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MODERN METHODS AND TREATMENT OF FIBROMYALGIA SYNDROME
Egamov Dadajon Bakhtiyorovich
Bukhara State Medical Institute
https://doi.org/10.5281/zenodo.13932691
Abstract
: One of the most widely discussed currently various models of chronic pain
syndrome is fibromyalgia (FMA), a symptom complex characterized by chronic diffuse
musculoskeletal pain, the presence of pain points, depression, sleep disorders, morning
stiffness, asthenia. FMA refers to a common form of pathology - 2-6% in the population (up to
10%, according to some authors) which undoubtedly determines the relevance of its study.
Women suffer significantly more often (80-90%) than men (10-20%)
Key words:
fibromyalgia, fibromyositis, neurology.
Introduction.
The term "fibromyalgia" comes from Latin. fibro (tendons and ligaments),
Greek. myo (muscles) and algos (pain). It first appeared in the literature in 1981, after the
publication of the diagnostic criteria of the disease proposed by M. Yunus. Before that, many
terms were used: fibromyositis, neuroosteofibrosis, tendon myopathy, soft tissue rheumatism.
All of them emphasized the role of inflammatory changes in muscles as the cause of pain.
During the evolution of views on the nature of the disease (when the absence of
inflammatory changes in muscle tissue was established), FM was "displaced" beyond the limits
of purely rheumatological pathology. Currently, FM is an interdisciplinary problem and is
studied within the framework of various medical specialties: rheumatology, neurology,
endocrinology, psychiatry. However, due to tradition, FM patients are most often represented
in rheumatology practice. At the same time, there is a paradoxical situation when the actual
diagnosis of FM is practically absent in the daily practice of a rheumatologist, since FM is still
not well known to Russian doctors and is often not recognized by them as an independent
disease. In many cases, rheumatologists (as well as neurologists) evaluate the condition of FM
patients in accordance with the leading comorbid manifestations (diagnose "widespread
osteochondrosis", "chronic myofascial syndrome", "osteoarthritis", "tension headaches", "panic
attacks", etc. D.), underestimating the role and importance of mental disorders and stress in
these patients. On the other hand, psychiatrists also do not diagnose FM, because they do not
analyze the somatic condition of patients (they do not examine sensitive points, etc.). Such
medical ignorance is a problem (and even a danger) for patients who need timely and adequate
treatment. The predominance of PMA among people of the most working age, the duration of
pain, and negative emotional experiences associated with pain manifestations lead to a
significant decrease in the quality of life of patients, which manifests itself in limited
communication and the inability to fully participate in social life.
Treatment: The aim of treatment is to control the manifestations of FM to the maximum
extent possible.
Drug therapy
Analgesic drugs. Since pain is the leading symptom, patients are often prescribed
painkillers, in addition, patients themselves, as a rule, have long-term experience of their use.
Such drugs include analgin, paracetamol, and a synthetic analgesic of central action —
tramadol. The effect is short-term. Morphine alkaloids are poorly tolerated and are not used in
the treatment of FM.
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Nonsteroidal anti-inflammatory drugs. Although FM is not an inflammatory rheumatic
disease, sometimes local NSAID therapy is used in the form of ointments or gels with dimethyl
sulfoxide, as well as local injections in combination with anesthetics (in particular, lidocaine).
Ketorolac, diclofenac, naproxen, etc. are used.
Steroids. Drugs of this group are ineffective, however, they are sometimes used as a local
injection into a painful point.
Tranquilizers. The use of benzodiazepines in FM is not indicated, since they cause a
reduction in stage IV sleep and may contribute to an exacerbation of the symptoms of the
disease.
Antidepressants.
Antidepressant therapy is actually aimed at eliminating serotonin
deficiency. These drugs are also effective in the treatment of sleep disorders, pain and asthenia.
Of the group of tricyclic antidepressants, amitriptyline is most often used, usually at an
initial dose of 10 mg per night, the dose can gradually be increased to a maximum of 50 mg. The
drug also has many side effects: it contributes
to weight gain, the appearance of xerostomia, headaches. Imipramine is used less often.
Currently, more modern antidepressants are used — serotonin reuptake inhibitors:
sertraline, fluoxetine, paroxetine, duloxetine, citalopram. The results of their use in the
treatment of FM are still contradictory. The disadvantage of using these medicines is that they
can cause insomnia, anxiety, nervousness, which is why they should be prescribed only in the
morning.
It has been proven that in order to obtain a therapeutic effect in patients with FM, the
appointment of lower doses of antidepressants is required than for the treatment of depression.
Treatment should begin with a minimum dosage, in the absence of an effect, the dose is
gradually increased. 2-3 months are needed to adequately assess the effectiveness of
antidepressants. In the absence of an effect, the drug is changed. The withdrawal of
antidepressants must necessarily be gradual. As a rule, the actual depressive manifestations
begin to be reduced only from the 2nd-3rd week of treatment, which requires a certain amount
of endurance when working with a patient. A persistent therapeutic effect is noted under the
condition of long-term (up to 6 months) constant intake of antidepressants.
Hypnotics. Zopiclone and zolpidem are used. They do not reduce the proportion of REM
sleep. They can be used for severe symptoms of sleep disorders. They are characterized by good
tolerability and have a minimum of side effects. These drugs can be used 1 tablet 2-3 times a
week 30 minutes before bedtime.
Muscle relaxants. In some cases, muscle relaxant drugs are used: tizanidine, tolperisone,
cyclobenzaprine, baclofen, dantrolene. These drugs have an antispasmodic and analgesic effect,
especially pronounced if taken before bedtime.
Anticonvulsants. These medications are commonly used to treat epilepsy. An
anticonvulsant drug, pre—gabalin, is sometimes used in the treatment of FM.
Antioxidants. There are reports on the effectiveness of antioxidants (ascorbic acid,
vitamin E).
Botulinum toxin. Currently, the introduction of botulism toxin (botox, dysport) into
painful points has found application.
Conclusions:
thus, the relevance of this study is due to the prevalence of PMA, the
importance of medical and social aspects of the disease, taking into account economic losses,
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the need to develop a differentiated approach to therapy and rehabilitation of PMA, taking into
account the clinical and functional characteristics of the course of the disease and the
emergence of new rehabilitation tools.
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Lotman F., Branko J. Bibliography. New York: Privat Publishing House, 2017: 253 p.
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Cloud D. J. Cybernetics: extensive information on mechanisms and treatment // J. Klin.
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Crawford L. J. The relationship of fibromyalgia with neuropathic syndromes // J.
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