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Fibromyalgia (FM) is a common chronic diffuse pain syndrome.
In addition to multi-site pain, patients are often accompanied by various clinical symptoms such as fatigue, sleep and mood disorders
.
Due to the lack of clear specific laboratory indicators, the diagnosis is mostly based on clinical symptoms, which is prone to missed and misdiagnosed
.
In order to further promote the standardized diagnosis and treatment of domestic FM, domestic pain experts have compiled this consensus for reference while referring to the latest foreign guidelines, extensively collecting clinical evidence, and combining clinical experience and China's national conditions
.
Definition and mechanism of fibromyalgia, also known as fibromyalgia syndrome, is a chronic diffuse pain syndrome caused by the dysfunction of central nervous system sensory afferent processing.
Its main symptoms include pain in multiple locations, severe fatigue, stiffness, Sleep disorders, cognitive disorders, and psychological problems
.
FM often coexists with other systemic diseases, which has a serious impact on the quality of life of patients
.
The etiology and pathogenesis of FM are still unclear
.
Central sensitization is one of the main mechanisms of the pathogenesis of FM, and other aspects such as neurotransmitter imbalance, neurological dysfunction, abnormal hypothalamus-pituitary-target gland axis, etc.
may also be related to its pathogenesis
.
Clinical manifestations 1.
Pain and tenderness Pain is the core symptom of FM, manifested as pain and tenderness in multiple parts of the body, abnormal pain, hyperalgesia and hyperalgesia
.
The pain is of various natures, such as soreness, cold pain, cramping pain, etc.
, and the shoulder girdle, neck, back, hip and other parts are common
.
Pain can occur in the trunk, limbs, or joints, but there will be no joint swelling and functional limitations
.
2.
Fatigue Most patients complain of being fatigued, and some patients may experience varying degrees of decline in work ability, and may even be unable to perform ordinary housework
.
Patients often complain of obvious fatigue after waking up early in the morning
.
3.
Sleep disorders are manifested as difficulty falling asleep, light sleep, easy awakening, dreaminess, no restorative sleep, and lack of energy
.
4.
Neuropsychiatric symptoms are manifested as depression, irritability, excessive attention to one's own condition, and even severe anxiety and depression
.
Many patients have cognitive impairments such as difficulty concentrating, memory loss, and impaired executive ability
.
5.
Headaches are usually caused by tension in the neck muscles, and may also be caused by tender points in the head and neck
.
6.
A variety of accompanying symptoms Most patients have the symptoms of being afraid of cold and wind.
When the ambient temperature is low or the cold breeze is blowing, the patients often feel discomfort and pain, which is aggravated by this
.
Dizziness, paroxysmal dizziness, numbness, soreness, tingling, and ant movement are also common symptoms
.
Diagnostic criteria: FM should be suspected for patients with diffuse pain whose symptoms last ≥ 3 months and have no other explanation
.
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 diagnostic criteria of FM are shown in Table 1
.
Treatment and management of FM treatment 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 recommended regimen for FM treatment is shown in Table 2
.
(1) Medication The choice of medications should be based on the symptoms that most bother the patient, while taking into account any possible adverse reactions
.
Start with a low dose and gradually increase the dose to improve tolerance
.
When multiple symptoms need to be resolved at the same time, combined medications are required.
In this case, attention must be paid to drug interactions
.
Regularly evaluate the efficacy and adverse effects of the drug, and understand that the adverse effects of the drug may be similar to the symptoms of FM
.
(2) Non-drug therapy Non-drug therapy includes neuromodulation therapy, patient disease health education, exercise exercise, cognitive behavior therapy, physical therapy, exercise therapy (Qigong, Yoga, Tai Chi) and mindfulness decompression
.
Table 2 Recommendations for FM treatment.
Follow-up and prognosis can generally be controlled through active intervention in FM
.
Therefore, at the beginning of treatment, setting treatment goals and follow-up cycles can help improve compliance and improve outcomes
.
FM will seriously affect all aspects of the patient's life, including daily activities and work, so the follow-up should evaluate the impact of FM in many ways, focusing on the most affected aspects
.
Especially in the early stage of treatment or before the symptoms are stable, regular follow-ups are required
.
Dynamically observe changes in the condition, and adjust the treatment plan according to the improvement of the condition and the treatment effect and complications
.
For new symptoms, a clinical evaluation is required to ensure that the symptoms are not caused by other diseases
.
Yimaitong is compiled from: Chinese Expert Consensus Compilation Group on Clinical Diagnosis and Treatment of Fibromyalgia.
Chinese Expert Consensus on Clinical Diagnosis and Treatment of Fibromyalgia[J].
