroxyindole acetic acid. 5-HT is also present in the mucosa of the digestive tract, platelets and mammary cells. 5-HT is also found in the mucosa of the digestive tract, platelets and mammary gland cells. Since it is difficult to cross the blood-brain barrier, 5-HT in the central nervous system and in peripheral blood belong to two systems. It has been found that: (1) free tryptophan and its transport ratio (trannsport ratio) are reduced in the plasma of patients with fibromyalgia syndrome. The degree of reduction correlated with musculoskeletal pain, i.e. the lower the plasma degree and the trannsport ratio, the more pronounced the pain. (ii) High affinity 5-HT receptors on platelet membranes, promethazine can bind competitively with 5-HT to platelet receptors, and 5-HT receptor density on platelet membranes was measured with tritium-labeled promethazine and found to be more affected in fibromyalgia syndrome than in normal subjects. (iii) 5-HT was significantly reduced in the brain tissue of presenters with fibromyalgia anterior syndrome compared to normal subjects. Experiments have shown that 5-HT can regulate non-rapid eye sleep, reduce sensitivity to pain, improve depressive states, and also enhance the analgesic effects of anesthesia. Amitriptyline and cyclobenzaprine can convert 5-HT to 5-hydroxyindole acetylase and increase 5-HT concentration, so they are effective in fibromyalgia syndrome. In contrast, the administration of the tryptophan hydroxylase inhibitor, p-chlorophenylalanine (parachlorophenylalamine), results in fibromyalgia syndrome-like pain, which disappears when this drug is discontinued. Another neurotransmitter associated with fibromyalgia syndrome is substance P. Littlejohn found that physical or chemical stimuli can induce a marked cutaneous congestion response in patients with fibromyalgia syndrome, and this overreaction may be related to the presence of a persistent terminal injury stimulus. As a result of these stimuli, cutaneous polymodal cutaneous nociceptors reflexively release pathological amounts of substance P from nerve endings, which in turn can cause local vasodilation, increased vascular permeability, and a form of neurogenic inflammmation. After the release of substance P from the nerve endings, the primary sensory nerves in the dorsal root ganglia synthesize more substance P in order to maintain a constant level. The synthesized substance P increases simultaneously to the terminal and central substance levels. Due to its slow but persistent and strong excitatory effect, the central nervous system must be affected to some extent. It has also been found that in the presence of normal or high levels of 5-HT, substance P has a dampening effect on the release of sensory nerve impulses. In the absence of 5-HT, it will lose this control role, leading to nociceptive hypersensitivity. 3. Immune disorders Some authors have reported deposits of immunoreactive substances at the dermal-epidermal junction in patients with fibromyalgia syndrome, and electron microscopic observation revealed swelling of muscle capillary endothelial cells in patients with fibromyalgia syndrome, suggesting acute vascular injury; tissue hypoxia and increased permeability. The unexplained weight gain, diffuse swelling of the hands and increased nocturia often reported by patients may be related to increased permeability. In addition, preliminary studies have found that interleukin-2 (IL-2) levels are elevated in fibromyalgia syndrome. Patients with tumors treated with IL-2 are born with fibromyalgia syndrome-like symptoms, including widespread pain, sleep disturbances, morning stiffness, and the appearance of pressure points. Alpha interferon has also been found to cause fatigue. The above phenomena suggest immune regulation disorders. Abnormal cytokine levels in the body may be associated with the onset of fibromyalgia syndrome. Epidemiology】 The epidemiology of fibromyalgia anterior syndrome has not been reported in China, and there is no precise statistical data abroad, but from some preliminary data, it seems that the disease is not uncommon. A survey in the United Kingdom shows that 10.9% of the population unable to work due to illness is caused by rheumatic disorders, of which fibromyalgia syndrome accounts for about half. The American Rheumatism Association points out that primary fibromyalgia syndrome is one of the most common rheumatic diseases, occupying the third place after RA and OA. Yunus et al. treated 285 patients with skeletal muscle system diseases in 1 year, of which 29% were OA, 20% were primary fibromyalgia syndrome, and 16% were RA. A total of 182 patients with rheumatic diseases were treated in the outpatient clinic, of which 11 cases of fibromyalgia syndrome accounted for 6% of the total. It ranked seventh after rheumatoid arthritis (27.5%), systemic lupus erythematosus (16%), systemic sclerosis (10.4%), and dry syndrome (7.7%). Clinical manifestations】 Fibromyalgia syndrome is mostly seen in women, and the most common age of onset is 25-45 years old. Its clinical manifestations are diverse, but there are mainly four groups of symptoms as follows: 1. Although some patients complain of pain in only one or a few places, 1/4 of them have more than 24 pain sites. The disease is widespread throughout the body, especially in the medial skeleton (neck, thoracic spine, lower back) and scapular and pelvic girdles. Other common sites are, in order, the knee, head, elbow, ankle, foot, upper back, mid-back, wrist, hip, thigh and calf. Most patients describe this pain as stabbing and distressing. Another symptom that all patients have is the widespread presence of pressure points that are present in tendons, muscles, and other tissues, often in a symmetrical distribution. The patient’s response to “pressure” is different from that of a normal person at the site of the pressure point, but there is no difference in other areas. 