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*For reference only for medical professionals.
As a disease lacking specific laboratory indicators, how to diagnose and how to treat it after diagnosis? Recently, the "Consensus of Chinese Experts on the Clinical Diagnosis and Treatment of Fibromyalgia" [1] was officially published in the "Chinese Journal of Pain Medicine".
Regarding fibromyalgia, what does the consensus emphasize in? Let's take a look! Fibromyalgia (FM), also known as fibromyalgia syndrome, is a chronic diffuse pain syndrome caused by central nervous system sensory afferent processing dysfunction.
Its main symptoms include multi-site pain, severe fatigue, stiffness, and sleep.
Obstacles, cognitive impairments and psychological problems have a serious impact on the quality of life of patients
.
At first hearing "fibromyalgia", many patients and even doctors will think it is a rare disease, but in fact, the prevalence of FM in the general population is as high as 2% to 4%
.
Coupled with the aging of the population, the increase of psychological pressure, and the increase of bad living habits in today's society, the incidence of FM is showing a gradually increasing trend
.
1 Fibromyalgia, how did it come? FM belongs to chronic diffuse pain in chronic primary pain, but its etiology and pathogenesis are still unclear
.
It is generally believed that central sensitization may be the most important pathophysiological change of FM
.
Central sensitization refers to the excessive response of the central nervous system to stimuli, including increased pain caused by normal pain-causing stimuli and non-noxious stimuli
.
The overexpression of the α2δ subunit on the voltage-gated calcium channel in the dorsal horn of the spinal cord leads to an increase in the release of calcium-dependent excitatory neurotransmitters.
Body-mediated, regulation of spinal cord descending inhibition of pain pathway damage can cause central sensitization
.
In addition, neurotransmitter imbalance, abnormal neurological function and abnormal hypothalamic-pituitary-target gland axis may also be related to its pathogenesis
.
The risk factors of FM include psychosocial factors, gender, genetics, obesity and age
.
The prevalence of FM increases with age in the 18 to 60-year-old age group.
It is mostly female and has family inheritance.
Obese people and people with high psychological pressure will also increase the risk of disease
.
2The whole body is always painful, is it fibromyopathy? Clinically, pain is the core symptom of FM, manifested as pain and tenderness in multiple parts of the body, abnormal pain, hyperalgesia and hyperalgesia
.
In addition, there are various symptoms such as fatigue, sleep disturbance, neuropsychiatric symptoms, and headaches
.
But what brings difficulty to the diagnosis of FM is that it currently has no specific laboratory indicators
.
During the imaging examination, it is only possible that the activation response of the frontal cortex, amygdala, hippocampus, and cingulate gyrus may be abnormal, as well as abnormal fiber communication between each other
.
So how to diagnose FM? This expert consensus emphasizes that the diagnosis of FM is based on the diagnosis of symptoms.
Effective diagnosis of FM and explaining the condition to the patient can help reduce anxiety, reduce unnecessary examinations, and provide reasonable intervention measures
.
The consensus adopted the 2016 revised version of the FM diagnostic criteria-when the patient’s clinical manifestations meet the following first 3 criteria, FM can be diagnosed: 1.
Diffuse pain index (WPI) ≥ 7 and symptom severity score (SSS) ≥ 5; or WPI=4~6 and SSS≥9; 2.
Diffuse pain is defined as pain in at least 4 of the 5 areas, and pain in the jaw, chest, and abdomen is not included in the definition of diffuse pain; 3.
Symptoms The same level lasts for more than 3 months; 4.
Even if there are other diseases, the diagnosis of FM is effective, and the diagnosis of FM does not exclude the existence of other clinically important diseases
.
Figure: The specific content of diffuse pain index and symptom severity score.
However, due to the diverse clinical symptoms of FM, there is no specific laboratory and imaging examination to confirm the diagnosis, and the lack of understanding of the disease, so it is clinically misdiagnosed as other diseases The situation is very common and needs to be identified
.
The relevant differential diagnosis is also listed in the consensus.
Interested readers can go and read carefully~3 With this disease, what should I do next? Due to the heterogeneity of FM clinical manifestations and the diversity of core symptoms, its treatment is very challenging
.
Therefore, the consensus suggests that focusing on the relief of core symptoms (including pain, sleepiness after waking up, mood disorders, fatigue) is a good starting point for treatment
.
The treatment of FM should be based on the patient's symptoms to adopt a multi-modal treatment combining drug therapy and non-drug therapy
.
