(Myofascial pain syndrome, fibrositis, fibromyositis)
Fibromyalgia is a common, non-joint-related disease of unknown origin, characterized by generalized pain (sometimes severe), extended tenderness of the muscles, the areas around the tendon attachment points of the surrounding soft tissue, muscle stiffness, fatigue and poor sleep. The diagnosis is made clinically. The therapy involves exercises, local heat, stress management, medication for sleep regulation and for pain relief.
In fibromyalgia each fibromuscular tissue can be affected, v. a. the neck, neck, shoulder girdle, chest, back and thighs. It found no specific histological abnormalities. Symptoms and complaints are generalized as opposed to localized soft tissue pain and tenderness (d. E., The myofascial pain syndrome, myofascial pain syndrome), which often are related to overstraining or microtrauma.
Fibromyalgia is a common, non-joint-related disease of unknown origin, characterized by generalized pain (sometimes severe), extended tenderness of the muscles, the areas around the tendon attachment points of the surrounding soft tissue, muscle stiffness, fatigue and poor sleep. The diagnosis is made clinically. The therapy involves exercises, local heat, stress management, medication for sleep regulation and for pain relief. In fibromyalgia each fibromuscular tissue can be affected, v. a. the neck, neck, shoulder girdle, chest, back and thighs. It found no specific histological abnormalities. Symptoms and complaints are generalized as opposed to localized soft tissue pain and tenderness (d. E., The myofascial pain syndrome, myofascial pain syndrome), which often are related to overstraining or microtrauma. Fibromyalgia is widespread, it is about 7 times more common in women, usually those younger or middle-aged, but it can also occur in men, children and adolescents. Because of the differences between the sexes it is sometimes overlooked in men. Occasionally occurs in patients with systemic rheumatic diseases. suggest current evidence that it is in fibromyalgia is a centrally mediated disruption of pain sensitivity. The cause is unknown, disturbances in REM sleep and physical and emotional stress can contribute. Patients can tend to be a perfectionist. A viral disease, a systemic infection (z. B. Lyme disease), or a traumatic experience may enhance the fibromyalgia. Symptoms and complaints stiffness and pain often begin gradually and diffuse and have a boring character. The symptoms can be caused by environmental factors or emotional stress, poor sleep, trauma or exposure to moisture or cold or by a doctor who suggests that the disease is “alone in the head” takes place, be strengthened. Patients tend to be stressed, tense, anxious, tired, ambitious and sometimes depressed. Many patients also have symptoms of irritable bowel syndrome, interstitial cystitis, migraine or tension headaches. The pain may be aggravated by fatigue, muscle strain or overuse. Specific discrete areas of muscle (so-called. Tender points) may be sensitive to pressure on palpation. Diagnosis Clinical criteria Conventional tests to rule out other diseases Suspicion of fibromyalgia, patients with the following symptoms: generalized pain and tenderness, especially in a proportion to the physical findings negative laboratory results despite the extensive symptoms fatigue as the predominant symptom following tests are useful to exclude : ESR or CRP, CK and occasionally tests for hypothyroidism and hepatitis C, which can cause fatigue and generalized pain. The diagnosis. Based on clinical criteria, including pressure sensitivity in some of the 18 localized pain points (tender points, s. Diagnosis of fibromyalgia). Most experts no longer need a certain number of pain points in order to make the diagnosis, as originally proposed (? 11 of 18). Patients who meet a few criteria, can still suffer from fibromyalgia. Diagnosis of fibromyalgia Diagnosis is based on the following criteria: pain caused by palpation of tender points: A certain number of tender points (? 11 from 18) is no longer required for diagnosis, but may give an indication of stubborn pain. The digital palpation should be carried out at a pressure of about 4 kg. A positive result requires that the palpation is painful. A medical history of generalized pain for at least 3 months: The pain is considered to be generalized, if the patient pain in the left and right half of the body, having above and below the waist and in the axial skeleton (HWS, front chest or thoracic or lower LWS). To avoid potential pitfalls, the physician should consider the following: Fibromyalgia is often overlooked in men, children and adolescents. Chronic fatigue syndrome (chronic fatigue syndrome) can also cause generalized muscular pain and fatigue, and the laboratory tests are usually normal. The polymyalgia rheumatica (polymyalgia rheumatica) can generalized myalgia, v. a. bring in the elderly, with itself; it can be distinguished because it affects the proximal muscles selectively and the ESR is increased. In patients with systemic rheumatic diseases, the diagnosis of coexisting fibromyalgia may be more difficult. For example, fibromyalgia can be misinterpreted as an exacerbation of RA or SLE. Tips and risks in patients with increased stiffness and pain is to think of fibromyalgia as well as to an exacerbation of known systemic rheumatic disease such as RA or SLE. The prognosis fibromyalgia tends to chronic occurrence, but it may subside spontaneously when the load decreases. It can recur at regular intervals. The functional prognosis is frequently low in patients who receive an understanding, supportive therapy, although the symptoms tend to a certain degree of persistence. Therapy stretching and aerobic exercises, local heat and massage Stress Management Tricyclic antidepressants or cyclobenzaprine to improve sleep non-opioid analgesics relief may be effected by stretching exercises, aerobic exercise, adequate sleep, local heat applications and careful massage. A general stress management (z. B. breathing exercises, meditation, psychological support, counseling, if necessary) is important. Exercises to gently stretch the muscles concerned should be done daily; the strain should be for about 30 seconds and held repeated about five times. Aerobic exercise (eg. As brisk walking, swimming and cycling) can also relieve the symptoms. An improvement of sleep is of particular importance. But drugs should only at night and only be taken to improve sleep. Low dose tricyclic antidepressants (eg. B. Amitriptyline Doxepin 10-50 mg or 10-25 mg), taken before bedtime, or the pharmacologically similar cyclobenzaprine (10-40 mg) support a deeper sleep and reduce muscle pain. It should use the lowest effective dose should be used. However, to ensure incompatibility of some or all of these substances dizziness, dry mouth and other side effects, especially in older patients. Non-opioid analgesics (eg. As tramadol, paracetamol, NSAIDs) some patients can help. Opioids should be avoided. Pregabalin, duloxetine and milnacipran are available for the treatment of fibromyalgia available but should only be a supplement to physical exercises, measures to improve sleep and stress management are used to relieve the pain. Occasionally, injections of 0.5% bupivacaine or 1% lidocaine are (1-5 ml) was used to treat debilitating herd of massive tenderness. However, such injections can not be considered as a primary treatment because the evidence does not support its regular use. to be taken by the patient medications should be reviewed to those that worsen the insomnia to identify. Such drugs should be avoided. Anxiety, depression and, above all, if any, bipolar disorder should be treated. Summary fibromyalgia-related stiffness and pain can be amplified or by a doctor who suggests that the disease is “alone in the head” consists of environmental influences or emotional stress, poor sleep, trauma or exposure to moisture or cold. A fibromyalgia may be assumed if generalized pain, tenderness and fatigue can not be explained or bear no relation to the physical and laboratory findings. BSG, or CRP, CK and tests for hypothyroidism and hepatitis C should be made. be considered in chronic fatigue syndrome and polymyalgia rheumatica need. In patients with significant exacerbation of systemic rheumatic diseases such as rheumatoid arthritis or SLE fibromyalgia is to be considered. Treatment consists primarily in physical processes in stress management, measures to improve sleep and when required for pain relief, the administration of non-opioid analgesics.