Fibromyalgia - symptoms and causes in children and adults, methods of treatment and prevention. Fibromyalgia: Symptoms and Treatment How to Diagnose Fibromyalgia with its Symptoms and Treatment

Neurology”, 2010, No. 5, p. 6-12

Doctor of Medical Sciences, Professor, A.B. Danilov
Department of Nervous Diseases, FPPO, First Moscow State Medical University. THEM. Sechenov

Fibromyalgia is a disease characterized by chronic, diffuse pain accompanied by symptoms such as fatigue, sleep disturbances, cognitive impairment, and bouts of depression. Fibromyalgia is characterized by increased sensitivity and soreness in certain areas of the body. Women are more susceptible to this disease than men. Only about 10 years ago, the scientific basis for the pathogenesis of fibromyalgia and other idiopathic pain disorders was very arbitrary. However, over the past years, advances in imaging and genetics have led to significant advances in the understanding of fibromyalgia.

Story

Although the term fibromyalgia is relatively recent, the condition has long been described in the scientific literature. In 1904, William Gowers coined the term fibrositis. In the second half of the 20th century, some doctors believed that fibrositis was a typical cause of muscle pain, others believed that fibrositis was a consequence of "stress" or "psychogenic rheumatism", and the rheumatological community did not consider this pathology at all. The modern concept of fibromyalgia was created by Smythe and Moldofsky in the mid-1970s. They coined a new term, fibromyalgia. The ending -algia suggests that this condition is more due to pain than inflammation of the connective tissue (-itis). The authors identified the presence of local hypersensitivity - the so-called pain points (tender points), as a characteristic symptom of fibromyalgia. In addition, they found that patients with fibromyalgia often had sleep disturbances.

The next step in the study of the disease was the development of the American College of Rheumatology (ACR) diagnostic criteria for fibromyalgia, which were published in 1990. . According to this classification, the patient must have a history of chronic diffuse pain and more than 11 out of 18 possible tender points should be identified. Significant progress in the study of fibromyalgia was made after researchers came to the conclusion that this condition is not caused by damage or inflammation of peripheral tissues. Therefore, all efforts were directed to the study of the central mechanisms of pathogenesis. According to most experts, fibromyalgia is a multisymptomatic disease characterized by central disturbances in pain perception.

Etiology

Researchers have found that heredity plays an important role in the development of fibromyalgia. First-line relatives of patients with fibromyalgia are 8 times more likely to develop fibromyalgia than the general population. Twin studies have shown that approximately half of the risk of developing chronic diffuse pain is due to genetic factors, and the other half to environmental factors. As with most diseases that have a genetic basis, environmental factors play an important role in the "triggering" of fibromyalgia and comorbidities. Factors that provoke the development of fibromyalgia include physical trauma (especially trauma to the trunk), some infections (for example, hepatitis C, Epstein-Barr virus, parvovirus and tick-borne borreliosis), as well as emotional stress, etc. It is noteworthy that each of these factors leads to to the development of chronic diffuse pain or fibromyalgia in approximately 5-10% of cases.

In other words, these factors in themselves are not the trigger that includes the development of pathology in patients against the background of an infectious process or after injuries.

Possible factors triggering the development of fibromyalgia and associated pathology:

• peripheral pain syndromes;
• infections (parvovirus, Epstein-Barr virus, tick-borne borreliosis, Q fever);
• physical injury (for example, in a traffic accident);
• mental stress/distress;
• hormonal disorders (hypothyroidism);
• medicines;
• vaccines.

Pathogenesis and pathophysiology

The mechanisms responsible for the clinical manifestation of fibromyalgia and related disorders are likely to be highly complex and multifactorial. An essential role is played by the factor of chronic emotional stress. Studies of the relationship between stress and the development of fibromyalgia reveal changes in the hypothalamic-pituitary-adrenal system and the autonomic nervous system. Fibromyalgia research over the past two decades has provided a better understanding of the pathophysiology of pain and perception processes - they have shown that pain threshold depends on the degree of distress. Many psychological factors such as hypervigilance, suspiciousness, catastrophization, and external locus of pain control may play an important role in the severity of fibromyalgia symptoms. Special studies have shown that patients with fibromyalgia have reduced serotonergic and noradrenergic activity. It was also found that in patients with fibromyalgia there is a decrease in the level of serum serotonin and its precursor L-tryptophan and a decrease in the main metabolite of serotonin in the CSF (5-hydroxyindole acetate). Supporting this finding is the fact that drugs that increase serotonin and norepinephrine levels (tricyclic antidepressants, duloxetine, milnacipram, and tramadol) are simultaneously effective in treating fibromyalgia. Neurobiological evidence that fibromyalgia is a condition with increased pain sensitivity and disturbances in perceptual processes is supported by the results of instrumental diagnostic methods: single photon emission computed tomography and functional magnetic resonance imaging. Although sleep disturbances are quite common in patients with fibromyalgia, they rarely correlate with other symptoms of fibromyalgia. Many clinicians have found that identifying and treating specific sleep disorders (eg, obstructive sleep apnea, increased upper airway resistance, or impaired limb movement during sleep) will not necessarily improve the underlying symptoms of fibromyalgia.

Behavioral and psychological factors play a role in the development of the clinical picture of fibromyalgia. It has been established that the prevalence of psychiatric comorbidities in patients with fibromyalgia can reach 30-60%, and the frequency of mental disorders is even higher. Depression and anxiety disorders are the most common conditions.

Clinical picture and diagnosis

Some doctors consider the diagnosis of fibromyalgia highly controversial and controversial. Others see no problem in making a diagnosis. Controversy in the diagnosis of fibromyalgia arises from the lack of a well-defined pathology. Fibromyalgia is classified as a functional disorder, which implies the absence of organic pathology. There are no specific diagnostic laboratory tests, radiological or other criteria for this pathology. The only symptom that a doctor can detect is increased sensitivity or tenderness of soft tissues during palpation.

In 1990, the American College of Rheumatology developed guidelines for the diagnosis of fibromyalgia - ACR criteria (Table 1). Although these criteria are not intended to be used in a clinical setting, but only in research settings, they nonetheless provide greater than 85% accuracy in differentiating patients with fibromyalgia from similar conditions.

