Fibromyalgia
Description:
Fibromyalgia - the form of defeat of extraarticular soft tissues which is characterized by diffuse musculoskeletal pain and existence of the specific painful points or points of hypersensitivity defined at palpation.
Women of middle age suffer from fibromyalgia preferential.
Fibromyalgia symptoms:
Characteristic of fibromyalgia is the abundance and a variety of complaints and subjective feelings of the patient at very scanty objective symptoms of a disease.
The main sign of fibromyalgia is a diffuse musculoskeletal pain. Pain is considered as diffuse if it is present at various anatomic sites of the right and left half of a body above and lower than a belt, and also - in a backbone projection. Pain is, as a rule, combined with feeling of morning constraint, feeling of hypostasis of extremities, bystry fatigue of muscles and feelings of "goosebumps" or prickings. Strengthening of the listed signs during the changing of weather, overfatigue, a stress is characteristic. According to diagnostic criteria of the American board of rheumatologists duration of fibromialgichesky symptoms has to exceed 3 months as emergence of diffuse muscular pains and fatigue can be caused by the postponed viral infection, a temporary sleep disorder and stressful situations.
Considerable psychological frustration in many respects define shows of fibromyalgia and bring closer this disease to a syndrome of chronic fatigue.
One of the most typical complaints is bystry fatigue which is noted by 87% of patients with fibromyalgia. The sleep disorder which is shown the complicated backfilling process, a discontinuous uneasy dream and lack of feeling of recovery after a dream is observed at 79% of patients. Frequent headaches as migraine are noted by more than a half of patients with fibromyalgia.
Emotional frustration which can vary from small decrease in mood to the expressed depression and an alarming and hypochondriac state are characteristic of patients with fibromyalgia. Along with psychological disturbances a number of frustration can be found in patients with fibromyalgia. These frustration include such manifestations as a syndrome of the angry gut, a premenstrual syndrome, primary dysmenorrhea, vestibular frustration, a syndrome of hyper mobility of joints, a syndrome of the angry bladder, a liquid delay syndrome, Reynaud's syndrome and a shegrenopodobny syndrome, a prolapse of the mitral valve, dysfunction of a temporal and mandibular joint, detection of a mesh livedo, etc.
The great value is attached to search of specific painful points which presence distinguishes fibromyalgia from other diseases which are followed by chronic musculoskeletal pain. When determining painful points by the most optimum it is necessary to consider manual pressure with the effort which is not exceeding 4 kg. The point is considered as positive if the examinee notes pain. According to criteria of the American board of rheumatologists existence 11 painful of 18 possible points is necessary for the diagnosis of fibromyalgia. Their localization in muscles of a shoulder girdle, a back, lumbosacral and a rump prevails.
The essential moment in diagnosis of fibromyalgia is a search of painful points. The exception of human factor requires repeated definition of number of painful points by various persons. Besides, definition of painful sensitivity in control points is obligatory (in frontal, over a head of a fibular bone).
Fibromyalgia reasons:
The valid reasons of FM are at the moment unknown.
Was considered earlier that FM is an inflammatory or psychiatric disease, but modern diagnostic methods allow to claim that no certificates of an inflammation or arthritis at FM are revealed, and the depression and concern is rather a result, than FM reasons.
There are some certificates that disturbance of a phase of a deep sleep as pathology of brain waves in a phase of a deep sleep was found in sick FM and low level of hormone of a somatropin is the reason of FM (this hormone is produced by a hypophysis in a phase of a deep sleep). Similar signs are observed at healthy people at deprivation of their dream within several days (H. Moldofsky and соавт.). Not all researchers support this theory.
At a number of patients of FM developed after a physical injury (especially neck injuries) or operations.
However by consideration of all known clinical symptoms quite obviously that FM — the complex problem, more difficult, than just muscular pain. Representation of a set of the clinical symptoms which do not have in the basis of morphological, biochemical and other disturbances allows to speak about FM as about somatoformny disturbance. The symptoms taking place at somatoformny frustration are not intended, that is the person does not feel and does not control their emergence.
At the present stage of studying of FM an attempt of integration of peripheral and central mechanisms into the uniform theory is made.
Fibromyalgia treatment:
Existence of the expressed psychological disturbances dictates need of inclusion of antidepressants in fibromyalgia treatment. Amitriptyline, Melipraminum in a dose of 10-25 mg of 1 times for the night are most often used. Course of treatment of 4-6 weeks. Fluoxetine is appointed on 20 mg of 1 times in the first half of day.
Broad application in treatment of fibromyalgia was found by non-steroidal anti-inflammatory drugs. Chronic ingestion of non-steroidal anti-inflammatory drugs is undesirable because of possible side effects. Recently preference is given to local therapy in the form of ointments, gels, and also local injections in a combination with anesthetics, in particular with lidocaine.
Inclusion of muscle relaxants of so-called local action is considered expedient: Baclofenum in a dose of 15-30 mg a day or дантролен in a dose of 25-75 mg a day promote decrease in a muscle tone, possess soothing action.
Messages on efficiency of antioxidants (ascorbic acid, alpha tocopherol) are provided in fibromyalgia treatment.
From not medicines of treatment various physiotherapeutic procedures, in particular, massage, a balneoterapiya, cryotherapy are widely used.
Much attention is paid to physical exercises, namely aerobics as to an effective way of elimination of chronic muscular pain and fatigue in recent years. The importance is attached also to methods of psychological rehabilitation of patients with fibromyalgia - psychotherapy and an autogenic training.