2. Characteristic disease: This group of symptoms includes sleep disturbance, fatigue and morning stiffness. About 90% of patients have sleep disorder, which is characterized by insomnia, easy to wake up, dreaminess, and mental fatigue. The nocturnal EEG shows alpha waves intervening in the non-fast branching eye rhythm, suggesting a lack of sleepiness. 50-90% of patients have fatigue, and about half have fatigue symptoms so severe that they feel “too tired to work”. Morning stiffness is seen in 76-91% of patients, and its severity is related to sleep and disease activity. 3. Common symptoms: The most common symptoms in this group are numbness and swelling. Patients often complain of joint and peri-articular swelling, but there are no objective signs. Next are headache and irritable bowel syndrome. Headache can be classified as migraine or non-migrainous headache, the latter being a dull, compressive pain in the occipital region or throughout the head. Psychological abnormalities including depression and anxiety are also more common. In addition, the patient’s ability to work is reduced, with about 1/3 of patients needing to change jobs and a small number unable to hold down a daily job. The above symptoms are often aggravated by cold and humid weather, mental tension and overexertion. Local heat, mental relaxation, good sleep and moderate activity can reduce the symptoms. 4.Mixed symptoms: primary fibromyalgia syndrome is rare, and most patients with fibromyalgia syndrome are suffering from some kind of rheumatic disease at the same time. At this time, the clinical symptoms are the intertwining and overlapping of the two symptoms. Fibromyalgia syndrome often makes the symptoms of co-existing rheumatism appear more severe, and failure to recognize this condition often leads to over-treatment and examination of the latter. Unless combined with other diseases, there are usually no laboratory abnormalities in pre-fibromyalgia syndrome. However, it has been reported that patients with fibromyalgia syndrome have increased IL-1 levels, decreased natural killer cell and serotonin activity, and increased concentration of substance P in the cerebrospinal fluid. In this group of patients, there may be positive antinuclear antibodies and reduced C3 levels. Since Smythe first proposed diagnostic criteria for fibromyalgia syndrome in the 1970s, a number of diagnostic criteria have been introduced in succession. However, these criteria are not identical in terms of methodology and content, thus posing some difficulties in epidemiological and clinical studies. For this reason, foreign scholars, through multicenter collaboration, studied the clinical symptoms and pressure points of a large number of patients on the basis of previous criteria, from which one clinical symptom and 18 pressure points with the most discriminatory meaning were selected, and the classification criteria of fibromyalgia syndrome in 1990 were proposed. 1.Generalized pain lasting for more than 3 months: generalized pain is considered when there is simultaneous pain in the left and right side of the body, upper and lower parts of the waist and the medial skeleton (cervical or anterior or thoracic spine or lower back). 2. At least 11 of the 18 pressure points are painful when pressed with the thumb (the pressing pressure is about 4kg). The 18 (9 pairs) pressure points are: the suboccipital muscle attachment; the midpoint of the upper edge of the trapezius muscle; the front of the transverse space of the 5th to 7th cervical vertebrae; the beginning of the supraspinatus muscle, the near medial edge above the scapular spine; the distal 2cm of the lateral epicondyle of the humerus; the junction of the second rib and cartilage, just at the lateral upper edge of the junction; the upper quadrant of the hip I, at the anterior hip crease; the posterior aspect of the greater trochanter; the proximal side of the medial knee fat pad joint crease line. Those who are satisfied with the above 2 conditions at the same time can be diagnosed with fibromyalgia syndrome. Application of this criterion leads to a more consistent definition of fibromyalgia syndrome. The distinction between fibromyalgia syndrome and other similar disorders emphasized by this criterion thus does not include the characteristic manifestations of the syndrome, such as fatigue, sleep disturbance, and morning stiffness. The application of this criterion, taking into account the above-mentioned features, will increase the reliability and correctness of the diagnosis. However, this criterion cannot distinguish primary fibromyalgia syndrome from secondary fibromyalgia syndrome. Therefore, after the diagnosis of fibromyalgia syndrome is established, the presence of other concomitant diseases must also be examined to distinguish primary from secondary fibromyalgia syndrome. This distinction is obviously necessary in clinical research and observation of the efficacy. Differential diagnosis】 Symptoms of fibromyalgia syndrome, such as fatigue and pain, are common clinical symptoms. It needs to be differentiated from the following diseases. 