Table 1. Diagnostic criteria and clinical characteristics of fibromyalgia (American College of Rheumatology, 1990)

The main symptom of fibromyalgia is chronic diffuse pain, not caused by any pathology of the musculoskeletal system, which bothers the patient for at least 3 months. The pain is diffuse in nature, spreading throughout the body above and below the waist. Usually patients describe their condition as "I feel like I have pain everywhere" or "I feel like I have a cold all the time." Patients usually describe pain that radiates throughout the muscles, but sometimes pain and swelling in the joints is also noted. In addition, patients often complain of paresthesia, numbness, tingling, burning, crawling sensation on the skin, especially in the legs and arms. In patients with fibromyalgia, physical examination reveals only increased sensitivity or tenderness in certain areas of the body. The study of painful points requires experience. The doctor must know exactly where to palpate and with what force. According to the AKP criteria, 9 pairs of tender points were identified (see figure).

Rice. 1. Study of painful points (tender points)

The pressure applied at these points should be 4 kg/cm2 (the pressure at which the examiner's nail beds turn white). When performing palpation of 18 painful points, it is recommended to apply uniform pressure on paired points and palpate other parts of the body with the same effort to compare sensitivity. In patients with fibromyalgia, there is increased sensitivity in painful points compared to other parts of the body. In addition, it is necessary to conduct an examination of the joints, exclude the presence of synovitis and determine the sensitivity of the supra-articular areas. Painful points reflect areas of increased sensitivity to painful stimuli, and are not the result of local inflammation or tissue damage. The presence of a positive reaction in more than 11 out of 18 tender points was determined as a diagnostic criterion based on the analysis of statistical data from large patient populations. However, not all patients with fibromyalgia will have hypersensitivity at more than 11 points. Again, the AKP criteria for fibromyalgia are intended for research purposes and not for diagnosing specific patients. Nevertheless, examination of painful points is considered an important part of the study of the functioning of the musculoskeletal system in patients with generalized pain syndrome. Palpation of soft tissues and joints reveals areas of hypersensitivity. This examination excludes synovitis or myositis and is very important in the diagnosis of fibromyalgia. As can be seen from the ACR criteria, fibromyalgia is not only a pain syndrome. This condition includes a whole range of disturbing symptoms for the patient. Along with chronic diffuse pain, another typical symptom of fibromyalgia is increased fatigue. This symptom is most pronounced on waking, but occurs in the afternoon. Minor physical activity can drastically increase pain and fatigue, although prolonged rest and inactivity can also exacerbate symptoms. Since diffuse pain and fatigue can occur during the initial stages of influenza, colds, or overexertion, it should be noted that these symptoms must last more than 3 months to be diagnosed with fibromyalgia.

Patients with fibromyalgia in the morning feel stiff in the body and feel sleepy, even if they slept 8-10 hours. Such patients usually do not sleep soundly, often wake up and have difficulty falling asleep. Patients typically say, "It doesn't matter how much sleep I have, but I feel like I've been run over by a truck." In addition, most patients have cognitive impairment and mood pathology. Most often, they describe their problems with concentration as "fog in the head." Negatively affects the patient's well-being and many other clinical symptoms: headache (in more than 50% of cases), dizziness, muscle spasms, tinnitus, leg cramps, restless legs syndrome, Raynaud's disease, pain in the chest, lower back and jaw. As a result of the described disorders in patients, as a rule, the quality of life decreases.

Non-drug treatment

A specially conducted analysis of various non-drug methods of treating fibromyalgia showed that two methods have significant effectiveness - cognitive behavioral therapy and physical education (table 2). Against the background of both methods of treatment, there was a persistent improvement in the symptoms of fibromyalgia for 1 year or more.

Table 2. Non-pharmacological treatments for fibromyalgia

Medical treatment

Antidepressants. Tricyclic antidepressants (TCAs) were among the first drugs to treat pain in fibromyalgia. It has been shown that amitriptyline is able to relieve pain intensity, improve sleep and reduce fatigue in patients with fibromyalgia. At the same time, antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs) (fluoxetine, sertraline, citalopram, paroxetine) showed low efficacy in randomized, placebo-controlled trials.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) (venlafaxine, duloxetine, milnacipran) were found to be more effective than SSRIs. These drugs, like TCAs, inhibit the reuptake of serotonin and norepinephrine, but unlike TCAs, they practically do not affect other receptors. This selectivity results in fewer side effects and better tolerability. Data on venlafaxine indicate its successful use in the treatment of neuropathic pain and fibromyalgia.

In studies using duloxetine, there was a more pronounced decrease in the total score on the fibromyalgia severity scale (FIQ) and a 30% reduction in pain in 54% of those taking the drug compared to 33% of the placebo group. The most common adverse events were: nausea (29.3%), headache (20.0%), dry mouth (18.2%), insomnia (14.5%), fatigue (13.5%), constipation (14.5%), diarrhea (11.6%) and dizziness (11.0%). Duloxetine is FDA approved as an SNRI for the treatment of major depressive disorder, neuropathic pain in diabetes mellitus, and fibromyalgia.

Milnacipran, which is widely used as an antidepressant, is also FDA approved for the treatment of fibromyalgia. In a 12-week randomized clinical trial, 125 patients with fibromyalgia received either milnacipran once or twice daily (at doses up to 200 mg/day) or placebo (10). A 50% reduction in pain was achieved in 37% of patients with fibromyalgia on the background of a double dose, in 22% on the background of a single dose, and in 14% in the placebo group. Only milnacipran twice daily showed a statistical advantage over placebo. Only minor side effects have been reported. In a 27-week study of the use of milnacipran in 888 patients with fibromyalgia, 56% of the pain intensity decreased by at least 30%, while in the placebo group there were 40% of such cases. Side effects were usually mild, with nausea and headache being the most common.

Despite the fact that many chronic pain syndromes, including fibromyalgia, are accompanied by depression, some studies have shown that the analgesic activity of antidepressants does not depend on their effect on the emotional status of patients. A recent meta-analysis of 18 RCTs confirmed that antidepressants can reduce fibromyalgia pain, reduce depression, reduce fatigue, restore sleep, and improve quality of life. Anticonvulsants. Pregabalin, an a2-a calcium channel ligand, is approved for the treatment of neuropathic pain and was the first drug approved by the FDA for the treatment of fibromyalgia.

