What do you know about fibromyalgia?

  The Department of Rheumatology often sees patients with recurrent peripheral pain for many years, with significant pain on muscle compression but no local joint signs, along with symptoms such as weakness, insomnia, pain, irritability and anxiety. These patients are often referred to multiple hospitals repeatedly, but no abnormal findings are found in all tests. For a long time, they are diagnosed as “neurosis” by their family members or doctors, or mistakenly thought to be “not sick”. In fact, this is often due to “fibromyalgia”, and it is necessary to pay attention to “fibromyalgia”.  Fibromyalgia (FMS) has always been a complex and controversial disease characterized by severe somatic discomfort and widespread pain, but lacking any easily identifiable biological abnormalities. The etiology is often multifaceted and is generally thought to be related to genetic susceptibility, trauma, viral infection, emotional injury, allergies, sleep disorders, prolonged poor body posture, overwork, and malnutrition.  The current clinical understanding of fibromyalgia is far from adequate. On the one hand, clinicians lack sufficient attention to this disease, and on the other hand, the disease lacks diagnostic criteria suitable for clinical operation. At present, we generally still use the diagnostic criteria established by the American College of Rheumatology in 1990 (of course, there are now new criteria of the American College of Rheumatology FMS 2010). The diagnosis is made when the patient has diffuse generalized muscle pain lasting more than 3 months and when palpation of the fingers reveals 11 and/or more of the 18 (9 pairs) specific pressure points (mainly symmetrically distributed on both sides of the trunk) with pressure pain, plus the patient has no other disease that could explain the pain. It should be noted that the onset of pain in these patients is often insidious and the symptoms are very individualized; the pain can be aggravated by activity and exercise and not relieved by rest; the pain is diffuse but difficult to localize; the pain is variable in nature and accompanied by stiffness; the fluctuations are closely related to cold, work and family stress, menstrual cycle, etc.; the pain is accompanied by significant fatigue, sleep disorders, depression and anxiety and other related conditions The pain is often accompanied by significant weakness, sleep disorders, depression and anxiety.  There are no specific medications available for the treatment of fibromyalgia. Once diagnosed, it is most important to provide comfort and explanation to the patient and to relieve the patient’s anxiety and depression. Optimal treatment requires a multidisciplinary approach, combining pharmacological and non-pharmacological treatments depending on the intensity of pain, function and related characteristics such as depression, fatigue and sleep disturbances. Conventional anti-inflammatory and analgesic drugs lack efficacy in this disease. Analgesics (chimantin), antidepressants (amitriptyline, Prozac, duloxetine, etc.), myorelaxants, sedative-hypnotics, and cognitive-behavioral therapy are considered effective for this disease.  Chinese medicine has potential advantages for the treatment of this disease, but it also requires long-term treatment and a combination of therapeutic interventions, such as herbal medicine, acupuncture, tui na, physical therapy, warmth therapy, aerobic exercise, tai chi, etc.  In conclusion, clinical attention needs to be drawn to fibromyalgia, and the main goal of treatment for this disease is to reduce symptoms, and treatment should emphasize multidisciplinary collaboration, appropriate patient education, encouragement of aerobic exercise, and selection of appropriate medications.