More than 15% of rheumatic clinics are seeing this? The focus of the diagnosis and treatment once clear!

A article on the diagnosis and treatment of FMS! Rheumatologists should have heard of or seen patients with widespread muscle, bone, and joint pain throughout the body, and the location and nature of the pain will also change.however, no abnormality was found in routine physical examination and laboratory examination. At the same time, these patients often have anxiety, depression and sleep problems This kind of disease accounts for 15.17% of the patients in rheumatology clinic, which is second only to osteoarthritis. It is fibromyalgia syndrome (also known as fibromyalgia syndrome, FMS).Professor Daniel Claus of Anesthesiology, rheumatology and psychiatry of the University of Michigan has been devoted to the study of the pathogenesis and treatment of FMS. At the 2020 annual meeting of the European Union against Rheumatology (2020), Professor Daniel Claus has been working on the pathogenesis and treatment of FMS In EULAR, Professor Daniel Crowe combed the history, diagnosis, treatment and latest progress of FMS through an online lecture.DanielProfessor clauw-1-the elusive "third kind" pain can be traced back to a guitar. In 2017, the international society for pain research (IASP) approved the term "third pain", which is defined as "pain caused by changes in pain perception. There is no clear evidence that there is tissue damage leading to the activation of peripheral nociceptors or somatic sensory system diseases that do not cause pain The clinical characteristics of patients with FMS are the typical representative of "the third kind of pain".in order to make it easier for everyone to understand, he used the analogy of "electric guitar volume adjustment" to describe the meaning of the third kind of pain in detail.screenshot of expert speech Professor: we all know that when playing the same guitar, the audience can hear different volumes by adjusting the loudspeaker, and the pain is the same. The central pain processing regulator is equivalent to the loudspeaker of an electric guitar. When the volume is turned up (central sensitization), the patient can feel pain even if he is not stimulated by peripheral stimulation Patients with peripheral lesions, but the central pain regulator "volume" is very low, the patient will not necessarily show pain.and this "volume" may be jointly regulated by genetic and acquired neural stimulation. The higher the volume is, the stronger the pain will be felt, and there may not be corresponding physical diseases.Professor Daniel clausw pointed out: FMS is a kind of disease caused by abnormal amplification of "volume" of central pain processing regulator.FMS includes primary and secondary types.primary FMS is also known as "top-down" - without definite neuropathic or traumatic / inflammatory injury, the proportion of patients with psychological diseases such as anxiety and depression is high, and they are also highly sensitive to other sensory stimuli.secondary FMS, also known as the "down top" type, is caused by the central sensitization caused by continuous peripheral stimulation, resulting in pain amplification.the proportion of patients with psychological diseases such as anxiety and depression is slightly low, and there is no other sensory stimulation sensitivity enhancement.- 2 - "sound" can not be seen or touched, how to make a specific diagnosis? Since it was formally defined as a disease diagnosis in 1990, the diagnostic method of FM has gradually changed from focusing on pain to focusing on systemic symptoms (including mental symptoms): the 1990 American rheumatic Association (ACR) diagnostic standard emphasizes "pain" as the core symptom, with tenderness point count (11 out of 18 pressure pain points are positive), but the tenderness point count has limitations in clinical operation No other characteristic clinical manifestations of FMS were considered in one diagnostic criteria.there are 18 tenderness points in the 1990 diagnostic criteria. The 2010 / 2016 ACR diagnostic criteria abandoned the count of tenderness points, and used the questionnaire evaluation method for diagnosis. The questionnaire included two questionnaires: diffuse pain index (WPI) and somatic symptom severity score (SSS), with a total score of 31 points. If the score was greater than or equal to 12 points, the suspected FMS could be diagnosed.Danniel ClauwProfessor: in addition to clinical diagnosis, the questionnaire score can also help clinicians assess the amplification of the "volume" of the central pain processing regulator, so as to help clinicians identify the mechanism of pain. It should be noted that any chronic and overlapping pain symptoms of the patient may indicate that the "volume" of the central pain processing regulator tends to be amplified, and the real diagnosis is f MS patients are just the tip of the iceberg.comorbidities must be considered in the diagnosis of FMS. For example, in patients with rheumatoid arthritis, clinicians should consider whether the