Pregabalin (Lyric) is the first and so far the only drug in Russia officially registered for the treatment of fibromyalgia. Pregabalin binds to the α2-σ region of voltage-gated calcium channels in the CNS. Due to a decrease in the influx of calcium into neurons, the release of substance P, glutamate and norepinephrine decreases, providing analgesic and anxiolytic (anti-anxiety) effects of pregabalin. The activity of this drug is limited to neurons and does not affect vascular calcium channels. In a large RCT in 528 patients with fibromyalgia, Pregabalin showed a significant reduction in pain score, improved sleep quality, decreased fatigue, and improved overall well-being. Study participants received a placebo or one of the doses of pregabalin (150, 300, or 450 mg/day) for 8 weeks. All patients treated with the drug showed improvement within 2 weeks, which persisted until the end of the study. Treatment with Pregabalin resulted in a moderate but statistically significant reduction in pain in a dose-dependent manner, improved sleep, and reduced fatigue. Adverse events were quite common, but were mild and short-lived: dizziness (49%), drowsiness (28%), dry mouth (13%), peripheral edema (11%) and weight gain (7%). A follow-up 6-month placebo-controlled study included 566 patients with fibromyalgia who completed a 6-week open-label study and responded to treatment (responders). Pregabalin was monotherapy at doses of 300, 450, or 600 mg/day (2 times a day). The primary objective of this study was to evaluate the duration of effect of pregabalin therapy versus placebo in the treatment of fibromyalgia pain in patients responding to pregabalin. In addition, the effectiveness of pregabalin compared with placebo was assessed in terms of analgesic effect, general well-being of patients, treatment of sleep disorders, fatigue and safety. As a result, it is shown that the response to treatment with Pregabalin is extended in time. The time to decline in therapeutic response was significantly shorter in placebo-treated subjects than in those treated with pregabalin. At doses of 300, 450, and 600 mg/day, pregabalin was superior to placebo in terms of time to loss of response to treatment. Pregabalin with long-term therapy led to a later deterioration in parameters such as sleep disturbance, fatigue and general well-being of the patient.

Two other large randomized clinical trials, where treatment lasted 13-14 weeks, showed that pregabalin monotherapy was effective in reducing the intensity of pain in fibromyalgia at dosages of 300, 450 and 600 mg / day. The effect came quickly and persisted with continued treatment. In addition, Pregabalin therapy resulted in a significant and consistent improvement in patient self-report scores across all doses in both studies, and in one study a significant reduction in fibromyalgia severity at 450 and 600 mg/day. An improvement in the qualitative and quantitative characteristics of sleep was noted. Finally, the efficacy of Pregabalin in the treatment of fibromyalgia was evaluated in a meta-analysis of 6 RCTs of more than 2000 patients with fibromyalgia. This analysis showed that pregabalin reduced fibromyalgia pain, improved sleep and quality of life, but had no effect on the severity of depressed mood. In addition, patients treated with Pregabalin experienced a reduction in fatigue and anxiety.

Gabapentin, whose pharmacological properties are similar to Pregabalin, was used in a 12-week randomized clinical trial in 150 patients with fibromyalgia. In the Gabapentin group, there was a significant decrease in the mean pain intensity score than in the placebo group. In addition, Gabapentin significantly improved scores on the Fibromyalgia Severity Scale (FIQ), the Patient Self-Assessment Scale (PGIC), and the Sleep Quality Scale. Compared with placebo, Gabapentin resulted in a significant increase in the incidence of sedation, lightheadedness, and dizziness.

Muscle relaxants. Currently, doctors use muscle relaxants (cyclobenzaprine, tizanidine) in the treatment of fibromyalgia, despite the lack of results from relevant clinical studies. The drug Tizanidin is registered by the FDA as a muscle relaxant for the relief of spasticity in multiple sclerosis and cerebrovascular accidents. It belongs to the group of a2-adrenergic receptor agonists. A study of Tizanidin in fibromyalgia (4-24 mg/day) showed a decrease in the concentration of neuroamines and substance P in the cerebrospinal fluid. Tramadol is a centrally acting analgesic that binds to μ-opioid receptors and inhibits the reuptake of norepinephrine and serotonin. The combination of paracetamol (acetaminophen) with tramadol in a ratio of 8:1 showed synergy of both drugs in preclinical pain models. In a 13-week, multicenter, randomized clinical trial, tramadol/paracetamol at doses of 37.5 mg/325 mg relieved fibromyalgia pain more effectively than placebo. All adverse events reported in this study (transient and non-serious adverse events) were well-known complications of tramadol: dizziness/vertigo, nausea, vomiting, constipation, drowsiness, headache and weakness.

Benzodiazepines. The effectiveness of benzodiazepines in the treatment of fibromyalgia is not fully understood. Many studies have produced conflicting results. For example, benzodiazepines, including alprazolam (0.5–3.0 mg at bedtime), have not been shown to be superior to placebo for the treatment of fibromyalgia pain, but clonazepam has been shown to be effective in managing temporomandibular joint pain, which is often seen in fibromyalgia. In addition, this drug was quite effective in relieving restless legs syndrome, which is a common cause of restless and interrupted sleep in patients with fibromyalgia.

local anesthetics. Systemic use of lidocaine has been used to treat patients with fibromyalgia: single and course infusions of lidocaine at doses of 5-7 mg/kg led to a fairly noticeable reduction in pain in patients with fibromyalgia. In a recent randomized clinical trial in patients with fibromyalgia, lidocaine 50 mg was injected into a painful point in the trapezius muscle. As a result, not only a local reduction in pain at the injection site was noticed, but also a general analgesic effect. This study showed the important role of peripheral tissues in the development of hyperalgesia in fibromyalgia and proved the clinical application of local anesthetic injections for pain relief in fibromyalgia.

Conclusion

Thus, today there are four main directions in the treatment of fibromyalgia (table 3):

1. reduction of peripheral pain, in particular muscle pain;
2. prevention of central sensitization;
3. normalization of sleep disorders;
4. treatment of comorbidities, in particular depression.

The first approach is more focused on relieving acute pain in fibromyalgia and includes the use of physical therapy, muscle relaxants, muscle injections and analgesics. Central sensitization is successfully treated with cognitive behavioral therapy, sleep correction, antidepressants, and anticonvulsants. Sleep disturbances are corrected by stress reduction, aerobic exercise, and GABA agonists. Drug and behavioral therapies for secondary pain affect (anxiety, depression, fear) are among the most promising treatment strategies for fibromyalgia. Although any combination of these approaches can be very beneficial for patients with fibromyalgia, only comparative studies can provide reliable data on the effectiveness of one or another treatment method.

Fibromyalgia symptoms and treatment is a mystery behind seven seals. How much science is struggling with this problem - there is no complete answer to the question of what fibromyalgia is, where it comes from.

• Constant fatigue, constant sleep problems, debilitating pain in the joints, tendons and muscles?
• It could be fibromyalgia. Even though one in 10 people may suffer from it, it is still rarely diagnosed and treated.

