1.What is fibromyalgia syndrome? Fibromyalgia syndrome is a group of clinical syndromes of unknown etiology characterized by widespread generalized pain and significant physical discomfort, often accompanied by fatigue, sleep disorders, morning stiffness, and mental symptoms such as depression and anxiety. 2. What is widespread chronic pain? The pain lasts for at least 3 months, is distributed on both sides of the body, and involves at least above and below the wrist. 3.Does having widespread chronic pain mean I have fibromyalgia syndrome? No. Widespread chronic pain is a relatively common group of symptoms, but not all patients with widespread chronic pain have fibromyalgia syndrome. Other conditions such as inflammatory rheumatic diseases and diffuse bone metastases can also present as widespread chronic pain. 4. What are the clinical manifestations of fibromyalgia syndrome? Widespread chronic pain with skin tenderness, most commonly in the muscles of the neck, chest, lower back, scapular girdle, and pelvic girdle. Sleep disturbance, fatigue, headache, dizziness, chest pain, diarrhea, abdominal pain, sensory abnormality, arthralgia, dyspnea, cognitive dysfunction, depression, or anxiety are also common. 5.What are the core manifestations of fibromyalgia syndrome? Widespread chronic pain, back pain, fatigue, multiple joint pain, sleep disorder, morning stiffness, morning sickness, difficulty concentrating and forgetfulness. 6. Is fibromyalgia syndrome a separate disease? This issue has been controversial for a long time, and it is currently considered to be a clinical syndrome that includes widespread pain, obvious physical discomfort, often accompanied by sleep disorders and fatigue. 7. Can fibromyalgia syndrome coexist with other diseases? Yes. Fibromyalgia syndrome can be divided into two categories: primary and secondary. The former is idiopathic and does not combine with any organic disease; while the latter is secondary to various rheumatic diseases such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, etc., and can also be secondary to non-rheumatic diseases such as hypothyroidism and malignant tumors. 8. Is the diagnosis of fibromyalgia syndrome an exclusive diagnosis? No, it is not. Fibromyalgia syndrome can co-exist with other diseases such as inflammatory arthritis and osteoarthritis. 9. Do people with fibromyalgia syndrome always show signs of depression? No. Not all patients with fibromyalgia syndrome are depressed. Not all patients with the disease are depressed, and similarly not all patients with depression have generalized pain. Fibromyalgia syndrome and depression may share some common features, including pain and fatigue, but they do not belong to the same category of disease. 10. How many patients have fibromyalgia syndrome? According to the epidemiological survey abroad, the incidence rate of adults is about 0.7%~3.3%, among which the incidence rate of females is about 1.0%~4.9% and the incidence rate of males is about 0.0%~1.6%. There is no exact epidemiological statistics in China. 11. Who is more likely to develop fibromyalgia syndrome? Fibromyalgia syndrome is more common in 20~70 years old people, preferred by women, the incidence ratio of women to men is 2~21:1, the prevalence rate increases with age, and the incidence rate is the highest when the patient is over 60 years old. 12. Is fibromyalgia syndrome related to climate? There is no substantial research to suggest that climate has an effect on the daily pain and fatigue status of patients with fibromyalgia syndrome. 13. Is there a risk of death associated with fibromyalgia syndrome? A study in the United States pointed out that the mortality rate of patients with fibromyalgia syndrome is not higher than that of osteoarthritis patients, but the suicide rate of such patients is higher than that of the general population. A Danish study came to a similar conclusion, and female patients had an increased risk of suicide. 14. Is fibromyalgia syndrome hereditary? Genetic factors play a role in the development of this disease. A survey on the family genealogy of fibromyalgia patients found that siblings of patients with fibromyalgia were 13.6 times more likely to have fibromyalgia than the normal population. 15. What is the etiology and pathogenesis of fibromyalgia syndrome? The exact etiology and pathogenesis of fibromyalgia syndrome are unknown. The etiology is related to genetic susceptibility, trauma, stress, infection, allergy, sleep disorders, overwork, malnutrition, etc. The pathogenesis is related to abnormalities of the central nervous system, neuroendocrine system and immune system. 