pain of patients is "central" and carry out corresponding test questionnaire survey or medical history inquiry, which can help clinicians better treat patients.Professor Daniel clausw pointed out that in clinical practice, many doctors ignore the screening of FMS when they are faced with chronic pain patients with certain primary diseases, resulting in patients receiving wrong treatment.in the face of this situation, he suggested that clinicians, especially rheumatologists, should pay attention to the mental and psychological performance of patients with chronic pain, regardless of whether the patients have primary diseases or not.Professor Daniel clausw also mentioned that functional magnetic resonance imaging (fMRI) can clearly show the changes of brain structure in patients with central pain, which is significantly different from that in patients with non central pain. FMRI is expected to be the basis for clinical evaluation of FMS.in addition to the imaging findings, the brain neurotransmitters in FMS patients also changed. The concentrations of glutamate, 5-HT 2a, 3a and other transmitters involved in the increase of pain control "volume" increased, while norepinephrine and 5-HT 1A participated in the decrease of pain control "volume", B concentration decreased, resulting in pain amplification, patients with generalized pain.neurotransmitter changes in patients with FMS - 3-2020, what are the latest treatment options for FMS? Based on the mechanism of central pain regulation, the treatment of FMS includes drug treatment and non drug treatment.and it is very important for the patients to understand that the disease does exist, there is no damage to any internal organs, effective treatment can be obtained, and it will not seriously deteriorate or be fatal; at the same time, the mental and sleep problems of patients should be taken into account.strong evidence drug therapy includes tricyclic antidepressants (such as amitriptyline), calcium channel regulators (such as pregabalin, gabapentin), norepinephrine reuptake inhibitors (SNRIs, such as duloxetine, venlafaxine), serotonin reuptake inhibitors (SSRIs), etc.moderate evidence drug therapy includes tramadol, low selective SSRIs, gamma hydroxybutyric acid, low-dose naltrexone, and medical hemp extract.low evidence intensity drug therapy includes: growth hormone, 5-hydroxytryptamine, tropisetron, S-adenosylmethionine.in addition, in terms of drug treatment, Professor Daniel clausw emphasized that non steroidal anti-inflammatory drugs (NSAIDs), benzodiazepines / non benzodiazepines insomnia drugs and opioids were ineffective in the treatment of central pain, but benzodiazepines / non benzodiazepines could improve sleep problems in patients with FMS.Professor Daniel clausw: with the progress of the research, we have noticed more and more that the complexity of central pain represented by FMS is beyond our imagination.opioids are high-level transmitters involved in the "volume" lowering effect, so they are useless for the treatment of FMS.although opioids have no effect in the treatment of FMS, medical marijuana shows a wide range of prospects in this respect.Professor Daniel Claus said he didn't like marijuana for pain - because it looked like drug use - but apparently marijuana was much better than opioids In recent years, the field of non drug treatment of FMS has gradually attracted the attention of clinicians. The non drug treatment with strong evidence level includes patient education, aerobic exercise and cognitive behavior therapy; the non drug treatment with medium evidence level includes strength training, hypnosis, massage, yoga and Taiji, acupuncture and massage, etc.Professor Daniel clausw pointed out that the combination of non drug therapy and drug therapy is the best way to treat FMS. His team has achieved good results by setting up a website for patients with cognitive behavioral therapy. After that, this part of work will gradually turn to mobile phone application (APP). Danniel Clauw Professor: Although the level of vitamin D is generally insufficient in patients with FMS, there is no evidence to show that vitamin D supplementation is effective in relieving the pain of FMS. I don't think that there is a relationship between small fiber neuropathy and FMS, but some scholars hold different views, which is a controversial topic. Neuroinflammation and glial activation also seem to be related to FMS. In addition, nutritional therapy has shown that it is effective in relieving pain in FMS Potential. these are new findings, which can provide some reference for future treatment. this year, Professor Daniel Claus has also included diet and nutrition therapy in his speech. in a study published in 2017, his team tried to carry out diet intervention on patients with FMS. The results showed that when patients successfully lost weight, their pain and fatigue were greatly relieved. Professor Daniel clausw said that for some patients with severe pain, daily exercise is not realistic, and diet therapy may be a new direction in the future.