Fibromyalgia is a rheumatic disease characterized by generalized muscle weakness (feeling tired) and tenderness on palpation of characteristic areas of the body, referred to as tender points. Frequency – 3% of the adult population. The predominant age is 30-50 years. The predominant sex is female (5-10:1). Pathogenesis. The nature of pathological changes in the muscles remains unclear. Discussed Mechanisms

    • Exposure to endogenous agents (bradykinin, serotonin, leukotrienes, etc.)
    • Neurogenic inflammation associated with the release of neuropeptides (substance P, neurokinin A)
    • Neurogenic pain associated with muscle hypertonicity
    • The central origin of pain as a result of a decrease in the inhibitory influence of spinal neurons
    • Psychosomatic pain arising from emotional depression or social stress.

Clinical picture

    • Generalized pain and fatigue in the muscles, stiffness
    • General fatigue
    • Sleep disorders
    • Functional disorders
    • CCC (cardialgia; rhythm disturbances – sinus tachycardia, extrasystrolia, labile arterial hypertension
    • Raynaud phenomenon
    • Gastrointestinal (irritable bowel syndrome, irritable stomach syndrome)
    • Lungs – hyperventilation syndrome (tachypnea, hypocapnia)
    • Genitourinary system – dysuria
    • Premenstrual syndrome, dysmenorrhea
    • Migraine
    • Sjögren’s syndrome
    • Psychoneurological disorders
    • Multiple painful points in certain anatomical areas.

Clinical forms

    • Primary fibromyalgia – develops in the absence of trauma, rheumatic or non-rheumatic (hypothyroidism) diseases
    • Secondary fibromyalgia – in the presence of background pathology.

Research methods

    • X-ray examination – signs of osteochondrosis, pseudospondylolisthesis are detected more often than in the same age groups in the general population
    • Laboratory studies – an increase in the concentration of CPK; hypokalemia, hyperuricemia are not often noted.

Differential Diagnosis

    • Hypothyroidism
    • chronic fatigue syndrome
    • Myositis
    • Myopathies
    • Rheumatic polymyalgia.


General recommendations

    • Physical activity is not limited
    • Non-pharmacological means (physiotherapy [massage, warm baths, ultrasound, reflexology], cryotherapy)
    • In 5% of patients, any form of therapeutic intervention does not bring relief. In this case, the use of hypnosis is acceptable.

Drug therapy

    • NSAIDs – use is likely, but the effectiveness has not been proven.
    • Local analgesia of painful points 1-2 ml of 1% lidocaine solution (possible together with 40 mg of hydrocortisone acetate): find points of maximum pain (seal), inject an anesthetic solution into the center of the seal with a thin needle, and then make it chipped.
    • To improve sleep and relieve pain
    • Amitriptyline 10mg (up to 50mg) at night. With the development of side effects, for example, drowsiness, other drugs are prescribed in minimally effective doses, for example
    • Temazepam 15 mg (up to 30 mg) at night
    • Triazolam 0.125 mg (up to 0.5 mg) at night.

See also Migraine, Irritable Bowel Syndrome, ICD Chronic Fatigue Syndrome. M79.0 Rheumatism, unspecified

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