1, psychogenic rheumatic pain: fibromyalgia syndrome piece easily confused with psychogenic rheumatism, but the two have significant differences. Psychogenic rheumatism has symptoms with emotional overtones. For example, the pain is described as severe pain like slashing and burning, or described as numbness, tightness, needle-like or pressure pain. These symptoms are often vaguely localized. Variable, without anatomical basis, and unaffected by weather or activity, patients often have mental or emotional disturbances such as psychoneurosis, depression, schizophrenia, or other psychiatric disorders. It is important to distinguish between the two, as the former is more difficult to manage and often requires treatment by a psychiatrist. 2. Chronic fatigue syndrome: Chronic fatigue syndrome includes chronic active EBV infection and idiopathic chronic fatigue syndrome. It is characterized by fatigue and weakness, but lacks an underlying cause. Examination of patients for low-grade fever, pharyngitis, swollen cervical or axillary lymph nodes, and determination of anti-EB virus envelope antigen antibody IgM can help identify the two. 3, rheumatic polymyalgia: rheumatic polymyalgia manifests as widespread neck, scapular belt, back and pelvic belt pain, and the pain range is mostly located in the muscle groups around the large joints. However, it can be differentiated from fibromyalgia syndrome according to the characteristics of fast blood sedimentation, mostly seen in elderly people over 60 years old, synovial biopsy showing inflammatory changes, and sensitivity to hormones. 4, rheumatoid arthritis: patients with RA and fibromyalgia syndrome both have generalized pain, stiffness and joint swelling sensation. However, there is no objective evidence of swelling in the joints of fibromyalgia anterior syndrome, and its morning stiffness is shorter than that of RA. Laboratory tests including rheumatoid factor, blood sedimentation, and joint X-ray are also political. The distribution of pain in fibromyalgia syndrome is wider, less confined to joints, and mostly located in the lower back, thighs, abdomen, head and hips, while the pain in RA is mostly distributed in the wrists, fingers and toes. 5, myofascial pain syndrome: myofascial pain syndrome, also known as limited fibrositis, also has learned pressure points, easily confused with fibromuscular anterior point sign. However, there are differences in diagnosis, treatment and prognosis between the two. The pressure point in myofascial pain syndrome is usually called the point of excitation, and pressure on this point causes pain to radiate to other areas. Although the patient feels pain, they may not be aware of the excitation point anywhere. Myofascial syndromes usually have only one or a few localized trigger points. The point of excitation originates in the muscle, and the affected muscle is restricted in movement, and pain can be caused by passive pulling or active contraction of the muscle. Local closure of the excitation points with 1% procaine can temporarily eliminate the pain. It is different from fibrositis in that there is no widespread pain, stiffness or fatigue. However, if persistent pain causes stage IV sleep disturbance, myofascial syndrome may evolve into fibromyalgia syndrome. Myofascial syndrome is usually caused by trauma or overexertion. The prognosis is generally good. Treatment: One of the more important aspects of treatment is to provide comfort and explanation to the patient. To relieve the patient’s anxiety and depression. In terms of pharmacological treatment, most authors report that the tricyclic antidepressants amitriptyline and aminophenazone are currently ideal for the treatment of this disease. They improve sleep and reduce the amount of stiffness and pain by: (i) antidepressant; (ii) increasing non-rapid eye movement sleep and reducing fast eye movement sleep; (iii) increasing serotonin content; and (iv) relieving muscle spasm. Amitriptyline 10mg, according to can be slowly increased to 20-30mg, or aminophene 10-40mg, both for a single dose before bedtime. The side effects are dry mouth, sore throat and constipation, which are mostly tolerated by patients due to the small dose. In recent years, S-adenosylmethionine has been found to be effective in the treatment of fibromyalgia syndrome. It is the methyl arch of many methylation reactions in brain tissue and has antidepressant effects. In terms of non-pharmacological treatment, cardiovascular adaptation training and EMG biofeedback training have been reported in the literature to have some efficacy. Other treatments such as local sympathetic blockade, pain point closure, transcutaneous nerve stimulation, interferential electrical stimulation, acupuncture, and massage can be tried. The efficacy and mechanism of these treatments await further study.