Fibromyalgia syndrome (FM) is an idiopathic rheumatic disease characterized by diffuse muscle pain, often accompanied by a variety of nonspecific symptoms, such as fatigue, sleep disturbances, and cognitive dysfunction [1]. The prevalence of this disease is approximately 0.5% to 5% of the total global population [2]. The pathogenesis is unclear, and a growing body of data suggests that abnormal central pain processing plays an important role in the pathogenesis of this disease [3]. Jiao Juan, Department of Rheumatology and Immunology, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine
Rheumatologists in China often neglect this disease, and the degree of awareness of fibromyalgia syndrome is significantly lower than that of European, American and Southeast Asian countries. At the 16th Annual National Rheumatology Conference in 2011, a survey conducted by the People’s Hospital of Peking University on rheumatologists in China showed that only about 1/3 of physicians in China knew the diagnostic criteria of fibromyalgia syndrome, and the knowledge rate of other aspects such as treatment and pathogenesis was even lower, showing the need for physicians in China to understand fibromyalgia syndrome.
The lack of effective treatment for fibromyalgia syndrome and the frequent application of multiple drugs for symptomatic management leads to a superimposition of side effects.
The clinical manifestations of fibromyalgia syndrome are diverse and often present with multiple symptoms, including generalized muscle pain, fatigue, somatic stiffness, sleep disturbances, headaches, cognitive dysfunction, and depression and anxiety, which significantly reduce the quality of life of patients. The current treatment mainly focuses on symptom management, aiming at improving sleep status, reducing the sensitivity of nociceptive sensilla, and improving muscle blood flow. The drugs used include antidepressants, central skeletal muscle relaxants, analgesics, and sedative-hypnotic drugs, but the combination of multiple drugs leads to a significant increase in side effects and a significant decrease in safety.
Non-pharmacological therapy is currently recognized as an important treatment method, and traditional qigong has unparalleled advantages.
In recent years, non-pharmacological treatment for FM has gradually become more important to the majority of health care professionals. In the guidelines for the management of fibromyalgia syndrome developed by the European League Against Rheumatism in 2008, non-pharmacological therapies are affirmed, including hot baths, tailored exercise programs (e.g., aerobic and strength training), and relaxation, physical therapy, patient education, and psychological support [4]. Cognitive behavioral therapy and multidisciplinary integrative therapies have also been recommended by several fibromyalgia syndrome guidelines in recent years [5].
A randomized controlled trial published in the New England Journal in 2010 by Dr. Chenchen Wang and colleagues in the Department of Rheumatology at Tufts University Medical Center confirmed that practicing tai chi twice a week significantly improved clinical symptoms, as well as patient sleep status, overall physician and patient evaluations, and improved patient quality of life [6]. It caused a great sensation at the time and inspired the subsequent international trend of research on Tai Chi for fibromyalgia syndrome. However, Tai Chi movements are more numerous, more complex, and relatively difficult to learn, and international attempts are being made to simplify the 24-styles of Tai Chi into 8-styles [7].
Appendix: Diagnostic criteria of fibromyalgia syndrome
1. The classification criteria developed by the American Rheumatism Association in 1990, while meeting the following 2 conditions.
① generalized pain lasting more than 3 months: when pain occurs simultaneously in the left and right side of the body, the upper and lower part of the waist and the medial skeleton (cervical or anterior or thoracic spine or lower back), it is called generalized pain.
② pressure points: press with the thumb, the pressure is about 4kg, and at least 11 of the 18 pressure points are painful when pressed. 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 2 cm of the lateral epicondyle of the humerus; the junction of the 2nd rib and cartilage; the upper outer quadrant of the hip, the front crease of the gluteus muscle; the posterior aspect of the greater trochanter; the proximal side of the medial fat pad joint crease of the knee.
If the above two conditions are satisfied at the same time, fibromyalgia syndrome can be diagnosed.
2. The classification criteria developed by the American Rheumatism Association in 2010, satisfying the following 3 conditions at the same time.
①Prevalent pain index (WPI) ≥7 and symptom severity scale (SS) score ≥5 , or prevalent pain index (WPI) 3-6 and symptom severity scale (SS) score ≥9. ②Symptoms appear and are maintained at approximately equivalent levels for at least 3 months. (iii) No other illness that could explain the pain.
Prevailing pain index score (score between 0 and 19) with the number of pain sites in the past week as.
upper arm: □ left □ right; forearm: □ left □ right; upper limb with bone: □ left □ right
thigh: □ left □ right; calf: □ left □ right; hip (hip/rotor): □ left □ right; jaw: □ left □ right
Upper back: □; Lower back: □; Chest: □; Neck: □; Abdomen: □.
Symptom severity scale (rated between 0 and 12) for the severity of the following symptoms during the past week.
a. fatigue: 0=no problem; 1=mild or weak, usually weak or intermittent; 2=moderate, or equivalent, often present and/or at a moderate level; 3=severe, widespread, continuous, interfering with life
b. Waking state without recovery of mind: 0=no problem; 1=mild or weak, usually weak or intermittent; 2=moderate, or equivalent, often present and/or at a moderate level; 3=severe, pervasive, continuous, interfering with life.
c. cognitive symptoms: 0=no problem; 1=mild or weak, usually weak or intermittent; 2=moderate, or equivalent, often present and/or at a moderate level; 3=severe, widespread, continuous, interfering with life
d. Presence of overall somatic symptoms: 0=no symptoms, 1=very few symptoms, 2=moderate amount of symptoms, 3=many symptoms.
References.
1. Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of Arthritis Care Res (Hoboken).2010,62(5):600-10.
2. White KP, Harth M. Classification, epidemiology, and natural history of fibromyalgia. Curr Pain Headache Rep. 2001,5:320-9.
3. Abeles AM, Pillinger MH, Solitar BM, et al. Narrative review: the pathophysiology of fibromyalgia. Ann Intern Med. 2007,146(10):726-34.
4. Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence- based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008, 67(4):536-41.
5. Ablin J, Fitzcharles MA, Buskila D, et al. Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies.Evid Based Complement Alternat Med.2013,2013:485272.
6. Wang C, Schmid CH, Rones R, at el. A randomized trial of tai chi for fibromyalgia. N Engl J Med.2010,363(8):743-54.
7. Jones KD, Sherman CA, Mist SD, at el. A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients. clin Rheumatol. 2012,31:1205-14.