纤维肌痛综合征的研究进展

纤维肌痛综合征(fibromyalgia syndrome,FMS)是一种原因未明的临床综合征,表现为慢性全身性关节及肌肉的疼痛。1990年美国风湿病学会(ACR)分类标准定义为弥漫性的慢性疼痛持续3个月以上,累及身体两侧及腰上下部,18个特殊压痛点中大于11个压痛点有增强。症状常因劳累、应激、缺乏睡眠和天气的改变而加重[1]。FMS是风湿痛门诊中的常见病,是一种与生命质量及身体机能减退相关的复杂的综合征,迄今为止,FMS的病因、发病机制尚未完全阐明,治疗亦未有一个明确的指南,但近10年来,FMS在以上方面的研究有很大的进展,现综述如下。1发病机制新的研…     

纤维肌痛综合征的诊治进展

一直以来,纤维肌痛综合征(FMS)是慢性疼痛综合征里面最难治疗的疾病之一.国内无相关患病率报道,在发达国家患病率约0.5％～5.8％[1].相比于类风湿关节炎、骨关节炎,FMS对生活质量的影响更大,常常能致残,其造成自杀和意外死亡也明显高于正常人群,给社会和家庭带来了严重的负担.尽管美国风湿病学会制定诊断标准,但本病并无风湿的生物标记,发病机制尚未明确,因此疾病性质存疑.我们就有关FMS诊断和治疗方面的进展简述如下.     

纤维肌痛综合征研究近况

纤维肌痛综合征(Fibromyalgia Syndrome,FMS)是一种以全身广泛性肌痛和触痛、睡眠障碍、晨间僵硬以及疲劳为特征的疾患。本文对FM3发病机理、临床表现、诊断和治疗作一综述,以提高对本病的认识。 FMS的病因和发病机理 FMS是累及肌肉和邻近组织的非关节风湿综合征,其发生主要与代谢、神经内分泌异常相关。关于FMS的发病机理,文献报道有:(1)食物中色氨酸摄入不足,脑组织中血清素减少学说;(2)儿茶酚胺产生增加,痛性感觉刺激失控学说;(3)丘脑-垂体-肾上腺轴机能异常学说;(4)甲状腺激素分泌减少学说;(5)女性激素失调学说等。多数作者提出,在本病的发病机制中,血     

纤维肌痛综合征52例临床分析

目的 分析纤维肌痛综合征(FMS)的临床特点、诊断和治疗等,提高对该病的认识.方法 回顾性分析我院2008年7月至2011年7月诊治的52例FMS的临床资料,并结合文献,探讨其临床特点、实验室检查、治疗和预后等.结果 52例FMS患者中女性和男性的比例约为9∶1,平均确诊时间4年,疼痛呈弥漫性,压痛多呈对称性,疲劳和睡眠障碍为最常见症状,无特异性的实验室检查,37例单纯药物治疗患者中有21例(57％)症状缓解,15例联合治疗患者中,有12例(80％)症状缓解.结论 FMS发病率高,临床表现多样,应引起临床医生的足够重视,由于本研究样本数量的限制,尚不能得出联合治疗优于单纯药物治疗的结论.     

严重急性呼吸综合征后纤维肌痛综合征一例

严重急性呼吸综合征(severe acute respiratory syndrome，SARS)是一种由冠状病毒感染引起的传染性呼吸道疾病。纤维肌痛综合征是一种以弥漫性、全身肌肉疼痛为突出临床表现的慢性风湿病，其发病与一些病毒感染和应激因素有关,常与许多疾病伴发。SARS感染后合并纤维肌痛综合征的病例较少报道，我院遇到1例．现报告如下.     

针罐结合治疗纤维肌痛综合征28例

纤维肌痛综合征(fibromyalgiasyndrome,FS)是一种以周身弥漫性疼痛为主要表现的特发性疾病。本病多发于中老年,发病机理尚不清楚,但多伴有疲劳、抑郁、睡眠障碍、头痛、肠道刺激症状。笔者采用背部腧穴针刺,结合走罐治疗FS28例,并与体针治疗作对照观察,进一步探讨针灸治疗该病的机理。1临床资料1.1一般资料所有病例均系2001年2月～2004年3月本院门诊病人,并随机分为两组。针罐组(治疗组)28例,男9例,女19例;年龄57～74岁,平均年龄66岁;体针组(对照组)20例,男4例,女16例;年龄56～72岁,平均年龄64.5岁。两组患者在性别、年龄、病程、压痛点个…     

