Myalgia is a group of common non-articular rheumatic pains characterized by pain, pressure and stiffness in the muscles, tendon attachments and adjacent soft tissues. The term myalgia is used to refer to muscle pain, whereas myositis is due to inflammation of muscle tissue, which is not precise enough for fibromyalgia, which lacks an inflammatory response. Fibromyalgia refers to pain in fibrotic tissues, muscles, tendons, ligaments and other areas. Any fibromuscular tissue can be involved, with occipital, cervical (cervical spasm), shoulder, thoracic (pectoralgia), lower back (low back pain), and femoral (thigh pain and quadriceps stiffness) being the most common. Etiology The lack of specific histological changes and inflammatory cellular response in this disease suggests that the older names of fibromyalgia “fibromyositis” or “fibromyositis” are more appropriate. The disease can be caused or aggravated by excessive physical work, stress, sleep deprivation, trauma, humidity, cold, etc. It is more common in women. Systemic diseases (usually rheumatic pain) can also occasionally trigger this disease. Viruses or other systemic infections (e.g., Lyme disease) can also trigger the disease in susceptible individuals. The disease can be systemic (sometimes secondary to other pathologies) or limited (e.g., myofascial pain syndrome is often associated with strain or minor trauma). Primary fibromyalgia syndrome (PFS) is a generalized idiopathic disorder that is particularly common in healthy young and middle-aged women with a tendency to stress, depression, apprehension, and struggle, but can also occur in children (especially girls) or older adults, often with mild vertebral osteoarthritic changes. Men are particularly prone to limited fibromyalgia due to specific occupational or recreational muscle strain. A few cases may be associated with psychological and physiological abnormalities. Symptoms can be exacerbated by environmental and mental stress, or by a physician’s inability to relieve the patient’s worries and simply dismissing them as “it’s all in your head”. Symptoms, signs and diagnosis In patients with primary fibromyalgia syndrome, the onset of muscle stiffness and pain is mostly gradual and diffuse, with a “sore” nature. In the limited form, the onset is often sudden and acute. The pain can be exacerbated by straining and overexertion. There may be pressure pain, which is often limited to a small area, the so-called “pressure point”. Local muscle spasm may be present, but is not always confirmed by electromyography. Inflammation is not a feature of the disease, but rather a manifestation of the primary systemic disease. The diagnosis of primary fibromyalgia syndrome is made by identifying the typical features of diffuse fibromyalgia with non-rheumatic symptoms (e.g., insomnia, anxiety, fatigue, intestinal allergy, etc.), excluding other systemic diseases (e.g., systemic osteoarthritis, RA, polymyositis, rheumatic polymyalgia, or other connective tissue diseases); and excluding psychogenic muscle pain and spasm (which is the most difficult). Fibromyalgia associated with the above diseases (coexisting or secondary) may have musculoskeletal signs and symptoms similar to primary fibromyalgia (with the exception of psychogenic rheumatism) and needs to be differentiated from it to facilitate better treatment of the underlying disease and fibromyalgia itself. In middle-aged female cases, underlying rheumatic disease and hypothyroidism must be excluded. Non-specific and mild histopathological changes may be present in the muscle, and these changes may also be seen in normal controls. Prognosis and treatment Mild fibromyalgia may resolve on its own with the release of tension, but it may often recur or become chronic. Reassuring the patient and explaining that the disease is benign, stretching exercises, aerobic fitness, improved sleep, local heat packs, and gentle massage can all help to reduce the condition. Small doses of tricyclic antidepressants (such as amitriptyline 10mg or the minimum effective tolerated dose) at bedtime can deepen sleep and have a moderating effect on pain. Aspirin 650 mg every 3-4 hours, or adequate doses of other non-steroidal anti-inflammatory drugs have been shown to be ineffective in clinical trials, but may be helpful in some individuals. Local injection of 1% lidocaine 1ml or 2ml alone or with 20-40mg hydrocortisone acetate suspension (see Soft Tissue Injections in the treatment of chronic lower back pain) can be used for pressure pain and weakness. If a drug has a drowsy effect, switch to another similar drug (in a small dose). Morning doses of 5-hydroxytryptamine-specific inhibitors (e.g., fluphenazole HCl 10 mg or 20 mg) can reduce depression and improve symptoms. Care must be taken to avoid aggravating sleep problems with medication, as this can cause insomnia. The functional prognosis is good with comprehensive supportive therapy, although symptoms can persist in varying degrees. Treatment of anxiety or depression requires a more aggressive and specific approach and patient support. In conclusion, the optimal treatment should be individualized, comprehensive and adaptable, and require direct patient involvement.