Based on clinical, focus on the forefront - fibromyalgia diagnosis and treatment of the big curry talk.

May 12 is the international day of care for fibromyalgia. The theme of this year's event is "exposing pain hidden in common diseases".on this occasion, the first "China fibromyalgia co disease management cloud Summit Forum" was solemnly held on the same day, which gathered experts from pain department, rheumatology department, neurology department, orthopedics department and other multidisciplinary fields to discuss and share issues on fibromyalgia and its diagnosis and treatment.Professor Fan bifa, Department of pain, China Japan Friendship Hospital, Professor Yu Shengyuan, Department of Neurology, General Hospital of Chinese people's Liberation Army, Professor Weng Xisheng, Department of orthopedics, Peking Union Medical College Hospital, Professor Zheng Yongjun, Department of pain, East China Hospital Affiliated to Fudan University, Professor Liang Dongfeng, Department of Rheumatology, first medical center, General Hospital of Chinese people's Liberation Army, and Luo Fang, Department of pain, Beijing Tiantan Hospital, Capital Medical University Professor Wu Dazhao and Professor Dong Dasheng of the people's Liberation Army General Hospital attended the meeting.during the fibromyalgia day 2020, fan bifa, pain department of China Japan Friendship Hospital, opened the era of comorbidity diagnosis and treatment strategy. Fibromyalgia (FM) is a relatively common chronic pain disease in clinical practice, with the prevalence rate of 2% - 4% in the general population. However, due to its comorbidity with other diseases, the diagnosis rate and treatment rate are low. Moreover, due to the particularity of its pathogenesis, the conventional treatment should be carried out In the past, the effect was not good.in China, the public's understanding and understanding of fibromyalgia is very limited, and clinicians are lack of knowledge and experience in diagnosis and treatment of this disease. This forum was held in "fibromyalgia day" to strengthen the public's understanding of fibromyalgia and improve clinicians' grasp of clinical characteristics, pathogenesis and diagnosis and treatment strategies of fibromyalgia.based on the "comorbidity" characteristics of fibromyalgia, this conference specially planned a multi-disciplinary academic theme, and invited experts in relevant fields to carry out multi-disciplinary in-depth interpretation.ZHENG Yongjun, pain department of Huadong Hospital Affiliated to Fudan University, said in simple words: the progress of clinical classification of fibromyalgia. By reviewing the concept, clinical characteristics and pathogenesis of fibromyalgia, we can find that the clinical manifestations of fibromyalgia are very heterogeneous. Patients often go to a specific department with a certain stage of outstanding performance and are diagnosed with other diseases.on the other hand, fibromyalgia has its core symptoms, namely chronic generalized pain, fatigue, non restorative sleep, anxiety and depression and other emotional disorders.central sensitization is an important pathogenesis of fibromyalgia. Unlike nociceptive pain and neuropathic pain, which are more well known in clinical practice, the pain caused by central sensitization is just like that the pain perception of the whole body of the mechanism body is amplified, showing pain sensitivity.from the generation of central sensitization, the "comorbidity veil" of fibromyalgia is opened.there are two kinds of central sensitization - "top-down" and "bottom-up". The former refers to the abnormal pain processing in the central nervous system, while the latter is due to the continuous peripheral pain stimulation input, which leads to the plastic changes of the central nervous system. When the peripheral input is released, the central sensitization will also be reduced or even eliminated."bottom up" type of central sensitization is the pathophysiological basis of fibromyalgia often coexists with many diseases, and other diseases are common in clinical practice.based on two central sensitization mechanisms, fibromyalgia can be divided into primary and secondary.Department of Rheumatology, first medical center, General Hospital of Chinese PLA Liang Dongfeng international vision: diagnosis and international experience sharing of fibromyalgia review the evolution of diagnostic criteria for fibromyalgia. From 1990 to 2016, the American Society of Rheumatology (ACR) published four editions of fibromyalgia diagnostic criteria. Each update of the diagnostic criteria reflects the deepening understanding of fibromyalgia.more and more evidence shows that fibromyalgia is a part of a series of discomfort symptoms, rather than a discrete entity. Therefore, the concept of "fibromyalgia tendency" is proposed, which can be used to evaluate the severity of symptoms of patients with fibromyalgia symptom scale (FS), so as to judge the necessity and effect of clinical intervention.about the diagnosis of fibromyalgia, the current international consensus is that diagnosis can be made according to clinical symptoms, laboratory or imaging examination is not necessary diagnostic basis, and can be used to identify other comorbid diseases as appropriate. Therefore, the diagnosis of fibromyalgia is not an exclusive diagnosis.the core of fibromyalgia diagnosis process in Mayo Clinic is: active diagnosis and intervention, continuous follow-up and evaluation, so as to fully relieve symptoms and improve quality of life. Objective: diagnosis and treatment status and prognosis of osteoarthritis and chronic low back pain. Osteoarthritis and chronic low back pain are the two most common diseases in orthopedic clinic. Although there are many treatment methods, many patients still can not get effective relief. and central sensitization may be the reason for the poor effect of various existing treatments, and there is more evidence to support it. In addition, fibromyalgia comorbidity is more common in these two groups of people, which further proves the universality of central sensitization in such patients. through the analysis of three studies conducted by the University of Michigan in patients with osteoarthritis and chronic low back pain, the results showed that the fibromyalgia symptom scale (FS) can better evaluate the short-term and long-term prognosis of patients