16.What are the abnormalities in the physical examination of fibromyalgia syndrome? Symmetrical pressure points often exist widely in the patient’s body, mostly located in the head, lower back, abdomen, hips and thighs, especially in the muscles on both sides of the central axis of the neck, back and lumbar region, and the patient’s response is more sensitive at the pressure points. The corresponding physical examination for comorbidities is positive. Other than that, there are no other objective signs. 17. What laboratory tests can help diagnose fibromyalgia syndrome? There is no specific blood or imaging test to diagnose fibromyalgia syndrome, and blood sedimentation and C-reactive protein concentrations are usually not elevated in these patients. However, because the disease can exist in combination with other conditions, basic laboratory tests are needed to establish a diagnosis of fibromyalgia in a patient, as well as tests needed to make a differential diagnosis. Basic laboratory tests include complete blood count, biochemistry, sedimentation, C-reactive protein, muscle enzymes, calcium, thyroid stimulating hormone, and vitamin D levels. 18. How is fibromyalgia syndrome diagnosed? The 1990 ACR criteria include: (1) Generalized pain lasting more than 3 months, including pain in the left and right sides of the body, the upper and lower lumbar region, and the mid-axis (cervical or anterior thoracic or thoracic spine or lower back). (2) Pressure points: Pressure with the thumb at 4 kg/cm^2, with pain in at least 11 of the 18 pressure points. (i) Bilateral suboccipital muscle attachment in the posterior occipital region; (ii) Midpoint of the upper edge of bilateral trapezius muscle; (iii) Bilateral lower neck: anterior to the transverse processes of the C5-7 cervical vertebrae; (iv) Bilateral supraspinatus muscle at the beginning of the supraspinatus muscle, near the midline of the scapula; (v) Bilateral cartilage junction of the 2nd ribs with the 2nd ribs, located on the upper edge of the outer part of the junction; (vi) Bilateral lateral aspect of lateral epicondyle of the humerus, 2 cm distal to lateral epicondyle of humerus; (vii) Bilateral gluteus maximus muscle: anterior crease of gluteus muscle, at the outer upper limit of gluteus (7) Bilateral gluteal muscles: gluteal anterior crease at the upper limit of the gluteal region; (8) Bilateral greater trochanter: posterior to the trochanteric ridge; (9) Bilateral knees: proximal to the joint crease line of the fat pad in the middle. Fibromyalgia syndrome is diagnosed when both of these conditions are met and other rheumatic diseases are excluded. The 2010 revision of the ACR no longer requires a designated site of tenderness, but instead divides the body into 19 regions, with pain in at least 7 regions, and adds up the number of pains in different regions to form a generalized pain index, while other comorbidities are included to form a symptom severity score (including fatigue, sleep disorders, and cognitive deficits, etc.), which is a combination of the two scores. 19. Is there a method for determining the severity of fibromyalgia syndrome? There is no method for determining the severity of the disease. The German guidelines suggest that there is no particular functional or symptomatic difference between patients with mild and severe disease. However, there are differences in clinical presentation and disease severity, and the more physical pain and subjective discomfort, the more medications and physical and mental health comorbidities are required. The difference between mild and severe clinical manifestations includes the number of physical symptoms, the duration and degree of physical symptoms, whether they are combined with psychological symptoms, whether they affect daily work, whether they are under great psychological pressure, whether they cooperate with the treatment, and whether they understand their own disease (serious people often suspect that they have a serious disease). 