Things to know about it:

• It has only recently been recognized as a distinct illness, but some doctors still consider it to be a depression with severe, prominent symptoms.
• Sufferers experience constant pain, sometimes for many years, because the manifestations of the excruciating disease are so incomprehensible that doctors find it difficult to make a correct diagnosis.

Pain that won't go away:

• On earth suffering from manifestations of the disease from 2-10 percent. population. This usually happens between the ages of 30 and 50.
• According to statistics, women suffer three to four times more often than men. Sometimes fibromyalgia "causes" a physical injury or infection. But most people just feel pain at some point.
• Chronic, muscular pain of the whole body is accompanied by a number of pain points, that is, places on the body with excessive sensitivity to pressure.
• The pain may be aching, deep, throbbing, rarely superficial, or has the character of numbness or tingling. It intensifies in the morning and when performing monotonous actions.

• People complain that "". Such pain, called by generalized physicians, includes the upper and lower, right and, by analogy, left sides of the body. They also suffer from axial pain which they feel in the spine.
• Often the pain is similar to the symptoms found in rheumatic diseases, including periarticular tissues, tendons, muscles and ligaments.
• Patients feel burning, muscle twitching. They often also describe muscle stiffness, especially in the morning, and joint swelling. About 30 percent complain of worsening cold tolerance.
• The pain is exacerbated by: infections, injuries, fatigue, stress, cold, dampness, and changes in the weather. Also with intense physical effort and ... rest. Sometimes the more you rest, the worse the pain.

Constant fatigue from illness:

• In the pain package, sufferers also experience a sense of chronic, permanent sleep disturbance (superficial with frequent awakenings).
• Even after 8-10 hours of sleep, they did not rest at all. There are memory impairments, problems with concentration, anxiety, depressed mood, lack of energy and a gradual deterioration in well-being.
• Perhaps the legs and scalp, trembling hands, dizziness, blurry, unclear vision, including coordination.
• Symptoms that are often considered by doctors as signals of neurosis: faster breathing, manifestation of shortness of breath or rapid heartbeat, a very real feeling that something in the throat is in the way. Where does all this come from? Medicine is still looking for answers.
• Fibromyalgia is a functional pain disorder. Everything is connected with his anomalous sensation, but its cause is not entirely clear.
• It is not a disorder of the musculoskeletal system or the nervous system itself. Not caused by inflammatory and autoimmune changes.
• Most likely, the pain is caused by impaired processing of stimuli at the level of failure of the central nervous system.

The ordeal of the sick:

• When “everything hurts”, doctors often find it difficult to make a diagnosis.
• Patients usually go to various specialists - a neurologist, an orthopedist, a general practitioner, a rheumatologist.
• Doctors simply helplessly, shyly shrug their shoulders, simply excluding diseases from "their" specialization.
• Because of the varying and less characteristic symptoms, the patient is often treated as a symptom of a tantrum.
• As a result, the diagnosis is not established, only early detection of fibromyalgia guarantees effective treatment.

How to diagnose fibromyalgia with its symptoms and treatment:

1. Fibromyalgia can be diagnosed if there are two factors: persistence of diffuse, recurrent pain for at least three months and detection of palpable tenderness at least at many points on examination.
2. These points are well known to neuropathologists. Often the diagnosis itself relieves the symptoms of the disease.
3. Most often, due to the long search for a diagnosis, people are afraid that they are suffering from a serious and unknown disease.
4. The relief can be explained by a sick person with a characteristic disease, it reduces anxiety, which exacerbates pain attacks.
5. In treatment, the greatest emphasis is placed on the fight against diseases and.
6. The diagnosis of fibromyalgia helps to diagnose tender points located around the neck, sternum, elbows, knees, lower back, hips. However, this study does not guarantee that the patient is suffering from this disease.

1. The suspicion of fibromyalgia is not supported by any other single study, so the diagnosis is based on the exclusion of other diseases that can also cause similar symptoms.
2. It should be excluded: RA (diagnosis of rheumatoid arthritis), possibly systemic lupus erythematosus, viral hepatitis or Lyme disease,.
3. If the patient has problems with the heart, it is necessary to consult a cardiologist, if the intestines - a gastrologist
4. Antidepressants, various antiepileptic drugs are used to restore normal functioning after a failure of the nervous system.
5. Often used are those that have an analgesic effect at maximum doses. Pain relievers such as paracetamol may also help.
6. Other anti-inflammatory drugs (nonsteroidal), steroidal or strong opioids are not effective
7. When you feel pain for several months or even years, it is not easy to maintain your vitality, interest in life.
8. However, it is worth working on it, because peace of mind is one thing that people with fibromyalgia can do to ease their suffering.

Fibromyalgia symptoms and treatment at home:

• Sometimes you need to check if there is depression masquerading as fibromyalgia. It affects not only the mental state of the patient, but also causes many somatic complaints. Unfortunately, there is no cure for fibromyalgia.
• This disease can only be treated by relieving the symptoms in an attempt to alleviate certain diseases.
• The most common are painkillers (not anti-inflammatory, because the disease is not inflammatory), such as, for example, paracetamol or tramadol.
• By reducing muscle tone and antidepressant. The latter can help even if the patient does not have typical symptoms.
• Studies confirm that one of the features of this disease is a pronounced decrease in the production of serotonin. Our mood, interest in life depends on it.
• Pharmacological treatment is only part of the treatment of fibromyalgia. Rehabilitation, work on emotions and the ability to cope with stress are also important. Psychotherapy, relaxation training, and mindfulness training can be helped by specialists.

Fibromyalgia and lifestyle:

• In relieving sleep problems, you should try to go to bed and get up at the usual time.
• Avoid exercise and heavy meals a few hours before bed. Late in the evening, refrain from using your smartphone, laptop and TV.

• Any physical activity is very important. Low or moderate intensity exercise increases the production of endorphins (the so-called happiness hormones), which have an analgesic effect.
• Doctors advise light workouts because fatigue causes increased secretion of cortisol, or the stress hormone. Recreational swimming is recommended for fibromyalgia, cycling, jogging, team games or fitness.
• A sauna is useful after a workout - it relaxes tense or clamped muscles.
• may be useful for reducing pain, fatigue. It is not clear why this is happening. Vitamin D is produced by exposure to the sun.
• Therefore, it is recommended to stay outside on sunny days. With significant vitamin D deficiencies and in the autumn-winter months, it is recommended to add them in a dosage form.
• Fibromyalgia is a mysterious, chronic rheumatic disease. Many other conditions must be ruled out before it can be diagnosed.
• In addition to pharmacology, various forms of therapy are used. It is advisable to learn methods of dealing with stress and low mood.
• This is called behavioral - cognitive therapy, the study of relaxation techniques, acupuncture, tai - chi, relaxing massage is good.

