Fibromyalgia is the syndrome of generalized pain without trigger zones: Modern principles of diagnostics and treatment
R.G. ESIN1,2, O.R. ESIN2, N.Z. LOTFULLINA2, I.Kh. KHAYRULLIN3, L.N. MURADIMOVA3
1Kazan State Medical Academy, 36 Butlerov St., Kazan, Russian Federation, 420012
2Kazan (Volga region) Federal University, 18 Kremlyovskaya St., Kazan, Russian Federation, 420000
3Republican Clinical Hospital №2 of the MH of RT, 1a Chekhov St, Kazan, Russian Federation, 420012
Esin R.G. — D. Med. Sc., Professor of the Department of Neurology and Manual Therapy, Professor of the Department of Applied Linguistics, tel. (843) 2-33-30-87, e-mail: radyesin@gmail.com
Esin O.R. — Cand. Med. Sc., Assistant of the Department of Applied Linguistics, tel. (843) 2-33-30-87, e-mail: olegesin@gmail.com
Lotfullina N.Z. — junior research scientit of OpenLab of neurobiology, tel. (843) 2-33-30-87, e-mail: kindxheart@gmail.com
Khayrullin I.Kh. — neurologist, tel. (843)2-33-30-87, e-mail: ilshat.master@gmail.com
Muradimova L.N. — deputy chief physician at the medical unit, tel. (843)233-30-60.
The review examines modern concepts of pathophysiological mechanisms connected with fibromyalgia, modern principles of diagnosis and treatment from the standpoint of evidence-based medicine. The authors consider that fibromyalgia is a consequence of the weakness of the analgesic protection system (antinociceptive system). This weakness leads to the situation when insignificant nociceptive signals (normally suppressed) reach the cortical parts of the nociceptive system, forming the phenomenon of chronic widespread pain. The authors offer a treatment plan involving not the transition from weak to stronger drugs, but the initiation of treatment with strong medicines and the gradual transition to a more mild treatment. This approach helps to increase the compliance of the patient and treatment efficacy.
Key words: fibromyalgia, treatment, central sensitization, alexithymia.
REFERENCES
- Fibromyalgia, available at: http://www.merckmanuals.com/professional/musculoskeletal and connective tissue disorders/ bursa muscle_and_tendon_disorders/fibromyalgia.html #v908031 (accessed: 05.01.2015).
- ICD-10 Version: 2015, availablae at: http://apps.who.int/classifications/icd10/browse/2015/en#/M79.7, (accessed: 07.07.2015).
- Esin R.G., Lotfullina N.Z., Esin O.R. Tservikalgiya, dorzalgiya, lyumbalgiya: differentsial’naya diagnostika, differentsirovannaya terapiya [Cervicalgia, dorzalgiya, lumbodynia: differential diagnosis, differentiated therapy]. Kazan: Izd-vo Kazanskogo universiteta, 2015. 280 p.
- Esin R.G., Esin O.R., Mukhametova E.R., Lotfullina N.Z. Syndromes of central sensitization. Nevrologicheskiy vestnik, 2013, XLV (3), rr. 64-70 (in Russ.).
- Wolfe F., Smythe H.A., Yunus M.B., Bennett R.M., Bombardier C., Goldenberg D.L., Tugwell P., Campbell S.M., Abeles M., Clark P., Fam A.G., Farber S.J., Fiechtner J.J., Michael Franklin C., Gatter R.A., Hamaty D., Lessard J., Lichtbroun A.S., Masi A.T., Mccain G.A., John Reynolds W., Romano T.J., Jon Russell I. and Sheon R.P. (1990). The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Arthritis & Rheumatism, 33: 160-172. doi: 10.1002/art.1780330203. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia And Measurement of Symptom Severity, 2010. Frederick Wolfe et al. (Arthritis Care & Research.Vol. 62, no. 5, May 2010, pp. 600-610, DOI 10.1002/acr.20140).
- Wolfe F., Clauw D.J., Fitzcharles M.-A., Goldenberg D.L., Katz R.S., Mease P., Russell A.S., Russell I.J., Winfield J.B. and Yunus M.B. (2010). The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care Res, 62: 600-610. doi: 10.1002/acr.20140
- Enrico Bellato, Eleonora Marini, Filippo Castoldi et al. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment. Pain Research and Treatment, 2012, vol. 2012, article ID 426130, 17 pages. doi:10.1155/2012/426130, available at: http://downloads.hindawi.com/journals/prt/2012/426130.pdf (accessed: 05.01.2015).
- Tabeeva G.R. Fibromyalgia: the formation of symptoms and treatment principles. Nevrologiya, neyropsikhiatriya, psikhosomatika, 2012, no. 1, pp. 3-27 (in Russ.).
- Ablin J., Fitzcharles M.-A., Buskila D., Shir Y., Sommer C., Häuser W. Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies. Evid Based Complement Alternat Med., 2013; 2013: 485272. Published online Nov 21, 2013. doi: 10.1155/2013/485272 (accessed: 05.01.2015).
- Esin R.G., Gorobets E.A., Galiullin K.R., Esin O.R. Alexithymia — the main directions of study. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova, 2014, no. 12, pp. 148-151 (in Russ.).