20.What diseases should be distinguished from fibromyalgia syndrome? It is mainly differentiated from other diseases that cause chronic widespread pain; medical diseases: chronic inflammatory rheumatic diseases, chronic viral hepatitis B, inflammatory bowel disease, osteoporosis, hyper/hypoparathyroidism, vitamin D deficiency, etc.; neurological disorders: metabolic myelopathy, degenerative myelopathy, endocrine metabolic myelopathy, toxic myalgia, myalgia, myalgia, myalgia caused by diseases of central and peripheral system, myalgia, rare diseases causing myalgia, and myalgias caused by diseases of central and peripheral system. Neurological diseases: metabolic myopathy, degenerative myopathy, endocrine metabolic myopathy, toxic myalgia, myotonia, myalgia caused by central and peripheral system diseases, rare diseases causing myalgia, etc. 21. What is chronic fatigue syndrome? Chronic fatigue syndrome is characterized by intolerable fatigue lasting more than 6 months, accompanied by headache, sore throat, lymph node pain, arthralgia, muscle aches and pains, memory loss, and inability to regain energy after sleep, which may be related to viral infections. 22.What is rheumatic polymyalgia? Rheumatic polymyalgia is common in the elderly and is a clinical syndrome characterized by pain in the proximal muscles of the limbs and trunk. It is characterized by muscle pain and stiffness in the neck, scapula, upper arm, buttocks, and femur, mostly symmetrical. It responds well to small doses of hormones 23. Can fibromyalgia syndrome be cured? No, but non-pharmacologic and pharmacologic treatments can relieve symptoms and reduce the impact of the disease on life. 24. What are the non-pharmacologic treatments for fibromyalgia syndrome? Non-pharmacologic treatments can be physical or psychological. Physical treatments include regular aerobic exercise (20 minutes/day, 2-3 times/week), and bath therapy, while massage, electrotherapy, ultrasound therapy, and acupuncture may also be effective in the treatment of the disease. Psychological treatments: education may relieve tension and anxiety due to the unknown of the disease, while behavioral cognitive therapy may improve pain perception in patients. 25. What are the medications for fibromyalgia syndrome? Drugs for fibromyalgia include painkillers, opioids, antidepressants and antispasmodics. (1) Analgesics: There is limited clinical evidence for the use of paracetamol or NSAIDs in patients with fibromyalgia. (2) Opioids: the only opioid currently shown to be effective in the treatment of fibromyalgia is tramadol (or tramadol in combination with paracetamol). (3) Antidepressants; e.g. amitriptyline, duloxetine. Antidepressants are very effective in the treatment of fibromyalgia and are present in a greater role in the treatment of pain, fatigue and sleep disorders. (4) Antispasmodics: pregabalin, gabapentin can be effective in the treatment of fibromyalgia syndrome and improve pain, sleep disorders, and anxiety. 26.What are the side effects of painkillers applied to fibromyalgia syndrome? The most common is gastrointestinal reaction, there is also cardiovascular risk. COX-2 selective inhibitors (such as celecoxib) can reduce gastrointestinal side effects, but its impact on cardiovascular, renal function, cerebrovascular and so on is still unclear. 27. What are the side effects of opioid application in fibromyalgia syndrome? Constipation, nausea, dyspepsia, headache, euphoria, confusion, drowsiness, lethargy, urinary retention, addiction. 28. What is the prognosis for fibromyalgia syndrome? Fibromyalgia syndrome is a difficult disease to cure and there is no specific treatment. However, the disease does not cause limb dysfunction or life-threatening conditions, and the prognosis is good. Overall, the younger the patient, the better the prognosis, and children have a better prognosis and earlier recovery time than adults. 29. How should patients with fibromyalgia syndrome participate in treatment? First of all, patients should relieve their worries that this disease is not life-threatening and accept the reality, otherwise it will easily aggravate the symptoms. Relying on self-psychological adjustment, relaxing mood and doing some sports on weekdays can improve the bad psychological state and improve the symptoms; they should cultivate various interests and communicate with others, especially with doctors to exchange their conditions. 30. How should the relatives of the patients help the patients with fibromyalgia syndrome? The concern of relatives can help the patients to establish confidence and determination to overcome the disease, help the patients to actively participate in social activities, find out the changes of their mood in time, and urge the patients to seek medical treatment when they are not feeling well.