• People who believe that changing their lives can free them from pain are giving themselves a chance to be free from suffering.

Help yourself:

• These are the recommendations of doctors to carry out regular exercises (cycling, swimming, walking, balneotherapy) - all with low intensity and as long as it gives pleasure, but not pain and fatigue.
• Eating plenty of vegetables, a variety of fruits, good protein (meat, fish), greens, whole grains should be the number one rule. More magnesium in food, it relaxes muscles.
• From herbs you can drink thyme, it makes the intestines work well, removes pain and bloating. You can also prepare a bath from it - lie down in the evening for about 20 minutes.
• Compresses with apple cider vinegar on sore spots will help well. You just need to wet the cloth and apply.
• The tincture of calendula pharmacy works similarly. We also moisten a napkin and apply it to sore points.
• Willow bark will make the blood become thinner, more fun to run through the vessels. It contains aspirin - it will help ease the pain.
• Drink St. John's wort - a natural antidepressant. When treating with St. John's wort, other antidepressants are prohibited.
• The success of treatment largely depends on the correct, modified lifestyle.
• It is recommended to avoid the stresses in life associated with work or family responsibilities. Sometimes you will have to take a vacation, maybe change jobs, or get away from other stressful situations.

A very serious topic is fibromyalgia symptoms and treatment, which requires constant adherence to certain rules in life. Thank God - the diagnosis is not fatal. We are used to the challenges of life.

I wish you health, my dears.

Run to the fire.

Almost every person experienced muscle pain that was not associated with stress or injury: it pulled there, then it entered here. Such muscle pain is called myalgia. The most common type is fibromyalgia. With fibromyalgia, it sometimes feels like literally “everything” hurts.

Symptoms

Fibromyalgia is a symmetrical musculoskeletal pain that is chronic. The name comes from the Latin word fibro - "fiber" and the Greek myo - "muscle", algos - "pain".

Patients with fibromyalgia, in addition to suffering from chronic, predominantly symmetrical pain throughout the body, often suffer from depression, sleep problems and complain of chronic fatigue. Pain can occur spontaneously, or it can be caused by pressing on certain pain points on the body.

Patients with this disease may also complain of numbness and tingling in the hands and feet, a crawling sensation. There may be pain in the joints. A third of patients have a syndrome of "restless legs" - an irresistible desire to move their legs at rest. Patients say that they do not rest during the night, they feel constantly cold, "the whole body hurts."

Of course, all these manifestations of the disease interfere with enjoying life and lead to a noticeable decrease in performance. At work and in family life, problems arise due to constant fatigue and bad mood.

Risk factors and possible causes

The most commonly reported risk factors for developing the disease are: Gender: Women are known to be 10 times more likely to develop fibromyalgia. Age: This disease usually affects people of working age from 20 to 60 years old, with a peak at 35 years old. There is evidence of an increase in the frequency of fibromyalgia in middle-aged women, as well as during menopause. Heredity: If one of your blood relatives suffers from fibromyalgia, then you are 8 times more likely to develop the disease than the average.

There are no exact data on the causes of the disease. It is believed that various infections (for example, the Epstein-Barr virus, borreliosis), hormonal disorders (decrease in thyroid function), vaccination, as well as mental trauma (for example, a stressful situation at work) and physical injuries (for example, after a traffic accident) can trigger the disease. traffic accident).

Difficulties in diagnosis

Usually the diagnosis is not established immediately. Unfortunately, if you have the above complaints, then even after consulting a neurologist, rheumatologist and psychiatrist, it is not always possible to immediately establish the correct diagnosis and receive adequate treatment.

The thing is that pain in the back and limbs can be a manifestation of a disease of the spine, and pain in the joints - osteoarthritis. Depression and sleep disturbances can be caused by a million other causes besides fibromyalgia, etc. Essentially, fibromyalgia is a diagnosis of exclusion. It is necessary to exclude many neurological, rheumatological and other diseases in order to confidently make a diagnosis of fibromyalgia.

Usually, the diagnosis is still made by rheumatologists, less often by neurologists. However, any doctor who examines a patient with the above complaints and symptoms can suspect fibromyalgia. It is extremely important that the doctor during the examination pays attention to the whole complex of complaints, as well as to the results of examinations that do not explain all these complaints and symptoms.

If fibromyalgia is suspected, the doctor will test for tenderness when pressed at certain points on the body. More than 11 points (a total of 18 points are examined) with fibromyalgia will be painful. Next, the patient will be offered a simple questionnaire (pain index and symptom severity scale), which will help determine the diagnosis. The diagnosis is established definitively if the pain and other symptoms last more than 3 months and there is no other disease that can cause them.

Treatment

An integrated approach is important in the treatment of fibromyalgia. Particular attention is paid to the psychological state of the patient (for example, depression and anxiety). Of the non-drug methods, behavioral therapy and various types of physical exercises are successfully used. Unfortunately, we often have to resort to medicinal methods. Antidepressants (amitriptyline, duloxetine, milnacipram), anticonvulsants (pregabalin), muscle relaxants (cyclobenzaprine), and tramadol have proven efficacy.

Fibromyalgia is a difficult diagnosis not only for the patient, but also for the doctor. However, despite the severity of the symptoms, this disease does not pose a direct threat to life. Modern non-drug and drug treatments will help to cope with this disease and return you to a normal life.

Be healthy!

Maria Meshcherina

Photo istockphoto.com

Fibromyalgia is a syndrome (set of symptoms) that causes muscle pain and general fatigue.

People with fibromyalgia often experience chronic (regular and long-term) pain. Certain areas of the body, called lumps, become especially painful when touched or pressed. The most common sites of dislocation of such seals are the back of the head, elbows, shoulders, knees, hip joint and neck.

Fibromyalgia most commonly occurs in people between the ages of 35 and 60, with women being more susceptible to this syndrome.

Story

Despite the fact that the modern term appeared in the medical literature relatively recently, the condition has been known since at least the beginning of the 20th century.

The pathology, then called "fibrositis", was considered as a consequence of "psychogenic rheumatism" or tension. The concept currently under consideration was first developed in the mid-1970s.

At the same time, it was found that patients develop points with hypersensitivity and develop sleep disorders.

