When middle-aged and elderly people have unexplained generalized pain, weakness, fatigue, and sleep disorders, do not think that it is due to poor exertion and rest, neurosis, menopause, etc., but need to be alert to fibromyalgia syndrome. Fibromyalgia syndrome is a chronic widespread soft tissue pain syndrome that manifests clinically as pain and stiffness in multiple areas of the musculoskeletal system with pressure points in specific areas. The pathogenesis of fibromyalgia syndrome is currently unknown and may be related to central sensitization, neuroendocrine abnormalities and autonomic nervous system abnormalities, and immune abnormalities.
Fibromyalgia syndrome is most often seen in women, with the most common age of onset being 30-50 years. The clinical manifestations are varied and include widespread pain throughout the body and widely present pressure points. Although some patients complain of only one or a few sites of pain, a quarter of patients have up to 24 or more sites of pain. The disease is widespread throughout the body, especially in the medial skeleton (neck, thoracic spine, and lower back) and in the 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. The pain is stabbing and distracting. There are widespread pressure points that are symmetrically distributed. When pressure is applied to these tenderness points, patients with fibromyalgia feel pain, while normal people feel only pressure. In addition to pain and pressure points, sleep disturbances, fatigue, and morning stiffness may also be present. Many people with fibromyalgia have sleep problems, including difficulty falling asleep or waking up frequently during the night. Studies have shown that some patients remain in a light sleep phase and never enter a deep sleep where they can get rest. About 90 percent of patients have sleep disturbances that manifest as insomnia, wakefulness, dreaminess, and lack of energy. 50-90 percent 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. In addition, patients may experience numbness and swelling. Patients often complain of joint and peri-articular swelling, but there are no objective signs. This is followed by headache and irritable bowel syndrome. Psychological abnormalities including depression and anxiety are also more common. In addition, the patient’s ability to work decreases, and about 1/3 of the patients need to change their jobs, and a small number of them cannot keep their daily work.
If you come to a hospital specialist promptly after developing the above symptoms and after ruling out other pain-causing diseases, you meet the criteria established by the American College of Rheumatology (ACR) in 1990 for diagnosing fibromyalgia (1. Prolonged widespread pain lasting three months or more. Widespread pain is defined as: affecting all four parts (quadrants) of the body – left, right, top and bottom. 2. Pressure points manifest in 18 areas of the body. These are located in the front and back of the neck, between the neck and chest, slightly below the back of the neck, at the knee, at the medial elbow, slightly above the hip (where the two sit bones are located), below the buttocks, and at the top bifurcation of the back of the thigh. There must be pressure pain at at least 11 points for fibromyalgia to be diagnosed. 4 kg of pressure is applied to the pressure points and the patient can feel the pain. Patients with fibromyalgia may feel pain elsewhere – however, for a diagnosis to be confirmed, pressure pain is limited to those 18 pressure points (at least 11)) for a diagnosis of fibromyalgia to be made.
In addition, in 2010, the American College of Rheumatology proposed new criteria for the diagnosis of fibromyalgia (see table below).
Table. 2010 American College of Rheumatology Fibromyalgia Diagnostic Criteria
Fibromyalgia diagnostic criteria are met if the following 3 conditions are met
1) Widespread pain index (WPI) ≥7 and symptom severity scale score (SSS) ≥5; or widespread pain index (WPI score) 3-6 and symptom severity scale score (SSS) ≥9
2) Symptoms present and maintained at approximately equivalent levels for at least 3 months
3) Exclusion of other diseases that could explain the pain
Confirmation methods
1.WPI (widespread pain index)
The number of painful sites in the patient’s past week. The score is between 0 and 19
Left upper extremity with bone, left hip (hip, rotor), left jaw, upper back
right upper extremity with bone, right hip (hip, rotor), right jaw, lower back
Left upper arm, left thigh, chest, neck
Right upper arm, right thigh, abdomen
Left forearm, left calf
Right forearm, right calf
2.Symptom Severity Scale (SSS)
The Symptom Severity Scale score is the sum of the severity of the 3 symptoms (fatigue, lack of mental recovery after waking, and cognitive symptoms) and general physical symptoms. The final score is between 0 and 12.
2.1 Somatic symptom severity
Fatigue
Not recovered after waking up
Cognitive symptoms
For any of the above symptoms, rate the severity of the past week using the following table: 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.
2.2 General somatic symptoms
Patients were scored according to the presence or absence of general somatic symptoms: 0=no symptoms, 1=very few symptoms, 2-moderate amount of symptoms, 3=many symptoms
*Possible somatic symptoms to consider: myalgia, irritable bowel syndrome, fatigue/tiredness, thinking or memory problems, muscle weakness, headache, abdominal pain/painful cramps, vertigo, insomnia, depression, constipation, epigastric pain, nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, pruritus, croup, Raynaud’s phenomenon, urticaria/clusters, tinnitus, vomiting, heartburn, mouth ulcers, no taste or altered taste, epilepsy, dry eyes, shortness of breath, lack of appetite, rash, photosensitivity, hearing impairment, bruising, hair loss, frequent urination, painful urination, bladder spasms.
Fibromyalgia is not a neurological disorder, not a psychological disorder, it is an organic disease, and after diagnosis, active treatment can improve the patient’s symptoms as well as quality of life. Fibromyalgia treatment begins with reassurance and explanation to the patient. Telling the patient that it is not a life-threatening disease and that it does not cause lifelong disability relieves the patient of anxiety and depression. Current treatment focuses on improving sleep status, decreasing the sensitivity of nociceptive receptors, and improving muscle blood flow. The efficacy of treatment is determined by the number of pressure points and changes in symptoms before and after treatment. The next treatment includes medication, aerobic exercise, massage, acupuncture, etc.
1.Medication: The goal of fibromyalgia treatment is to reduce pain, improve sleep disorders and adjust mood. These include Cymbalta (duloxetine hydrochloride), Lyrica (pregabalin) and Savella (milnacipran). Pregabalin was the first drug approved by the FDA for the treatment of fibromyalgia, and studies have shown that Lyrica can reduce pain and improve the daily life of some fibromyalgia patients.
2. Exercise: Exercise can relieve severe fibromyalgia symptoms. Physical activity can reduce pain and enhance comfort. Exercise only three times a week can reduce fatigue and depressive symptoms. Exercise should not be excessive. For people with fibromyalgia, exercise in the form of walking, stretching and water aerobics can be used. Studies have found that swimming and Tai Chi can reduce the symptoms of fibromyalgia patients, etc.
3. Dieting: Dieting is effective for fibromyalgia, but not for all patients. Specific foods (including MSG, coffee and tomatoes) seem to aggravate symptoms in some patients. However, avoiding these foods is not effective for everyone.
4. Massage: Some studies have shown that massage can help relieve fibromyalgia pain, although its effects have not been fully proven. The right amount of massage is crucial, while the massage technique is secondary. Massage, kneading or caressing are effective. The loved ones around you can learn massage, regular massage for patients, 20 minutes each time is enough to produce results.
5, acupuncture: formal research has found that acupuncture treatment has some effect on fibromyalgia and can relieve its symptoms.