Treatment should be initiated as soon as possible, long-term treatment, close monitoring and regular follow-up, especially in the early stages of treatment
.
The first-line drug treatments for FM include: Pregabalin: relieve pain, improve sleep and quality of life 5-hydroxytryptamine and norepinephrine reuptake inhibitors (SNRIs): Duloxetine-improve pain and depression symptoms; Mina Prolen-improve pain, fatigue and cognitive abilities.
Amitriptyline: good analgesic effects.
Non-drug treatments of FM include: patient disease health education, exercise, cognitive behavioral therapy, neuromodulation therapy, physical therapy, such as acupuncture, massage and Hydrotherapy exercise therapy and mindfulness decompression.
In addition, the consensus proposes that the corresponding assessment tools can be used to record the patient's baseline status and follow-up treatment: such as FS score, Fibromyalgia Impact Questionnaire Revised Version (FIQ-R) can assess the severity of FM symptoms Degree; Numerical scoring method (NRS), visual analogue scoring method (VAS), etc.
to assess the intensity of pain and its impact on patients; Beck Depression Scale, Beck Anxiety Scale, etc.
to assess patients’ emotional symptoms; Pittsburgh Sleep Quality Index ( PSQI) to assess the quality of sleep; SF-36 scale to assess the quality of life of patients
.
Finally, the consensus stated that FM will seriously affect all aspects of patients' lives, including daily activities and work.
Therefore, the impact of FM should be evaluated in various aspects during follow-up, focusing on the most affected aspects
.
Dynamically observe changes in the condition, and adjust the treatment plan according to the improvement of the condition and the treatment effect and complications
.
References: [1] Zhu Qian.
Chinese Expert Consensus on Clinical Diagnosis and Treatment of Fibromyalgia [J].
Chinese Journal of Pain Medicine, 2021,27(10):721-727.
https://kns.
cnki.
net/kcms/detail /detail.
aspx?dbcode=CJFD&dbname=CJFDAUTO&filename=ZTYZ202110002&uniplatform=NZKPT&v=JCr2uupVJPdZ8eiJvzKHvbDNAwGBPVXeFNB5uxRSzG2-NYm7BgNhRohd5VMOn9L_
As a disease lacking specific laboratory indicators, how to diagnose and how to treat it after diagnosis? Recently, the "Consensus of Chinese Experts on the Clinical Diagnosis and Treatment of Fibromyalgia" [1] was officially published in the "Chinese Journal of Pain Medicine".
Regarding fibromyalgia, what does the consensus emphasize in? Let's take a look! Fibromyalgia (FM), also known as fibromyalgia syndrome, is a chronic diffuse pain syndrome caused by central nervous system sensory afferent processing dysfunction.
Its main symptoms include multi-site pain, severe fatigue, stiffness, and sleep.
Obstacles, cognitive impairments and psychological problems have a serious impact on the quality of life of patients
.
At first hearing "fibromyalgia", many patients and even doctors will think it is a rare disease, but in fact, the prevalence of FM in the general population is as high as 2% to 4%
.
Coupled with the aging of the population, the increase of psychological pressure, and the increase of bad living habits in today's society, the incidence of FM is showing a gradually increasing trend
.
1 Fibromyalgia, how did it come? FM belongs to chronic diffuse pain in chronic primary pain, but its etiology and pathogenesis are still unclear
.
It is generally believed that central sensitization may be the most important pathophysiological change of FM
.
Central sensitization refers to the excessive response of the central nervous system to stimuli, including increased pain caused by normal pain-causing stimuli and non-noxious stimuli
.
The overexpression of the α2δ subunit on the voltage-gated calcium channel in the dorsal horn of the spinal cord leads to an increase in the release of calcium-dependent excitatory neurotransmitters.
Body-mediated, regulation of spinal cord descending inhibition of pain pathway damage can cause central sensitization
.
In addition, neurotransmitter imbalance, abnormal neurological function and abnormal hypothalamic-pituitary-target gland axis may also be related to its pathogenesis
.
The risk factors of FM include psychosocial factors, gender, genetics, obesity and age
.
The prevalence of FM increases with age in the 18 to 60-year-old age group.
It is mostly female and has family inheritance.
Obese people and people with high psychological pressure will also increase the risk of disease
.
2The whole body is always painful, is it fibromyopathy? Clinically, pain is the core symptom of FM, manifested as pain and tenderness in multiple parts of the body, abnormal pain, hyperalgesia and hyperalgesia
.