Reasons for development

Scientists around the world have long been conducting research aimed at identifying the cause of the disease. The main etiological factors of pain syndrome include:

• heredity;
• viral infections (HIV, Epstein-Barr virus (infectious mononucleosis), tick-borne borreliosis, herpes infection);
• negative psycho-emotional state, excessive alertness, fixation on one's own pain sensations;
• stress;
• failure in the endocrine system (hormonal disorders, such as hypothyroidism);
• bruises, fractures, burns with severe pain;
• certain medications or routine vaccinations can create discomfort and negatively affect neurotransmitters;
• damage to the peripheral nervous system (compression, neuritis, diabetic neuropathy, etc.).

Pathogenesis

Chronic pain syndrome, which accompanies fibromyalgia, is caused by central sensitization - constant hyperexcitation of sensitive neurons of the posterior horns of the spinal cord. Increased excitation is formed both under the influence of pain impulses coming from the periphery (injuries, peripheral syndromes), and as a result of neurometabolic changes against the background of distress, infection, hormonal disorders.

The leading role in pathogenesis belongs to serotonin- and noradrenergic neurotransmitter systems. It has been established that in patients the concentration of serotonin, L-tryptophan, norepinephrine in the blood is reduced, the level of 5-hydroxyindole, the basic metabolite of serotonin, is reduced in the cerebrospinal fluid. Since serotonin is considered to be responsible for good mood, the drop in its level explains the propensity of patients with fibromyalgia to depressive and anxiety states.

Location of sensitive points in fibromyalgia

Symptoms and first signs

To find out the presence of a disease, you need to know the symptoms inherent in this, because muscle pain is not always evidence of an illness. The main symptoms of the manifestation of the disease include:

• soreness in muscles and tendons;
• stiffness of hands and feet;
• fast fatiguability.

The development of the disease begins with the gradualness of pain. Moreover, the gradualness can be both protracted and active, i.e. a person can feel the first symptoms at the age of 25, and then the subsequent symptom will appear after a certain number of years. Psychological mood swings affect the provocation of such an ailment.

Pain in the muscles, accompanied by symptoms of fatigue, immobility, excessive physical activity, are the first indicators of disease activation. When exerting influence by applying warm objects to the place of activation of pain signs, such pains disappear or decrease. In the morning, the pain is sharply activated, and then subsides until the evening. In the morning there is a feeling of stiffness of the head, often the patient may complain of the manifestation of pain signs in the calf muscles (such pain is convulsive). A feeling of swelling of the fingers and toes begins to appear, but in fact there is no physical swelling.

The most common symptom that patients complain about is not pain in the muscle fibers, but general fatigue. Even waking up after a night, patients complain of greater body fatigue than before bedtime.

A characteristic feature of the disease is also the activation of pain after the place of indisposition, the so-called trigger point, is felt. These points are located in the following places on the human body:

• areas of 4,5 and 6 cervical vertebrae;
• on the trapezius muscles: left and right (the area of ​​\u200b\u200bthe muscular abdomen);
• upper part of the gluteal muscles;
• knee joints;
• bone points;
• in the area of ​​the scapula;
• elbow joints.

These are the main points of activation and reproduction of the disease, where a person can feel pain symptoms. Often, in addition to pain, an ailment is caused by an exacerbation of mental and somatic disorders, leading to a sharp maladjustment of the patient.

Patients also often complain of poor sleep, which is practically absent. A person is at rest during sleep, but constant muscle tension and mental disorder do not allow the body to relax and get proper rest. In addition to everything, the patient complains of constant headaches, including both migraine headaches and high blood pressure. Bursting pains in the joints of the hands and knees.

If the following symptoms have been observed:

• headache and dizziness;
• dryness and burning in the mouth;
• menstruation with pain;
• migraine;
• stitching pains in arms and legs;
• constant urge to go to the toilet to urinate;
• complaints of bowel dysfunction.

You should definitely contact the hospital for an accurate diagnosis and treatment.

Diagnostics

There are no tests or x-rays to support a diagnosis of fibromyalgia. Tests and examinations are prescribed to rule out other diseases. The diagnosis of fibromyalgia is based on the history of the disease and physical examination findings. In patients with chronic pain, the diagnosis of fibromyalgia can be made based on the detection of tender points (up to 80% of cases), the presence of tissue inflammation and the exclusion of other diseases. Many diseases have symptoms similar to fibromyalgia. For example, these are diseases such as:

• low levels of thyroid hormones (hypothyroidism),
• Vitamin D deficiency
• increased function of the parathyroid glands (causes an increase in blood calcium levels),
• muscle diseases accompanied by muscle pain (polymyositis),
• bone disease, with bone pain (Paget's disease),
• increased levels of calcium in the blood (hypercalcemia),
• infectious diseases (hepatitis, Epstein-Bar virus, AIDS),
• cancer. (Oncological diseases)

And, although blood tests do not verify fibromyalgia, they are necessary for differential diagnosis. Therefore, it is necessary to do blood tests for thyroid hormones, the level of calcium in the blood (to rule out hypercalcemia, hyperparathyroidism, hypothyroidism). Alkaline phosphatase levels are often elevated in patients with Paget's disease. Creatine phosphokinase is often elevated in patients with polymyositis. A detailed blood test and blood biochemistry allows diagnosing hepatitis.

Fibromyalgia can debut on its own or in association with systemic rheumatological diseases. In systemic rheumatological diseases (SLE, rheumatoid arthritis, polymyositis), inflammation and damage to various tissues and organs occurs. For the diagnosis of these diseases, such analyzes as ESR, the level of plasma proteins, antinuclear factor, C reactive protein, sialic acid are important. With fibromyalgia, these tests are within the normal range.

How to treat fibromyalgia?

Considering that the exact cause of the disease is not known today, fibromyalgia at home is treated exclusively symptomatically (i.e., I stop the clinic).

Therapy of the disease begins with a change in lifestyle: giving up bad habits, switching to a low-protein (sometimes vegetarian) diet, and normalizing sleep / wakefulness. An important stage of treatment is psychotherapy, aimed at reducing anxiety, raising mood and setting a positive outlook on life.

Medical treatment

The main pain symptoms of fibromyalgia can only be stopped with the help of medications. Basic therapy includes the following groups of medicines that are taken at home:

1. Antidepressants. Effective against fibromyalgia and associated depression, improve sleep. Amitriptyline, serotonin and norepinephrine reuptake inhibitors (venlafaxine, duloxetine) have proven efficacy.
2. Anticonvulsants, which are derivatives of GABA (pregabalin). Against the background of treatment, there is a significant decrease in pain symptoms, sleep is normalized, and the overall activity of the patient increases.
3. Central analgesics (tramadol). Used to relieve acute pain. The analgesic effect of tramadol potentiates its use in conjunction with paracetamol. Side effects are pronounced (dizziness, weakness, nausea), a long course of treatment is addictive.
4. Local anesthetics (lidocaine). Used as part of a course of treatment in the form of infusions. When locally injected into trigger points, they have a local and general analgesic effect.