Chinese Journal of Pain Medicine,2021,27(10):721-727.
In addition to multi-site pain, patients are often accompanied by various clinical symptoms such as fatigue, sleep and mood disorders
.
Due to the lack of clear specific laboratory indicators, the diagnosis is mostly based on clinical symptoms, which is prone to missed and misdiagnosed
.
In order to further promote the standardized diagnosis and treatment of domestic FM, domestic pain experts have compiled this consensus for reference while referring to the latest foreign guidelines, extensively collecting clinical evidence, and combining clinical experience and China's national conditions
.
Definition and mechanism of fibromyalgia, also known as fibromyalgia syndrome, is a chronic diffuse pain syndrome caused by the dysfunction of central nervous system sensory afferent processing.
Its main symptoms include pain in multiple locations, severe fatigue, stiffness, Sleep disorders, cognitive disorders, and psychological problems
.
FM often coexists with other systemic diseases, which has a serious impact on the quality of life of patients
.
The etiology and pathogenesis of FM are still unclear
.
Central sensitization is one of the main mechanisms of the pathogenesis of FM, and other aspects such as neurotransmitter imbalance, neurological dysfunction, abnormal hypothalamus-pituitary-target gland axis, etc.
may also be related to its pathogenesis
.
Clinical manifestations 1.
Pain and tenderness Pain is the core symptom of FM, manifested as pain and tenderness in multiple parts of the body, abnormal pain, hyperalgesia and hyperalgesia
.
The pain is of various natures, such as soreness, cold pain, cramping pain, etc.
, and the shoulder girdle, neck, back, hip and other parts are common
.
Pain can occur in the trunk, limbs, or joints, but there will be no joint swelling and functional limitations
.
2.
Fatigue Most patients complain of being fatigued, and some patients may experience varying degrees of decline in work ability, and may even be unable to perform ordinary housework
.
Patients often complain of obvious fatigue after waking up early in the morning
.
3.
Sleep disorders are manifested as difficulty falling asleep, light sleep, easy awakening, dreaminess, no restorative sleep, and lack of energy
.
4.
Neuropsychiatric symptoms are manifested as depression, irritability, excessive attention to one's own condition, and even severe anxiety and depression
.
Many patients have cognitive impairments such as difficulty concentrating, memory loss, and impaired executive ability
.
5.
Headaches are usually caused by tension in the neck muscles, and may also be caused by tender points in the head and neck
.
6.
A variety of accompanying symptoms Most patients have the symptoms of being afraid of cold and wind.
When the ambient temperature is low or the cold breeze is blowing, the patients often feel discomfort and pain, which is aggravated by this
.
Dizziness, paroxysmal dizziness, numbness, soreness, tingling, and ant movement are also common symptoms
.
Diagnostic criteria: FM should be suspected for patients with diffuse pain whose symptoms last ≥ 3 months and have no other explanation
.
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 diagnostic criteria of FM are shown in Table 1
.
Treatment and management of FM treatment 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 recommended regimen for FM treatment is shown in Table 2
.
(1) Medication The choice of medications should be based on the symptoms that most bother the patient, while taking into account any possible adverse reactions
.
Start with a low dose and gradually increase the dose to improve tolerance
.
When multiple symptoms need to be resolved at the same time, combined medications are required.
In this case, attention must be paid to drug interactions
.
Regularly evaluate the efficacy and adverse effects of the drug, and understand that the adverse effects of the drug may be similar to the symptoms of FM
.
(2) Non-drug therapy Non-drug therapy includes neuromodulation therapy, patient disease health education, exercise exercise, cognitive behavior therapy, physical therapy, exercise therapy (Qigong, Yoga, Tai Chi) and mindfulness decompression
.
Table 2 Recommendations for FM treatment.
Follow-up and prognosis can generally be controlled through active intervention in FM
.
Therefore, at the beginning of treatment, setting treatment goals and follow-up cycles can help improve compliance and improve outcomes
.
FM will seriously affect all aspects of the patient's life, including daily activities and work, so the follow-up should evaluate the impact of FM in many ways, focusing on the most affected aspects
.
Especially in the early stage of treatment or before the symptoms are stable, regular follow-ups are required
.
Dynamically observe changes in the condition, and adjust the treatment plan according to the improvement of the condition and the treatment effect and complications
.
For new symptoms, a clinical evaluation is required to ensure that the symptoms are not caused by other diseases
.
Yimaitong is compiled from: Chinese Expert Consensus Compilation Group on Clinical Diagnosis and Treatment of Fibromyalgia.
Chinese Expert Consensus on Clinical Diagnosis and Treatment of Fibromyalgia[J].
Chinese Journal of Pain Medicine,2021,27(10):721-727.