In addition, there are various symptoms such as fatigue, sleep disturbance, neuropsychiatric symptoms, and headaches
.
But what brings difficulty to the diagnosis of FM is that it currently has no specific laboratory indicators
.
During the imaging examination, it is only possible that the activation response of the frontal cortex, amygdala, hippocampus, and cingulate gyrus may be abnormal, as well as abnormal fiber communication between each other
.
So how to diagnose FM? This expert consensus emphasizes that the diagnosis of FM is based on the diagnosis of symptoms.
Effective diagnosis of FM and explaining the condition to the patient can help reduce anxiety, reduce unnecessary examinations, and provide reasonable intervention measures
.
The consensus adopted the 2016 revised version of the FM diagnostic criteria-when the patient’s clinical manifestations meet the following first 3 criteria, FM can be diagnosed: 1.
Diffuse pain index (WPI) ≥ 7 and symptom severity score (SSS) ≥ 5; or WPI=4~6 and SSS≥9; 2.
Diffuse pain is defined as pain in at least 4 of the 5 areas, and pain in the jaw, chest, and abdomen is not included in the definition of diffuse pain; 3.
Symptoms The same level lasts for more than 3 months; 4.
Even if there are other diseases, the diagnosis of FM is effective, and the diagnosis of FM does not exclude the existence of other clinically important diseases
.
Figure: The specific content of diffuse pain index and symptom severity score.
However, due to the diverse clinical symptoms of FM, there is no specific laboratory and imaging examination to confirm the diagnosis, and the lack of understanding of the disease, so it is clinically misdiagnosed as other diseases The situation is very common and needs to be identified
.
The relevant differential diagnosis is also listed in the consensus.
Interested readers can go and read carefully~3 With this disease, what should I do next? Due to the heterogeneity of FM clinical manifestations and the diversity of core symptoms, its treatment is very challenging
.
Therefore, the consensus suggests that focusing on the relief of core symptoms (including pain, sleepiness after waking up, mood disorders, fatigue) is a good starting point for treatment
.
The treatment of FM should be based on the patient's symptoms to adopt a multi-modal treatment combining drug therapy and non-drug therapy
.
Treatment should be initiated as soon as possible, long-term treatment, close monitoring and regular follow-up, especially in the early stages of treatment
.
The first-line drug treatments for FM include: Pregabalin: relieve pain, improve sleep and quality of life 5-hydroxytryptamine and norepinephrine reuptake inhibitors (SNRIs): Duloxetine-improve pain and depression symptoms; Mina Prolen-improve pain, fatigue and cognitive abilities.
Amitriptyline: good analgesic effects.
Non-drug treatments of FM include: patient disease health education, exercise, cognitive behavioral therapy, neuromodulation therapy, physical therapy, such as acupuncture, massage and Hydrotherapy exercise therapy and mindfulness decompression.
In addition, the consensus proposes that the corresponding assessment tools can be used to record the patient's baseline status and follow-up treatment: such as FS score, Fibromyalgia Impact Questionnaire Revised Version (FIQ-R) can assess the severity of FM symptoms Degree; Numerical scoring method (NRS), visual analogue scoring method (VAS), etc.
to assess the intensity of pain and its impact on patients; Beck Depression Scale, Beck Anxiety Scale, etc.
to assess patients’ emotional symptoms; Pittsburgh Sleep Quality Index ( PSQI) to assess the quality of sleep; SF-36 scale to assess the quality of life of patients
.
Finally, the consensus stated that FM will seriously affect all aspects of patients' lives, including daily activities and work.
Therefore, the impact of FM should be evaluated in various aspects during follow-up, focusing on the most affected aspects
.
Dynamically observe changes in the condition, and adjust the treatment plan according to the improvement of the condition and the treatment effect and complications
.
References: [1] Zhu Qian.
Chinese Expert Consensus on Clinical Diagnosis and Treatment of Fibromyalgia [J].
Chinese Journal of Pain Medicine, 2021,27(10):721-727.
https://kns.
cnki.
net/kcms/detail /detail.
aspx?dbcode=CJFD&dbname=CJFDAUTO&filename=ZTYZ202110002&uniplatform=NZKPT&v=JCr2uupVJPdZ8eiJvzKHvbDNAwGBPVXeFNB5uxRSzG2-NYm7BgNhRohd5VMOn9L_