Non-drug treatments

Physiotherapy helps relieve pain, reduce muscle tone and warm them up, improve blood flow in them. Nevertheless, their effect, alas, is often short-lived, and in some cases such treatment leads to the development of undesirable effects - an increase or decrease in blood pressure, an increase in heart rate, dizziness, and so on.

Mainly appointed:

• Cognitive Behavioral Psychotherapy. Allows the patient to develop a positive outlook on life, reduce anxiety, raise the background of mood.
• Physiotherapy. It has been proven that moderate physical activity helps to reduce pain, regression of the symptoms of the disease for a period of up to a year or longer.
• Other methods: biofeedback therapy, acupuncture, hydrotherapy, hypnotherapy. Showed moderate effectiveness in pain relief. Can be used as an addition to basic therapy.

Some patients feel an improvement in their condition only by following the recommendations on the regimen and behavior, even without taking medication. They include:

• a warm bath in the morning and, if possible, in the evening;
• exclusion of psycho-emotional stress;
• limitation of physical activity;
• observance of the regime of work and rest.

Folk recipes

Treatment of folk remedies for fibromyalgia does not lose its relevance. Patients with fibromyalgia traditional medicine recommends regular use of natural honey. It is better to take honey on an empty stomach in the morning, one tablespoon daily. Honey will saturate the body with nutrients, give strength, improve immunity and mood.

You should abandon traditional black tea in favor of herbal teas. In fibromyalgia, plants such as dandelion, clover, burdock root, echinacea, thistle, valerian, motherwort, sharpcorn, rosehip are useful. They can be brewed simultaneously or separately. It is good to combine 2-3 types. Regular use of decoctions of these medicinal herbs will alleviate the condition of the patient, invigorate him, improve vitality, increase resistance to disease and rid the body of toxins.

It is useful to take lemongrass tincture, which contains active substances that enhance the processes of perception and excitation of the central nervous system. The remedy is taken once a day, 5-7 drops per 100 g of water. Increasing the dosage can only be done under medical supervision.

Ginseng tincture will increase appetite, improve digestion, normalize blood sugar and increase immunity. Tincture is taken daily once a day, 10 drops per 100 g of water.

A compress from a mixture of red ground pepper with vegetable oil will help reduce pain. The oil prevents skin irritation from pepper. The compress neutralizes the conduction of nerve impulses responsible for pain.

Tinctures of lilac and birch buds can significantly reduce the pain syndrome if they are regularly rubbed into the “pain points”.

Prevention

It is impossible to prevent the onset of fibromyalgia, but you can reduce the risk of the onset of the disease:

• avoid injuries - bruises, fractures, hypothermia burns - especially in the limbs;
• timely diagnose and treat various neuropathies (carpal syndrome, neuritis, etc.);
• timely diagnose dwarfism (lack of growth hormone), as well as hypothyroidism (lack of thyroid hormones). If indicated, take hormone replacement therapy;
• in case of depressive conditions, with constant stress or emotional overstrain, be observed by a psychotherapist;
• timely detect and treat infectious diseases, as well as allergic conditions and intoxications of various etiologies.

If fibromyalgia has already developed, it is worth preventing the deterioration of the condition:

• eliminate stressful situations and emotional outbursts;
• engage in physical therapy and swimming;
• tune in to positive thinking (auto-training);
• if possible, change the place of residence in favor of a dry, non-cold climate;
• control the amount of protein by practicing a periodic vegetarian diet;
• counteract the symptoms of the disease by receiving therapy with antidepressants, anticonvulsants or other medications.

Treatment includes advice to the patient about his lifestyle, physiotherapy procedures and medications, the main expected effect of which is pain relief. If the patient follows all the recommendations of the doctor, his condition, as a rule, soon improves - the pain syndrome decreases, sleep normalizes, and anxiety, depression and other unpleasant symptoms become less intense.

Fibromyalgia is a disease that has appeared in medical reference books relatively recently and causes controversy among many specialists. The disease is indeed strange: in the bones of the skeleton, in the soft tissues of the patient (muscles, tendons, nerves), there is not a hint of inflammation or destructive damage. Nevertheless, a person is tormented by long-term incomprehensible pain, usually symmetrical, in the muscles and joints, which is why fibromyalgia is often mistaken for rheumatoid arthritis or a mental disorder, but this pathology is neither one nor the other.

What is fibromyalgia, how it can be caused, and how to treat this ailment - this is the topic of this article.

Fibromyalgia - what is it?

Fibromyalgia literally translates as pain in the muscle fibers (fibres). This pain is diffuse, it is blurred, and its exact location is sometimes difficult to determine. You may get the impression that literally everything hurts. On examination, such a patient often causes a skeptical attitude, and he can be immediately redirected to a neurologist, although this is wrong and can lead to a dead end: the neurologist will begin to treat symptoms that are a consequence of fibromyalgia, but certainly not its cause.

Against the background of FM, other diseases often develop:

• irritable bowel syndrome;
• muscle spasms;
• apnea;
• CFS (chronic fatigue syndrome);
• insomnia;
• restless leg syndrome, etc.

Fibromyalgia is considered a "female" disease: in the fair sex, it is observed 7-10 times more often than in men.

Medical history

And although the term "fibromyalgia" was first introduced into use in 1981, diffuse muscle pain as a separate disease began to be mentioned as early as the beginning of the 20th century under the name fibrositis, implying an inflammatory process in the muscles.

Later, when the inflammatory theory was not confirmed, a new version arose in the scientific community, based on the psychoneurological symptoms accompanying the pathology, about the psychosomatic nature of the disease, which began to be called psychogenic rheumatism.

But this concept did not last long, and today it is recognized:

Fibromyalgia can be either a chronic isolated disease that develops without a specific cause, or a consequence of certain factors (traumatic, rheumatic, endocrine, oncological, etc.)

In this regard, two forms of FM are currently distinguished - primary and secondary.

