Fibromyalgia – a form of extra-articular soft tissue lesions, characterized by diffuse musculoskeletal pain and the presence of specific painful points or hypersensitivity points, determined during palpation. The disease predominantly affects middle-aged women. This condition greatly limits the possibilities of dialogue and full participation of a human in social life.
The signs of fibromyalgia
A characteristic feature of fibromyalgia is the abundance and variety of complaints and subjective sensations of the patient with very little objective evidence of the disease. The main symptom of fibromyalgia is a diffuse musculoskeletal pain. Pain is considered as diffuse if it is present in different anatomical areas of the right and left half of the body above and below the belt, as well as in the spinal projection.
The pain is usually combined with a feeling of morning stiffness, limb edema, fatigue and tingling of the skin. Characteristically, these signs are strengthening with the changing weather, fatigue, stress. According to the diagnostic criteria of the American College of Rheumatology, the duration of the symptoms should be more than 3 months since the widespread muscle pain and fatigue can be caused as well by a viral infection, temporary disturbance of sleep and stress management.
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Significant psychological distress mainly determined by the signs of fibromyalgia and brings this disease to chronic fatigue syndrome. One of the most common complaints is fatigue, confirmed by 87% of patients. Sleep disturbance, during which the process of falling asleep is hindered, the sleep is restless and there’s an intermittent lack of recovery after sleep, observed in 79% of patients. Frequent headaches like migraine are noted by more than half of patients with fibromyalgia.
Patients are usually characterized by emotional disorders, which may vary from a slight reduction in the mood to severe depression and anxiety and suspiciousness. Along with psychological disorders, patients with fibromyalgia can be detected by a variety of other disorders.
These disorders include such symptoms as irritable bowel syndrome, premenstrual syndrome, primary dysmenorrhea, vestibular disorders, joint hypermobility syndrome, irritable bladder syndrome, fluid retention syndrome, Raynaud syndrome, and migraines, mitral valve prolapse, temporom andibular disorder, detection of livedo.
Great importance is attached to the search for the specific tender points, which are distinguished by the presence of fibromyalgia from other diseases associated with chronic musculoskeletal pain. In determining the most appropriate tender points, you should consider finger pressure with a force of not more than 4 kg.
The point is counted as positive if the patient feels the pain. According to the criteria of the American College of Rheumatology, it is necessary to see the presence of 11 painful out of 18 possible spots in order to diagnose fibromyalgia. Mostly their localization is in the muscles of the shoulder girdle, back, lumbosacral and gluteal regions.
One of the essential points in diagnosing fibromyalgia is a search of tender points. To eliminate the factor of subjectivity, there must be a repeated determination of the number of tender points by different specialists. Also, it is necessary to determine the pain sensitivity in the control points (in the frontal, over the head of the fibula).
Treatment of fibromyalgia
NSAIDs are found to be widely used in the treatment of fibromyalgia. Long term ingestion of NSAIDs is not recommended because of the possible side effects. Recently, topical therapy became more preferred, especially in the form of ointments, gels, and injections of local anesthetics in combination with painkillers.
Much attention in recent years is given to physical exercises, such as aerobics as an effective way to eliminate chronic muscle pain and fatigue. Methods of psychological rehabilitation of patients with fibromyalgia – psychotherapy and autogenic training – also have great importance.