Фибромиалгия: принципы диагностики и терапии

Abstract

Fibromyalgia (FM) is one of the causes of chronic pain syndrome. The prevalence of FM in the general population is 2%. Etiology and pathogenesis of FM are not well understood. It is believed that the disorder results from interaction of genetic and psychosocial factors, as well as from environmental exposure. Central sensitization associated with inhibition of pain inhibitory pathways and altered levels of a number of neurotransmitters underlies pathogenesis of the disorder. Clinical pattern of FM is characterized by generalized chronic widespread pain that lasts for over three months and persists in the absence of any apparent organic lesions, which is usually accompanied by joint stiffness, pathological fatigue, sleep disturbances, cognitive dysfunction, and depression. Failure to define the site of injury makes FM difficult to diagnose. The diagnosis is often ignored or incorrectly established. To avoid such mistakes, it is recommended to begin the examination of the patient with suspected FM with the detection of generalized chronic widespread pain (calculating the Widespread Pain Index and Symptom Severity values) lasting for over three months. Upon detection of generalized chronic widespread pain, the major FM symptoms (sleep disturbances, fatigue) should be checked in accordance with the criteria, established by American College of Rheumatology in 2016. Pharmacological (antidepressants – duloxetine, milnacipran, amitriptyline; analgesics – tramadol, paracetamol; antiepileptic drugs – pregabalin) and non-pharmacological (education and awareness-raising activities, physiotherapy and psychotherapy) FM treatment methods are recommended. Unfortunately, these methods show moderate efficiency in reversing persistent symptoms, functional limitation and reduced quality of life in patients with FM.