Causes of Primary Fibromyalgia

And although the causes of primary pathology are still unknown, the following hypotheses about the origin of FM are expressed:

• Heredity factor: It has been observed that people whose direct relatives suffered from fibromyalgia develop the disease eight times more often than the rest.
• Sleep disorders, shallow sleep: the lack of deep sleep creates a deficiency of somatotropin (growth hormone) produced by the pituitary gland at night, when a person is fast asleep. For this reason, fibromyalgia is considered a somatophoric disorder, that is, the emerging signs of the disease are not amenable to any control by the person, and their appearance is not felt.
• Vascular pathologies and circulatory disorders: according to one version, on the surface of the palms and feet, at the junctions of arteries and veins (anostoses), as well as on the walls of the vessels involved in thermoregulation, there are more nerve receptors than usual. This assumption also makes it possible to explain insomnia by poor blood supply to the brain.
• Too fast exchange of serotonin, due to which its deficiency occurs in the brain.
• Stress, fatigue.

Symptoms and treatment of fibromyalgia

Fibromyalgia is manifested not only in the peripheral symptoms of symmetrical articular or musculotendinous pain - it also clearly shows central disorders.

The general symptoms of FM are as follows:

• Pain in the joints and muscles, which can often occur in the form of morning stiffness or night cramps.
• On palpation of trigger points (there are 18 in total on the body), pain occurs with a pressure force of 4 kg.
• It seems to the patient that the joints are swollen, the muscles are stiff, but in fact there are no such clinical signs.
• Often there are symptoms of numbness, pin pricks, goosebumps crawling all over the body.
• Tension in the head, migraine, dizziness.
• Temperature fluctuation.
• At times, memory worsens, it becomes difficult to concentrate - signs of poor blood supply to the brain.
• There is a dependence of the state on the weather.
• Possible irritation of the colon or bladder, manifested in intestinal disorders, pain during urination, however, no signs of disease in these organs are found during the examination.

Scheme of sensitive trigger points in fibromyalgia:

FM may resemble the onset of a stroke, and according to some assumptions, it may provoke it.

With fibromyalgia, there are often depressions against the background of a sharp change in mood (euphoria is suddenly replaced by a depressive decline) and mental disorders, but these are not symptoms of FM, but its consequences, or separate independent pathologies.

Diagnosis of fibromyalgia

In fact, there are no special tests or tests that can detect this disease. The diagnosis is established “on the contrary”: first, other diseases are suggested that manifest similar symptoms (thyroid disease, rheumatoid arthritis, diabetic, systemic sclerosis, polymyositis, lupus erythematosus, etc.). Then they are excluded one by one. When no diseases remain on the list, fibromyalgia is confirmed by the existing standard criteria.

Thus, with this disease, a number of tests can be prescribed by the attending physician:

• rheumatic factor;
• glucose level;
• free thyroxine and thyroid-stimulating hormone;
• antinuclear antibodies, etc.

What are the criteria for fibromyalgia?

There are mandatory, major, and minor fibromyalgic criteria (underlying features).

Mandatory features include:

• The duration of pain (it must be at least three months) and its diffuseness (it is impossible to accurately determine the localization of pain, it spreads to several areas of the body).
• Non-confirmation of other diseases based on laboratory and instrumental diagnostics (See Diagnosis of Fibromyalgia above).

Major evaluation criteria include:

• Soreness with deep palpation of at least 12 points out of 18 (below is the location of trigger points on the human body).

The minor criteria are:

• The presence in the anamnesis of signs of various psychological and functional pathologies.
• Poor quality, often interrupted sleep, stiffness in the morning, chronic fatigue.

How to Treat Fibromyalgia

Since the causes of the disease are unknown, the treatment of fibromyalgia is mainly aimed at suppressing the symptoms (severe muscle pain, spasms, insomnia) and the consequences (depression, fatigue, etc.).

Medical treatment of FM

The following medications have been shown to be effective in treating fibromyalgia:

• Anticonvulsive (antiepileptic) action:
  • Among them, it is necessary to highlight the drug Lyrica (pregabalin), which simultaneously relieves pain, spasms and depression, and gives a very fast, lasting effect.
• Antidepressants of various types of action given in low doses (amitriptyline, Prozac, paroxetine, venlafaxine, duloxetine):
  • Amitriptyline belongs to the group of tricyclic antidepressants and was used as the first drug to treat fibromyalgia.
  • Prozac (fluoxetine), paroxetine, sertraline are SSRIs (selective serotonin reuptake inhibitors), but they are less effective than SNRIs (inhibit the reuptake of not only serotonin, but also norepinephrine
  • Venlafaxine and duloxetine are among the most effective SNRI drugs in the treatment of fibromyalgia, with venlafaxine showing the best results. The advantages of SNRIs include their selectivity: they do not affect other receptors and lead to fewer side effects.

• For the treatment of insomnia: benzodiazepam (diazepam, alprazolam); sleeping pills of a different structure, for example, Imovan.
• Painkillers(NSAIDs and opiates), which can be used in the form of injections and topically, making applications at trigger points: paracetamol, tramadol, etc.
• Dopaminomimetic drugs, which are prescribed in the treatment of Parkinson's disease: they are prescribed if none of the above remedies has helped. Pramipexole has proven itself well (the same drug is sometimes prescribed for untreated restless leg syndrome).
• Other drugs: pirocetam, antioxidants, hormonal agents (progesterone), malic acid derivatives, etc.

Non-drug treatment for fibromyalgia

Of great importance for patients with fibromyalgia are therapeutic actions aimed at maintaining normal muscle tone, creating a favorable psychological environment, and normalizing sleep.

• Natural methods of treatment, which are widely available in resorts and sanatoriums, have a positive effect.
• Swimming, balneotherapy are very useful. The water in the pool and bath should be warm, it is very important for muscle relaxation.
• Effective hyperbaric oxygenation: the patient is placed in an oxygen pressure chamber; when oxygen is inhaled under pressure, the amount of partial oxygen in the tissues and its content in the plasma increases.
• Other methods of treatment are used: exercise therapy, aerobics, massage, manual therapy, hypnosis, psychotherapy, auto-training, meditation, etc.
• The patient must necessarily establish a sleep pattern, avoid conflict, stressful situations, indulge less in anxiety and unrest.

Treatment at home

It is often advised to use all sorts of warming compresses, ointments for fibromyalgia, obviously confusing the disease with fibromyositis. But with this disease, these drugs are ineffective, as well as such popular ointments: fastum-gel, diclofenac, capsicam, etc.

These drugs will not help relieve chronic pain, the localization of which is sometimes unknown, and in order to conduct a competent application, you need to know the exact location of sensitive pain points.

Here are some steps you can take to treat fibromyalgia while at home.