with surgery. Every increase of FS score by 1 point, the short-term morphine use after hip / knee arthroplasty increases by 9.1mg, and the long-term failure rate increases by nearly 20% For patients with osteoarthritis or chronic low back pain, when FS score is high, or there are clinical characteristics related to FS elevation (such as longer course of disease, poor efficacy of non steroidal anti-inflammatory drugs (NSAIDs), accompanied by sleep, emotional problems, etc.), it is suggested that central sensitization exists, which should be considered when making drug or surgical plan. Luo Fang's classic interpretation: expert consensus on chronic pain management of musculoskeletal system, Beijing Tiantan Hospital Affiliated to Capital Medical University, recently released "expert consensus on chronic pain management of musculoskeletal system" has included relevant progress in the diagnosis and management of chronic musculoskeletal pain, including epidemiology and its hazards, pathogenesis, diagnosis and differential diagnosis, treatment, etc This paper introduces the level system, and provides a valuable reference for clinical practice. the pathogenesis of chronic musculoskeletal pain includes inflammatory response, fibrosis, peripheral sensitization and central sensitization. most patients with chronic pain are mixed pain, and three types of pain mechanisms - nociceptive pain, neuropathic pain and central pain coexist in a certain proportion. therefore, clinical examination should focus on understanding the characteristics of pain and related conditions, and comprehensively evaluate the specific conditions of patients. the treatment principles of chronic musculoskeletal pain are: clear diagnosis, active treatment of primary diseases, simultaneous pathological treatment and psychological adjustment, and comprehensive treatment with multiple methods. Dong Zhao, director of Department of Neurology, General Hospital of Chinese people's Liberation Army, is the first to describe the pain: chronic headache comorbidity and fibromyalgia progress in diagnosis and treatment. Chronic headache and fibromyalgia are like a pair of twin flowers, and they often coexist with each other and influence each other, bringing serious impact on patients. Among them, chronic migraine and chronic tension headache are two common headache types, and their fibromyalgia comorbidity The proportion was close to 55% and 45% respectively. studies have confirmed that patients with chronic headache comorbid fibromyalgia often have certain clinical characteristics, such as older age, high headache frequency, obvious tenderness, poor sleep quality and anxiety. central sensitization is a common pathogenesis of chronic headache and fibromyalgia, which may be an important reason for the prevalence of both diseases. clinically, for patients with chronic headache, while carrying out comprehensive management, we need to pay attention to the risk factors of fibromyalgia comorbidity. For patients with suspected fibromyalgia comorbidity, we should also carry out active targeted intervention and continuous follow-up to understand the patient's condition changes and adjust the plan in time. Jilin Provincial People's Hospital Wu Dasheng decided to move: two key points of fibromyalgia management and treatment of fibromyalgia clinical management: 1) positive - the diagnosis of FM is non exclusive diagnosis, for patients who meet the diagnostic criteria of FM, treatment should be actively initiated, without waiting for possible comorbidities or primary diseases to be identified before treatment. 2) the goal of powerful FM management is to improve the clinical symptoms and quality of life of patients. the comprehensive management mode of patient-centered FM includes five aspects: patient education, goal setting, multidisciplinary management, routine monitoring and follow-up and result evaluation. among them, patient education is very important in FM management, which is helpful for patients to make clear their condition, understand the causes of symptoms, help self-management and improve patients' satisfaction with self-health status. the treatment of fibromyalgia emphasizes the multimodal treatment of fibromyalgia based on bio psycho social approach, and non drug treatment and drug treatment can be selected. at present, a breakthrough has been achieved in the treatment of fibromyalgia with a new generation of calcium channel regulators in clinical practice, which can simultaneously regulate the up and down inhibition pathways, inhibit central sensitization, treat fibromyalgia quickly, effectively relieve pain, improve sleep, and has good safety. The drug has been included in the national medicine Insurance reimbursement directory. the finishing touch: a dialogue between the big names and the multidisciplinary cooperation in the management of comorbidities of fibromyalgia. Professor Yu Shengyuan, from the Department of Neurology, General Hospital of the Chinese people's Liberation Army, presided over the final discussion session of the meeting and held a warm discussion on the contents of the meeting. first of all, we summarized the "key words" that impressed us in this meeting, and we had a deeper understanding of fibromyalgia and its comorbidities. the key words mentioned by experts include: central sensitization, comorbidity, fibromyalgia tendency, non exclusive diagnosis and active intervention. based on the current situation of diagnosis and treatment of fibromyalgia in China, this paper discusses how to strengthen communication and cooperation among multiple disciplines to jointly promote the improvement of fibromyalgia cognition and management. Everyone expresses his own opinions and puts forward constructive opinions and opinions from the characteristics of his own discipline. finally, Professor Yu Shengyuan summarized the meeting. He pointed out that although the understanding and diagnosis and treatment of fibromyalgia in China are still in the initial stage, we believe that the clinical diagnosis and treatment of fibromyalgia in China should take "comorbidity" as the breakthrough point and the multi academic association as the starting point, and under the background that the country gradually attaches importance to public health and chronic pain diseases, he believes that the clinical diagnosis and treatment of fibromyalgia in China