纤维肌痛综合征疼痛症状临床疗效观察

目的比较阿米替林基础治疗,加用米氮平,加用白芍总苷胶囊及联合用药4组对纤维肌痛综合征(FS)的疗效。方法分别测定记录4组治疗前,治疗1、3个月末时,疼痛程度目测标尺法(VAS)评分、90项症状自评量表(SCL—90)、Hamilton焦虑量表(HAMA)、Hamilton抑郁量表(HAMD)的变化比较。结果①B组1、3个月末SCL—90下降值明显低于A组(P<0.05);②C组1个月末VAS下降值明显低于B组(P<0.05);③D组1、3个月末的VAS/SCL—90下降值明显低于A、B、C组(P<0.05);④本研究中使用的HAMA、HAMD量表,观察中与临床症状、体征变化缺乏一致性。结论①在阿米替林等药物治疗FS基础上,联合小剂量米氮平及白芍总苷胶囊能明显提高疗效,且较安全。②SCL—90量表引入FS疗效评定,对FS症状的量化、活动度观察可能有益。③HAMA和HAMD量表不适用于FS诊断及疗效观察。     

风湿性多肌痛19例临床分析

风湿性多肌痛（PMR）是一种好发于老年人的疾病．在白种人中发病率高，我国发病率不高，20世纪90年代才有陆续的报道。由于本病尚无特异性的诊断方法，易误诊、漏诊。为提高对PMR的认识，分析了1994-2006年我院收治的19例PMR的临床特点、实验室检查、治疗效果．并结合循证医学文献对诊断和治疗进行讨论。     

电致孔透皮给药治疗纤维肌痛综合征20例

原发性纤维肌痛综合征(FMS)是一种非关节性的软组织风湿病,主要表现为广泛对称的肌肉骨骼疼痛、僵硬,伴有失眠、心理障碍。劳累、应激、失眠和天气的变化会加重病情。目前,阿米替林是治疗FMS的主要药物,但疗效不理想,且副作     

Comparisons of spontaneous pain and tenderness in patients with primary fibromyalgia

Summary Pain was assessed in 47 patients with fibromyalgia in the University Rheumatology Clinic in Basle with the aid of three different techniques. First, a simple visual analog scale was used, later a body diagram on which patients could indicate pain separately in different regions of the body (pain score) and, finally, dolorimetric measurements at 56 typical PFS tender points. After four weeks of therapy, pain was again scored by patients using these techniques. The changes in assessment were compared with the aid of Spearman correlation. Data recorded with the aid of the body diagram correlated better with dolorimetric findings than did the results obtained from a simple visual analog scale. The severity of the disease can be more objectively assessed using these three techniques than it can using only the visual analog scale. In particular, the pain score and dolorimetry make possible a clear assessment of the value of therapeutic regimens.With the support of the Deutscher Akademischer Austauschdienst e.V., D-5300 Bonn-Bad Godesberg.     

Interdisciplinary treatment for fibromyalgia syndrome: Clinical and statistical significance

Objectives. The primary purposes of the study were to: evaluate the treatment efficacy of an outpatient, interdisciplinary treatment program for fibromyalgia syndrome (FMS); examine whether treatment gains would be sustained for 6 months following the treatment; assess whether improvements were clinically significant; and delineate the factors associated with clinically significant improvement in pain severity. Methods. Sixty-seven FMS patients completed a 4-week outpatient program consisting of medical, physical, psychologic, and occupational therapies. Six-month followup data were available for 66% of treated patients. Results. Comparisons between pretreatment and posttreatment measures revealed significant improvements in pain severity, life interference, sense of control, affective distress, depression, perceived physical impairment, fatigue, and anxiety; however, there was no improvement in interpersonal relationships or general activities. Clinically significant improvement in pain severity, using the Reliable Change Index, was obtained by 42% of the sample and was predicted by the pretreatment levels of depression, activity, perceived disability, solicitous responses of significant others, and idiopathic onset. Pretreatment level of pain severity was not a significant predictor of the degree of pain improvement. Comparisons among pretreatment, posttreatment, and 6-month followup data revealed that the patients maintained treatment gains in pain, life interference, sense of control, affective distress, and depression. However, the quadratic polynomial analysis revealed that relapse occurred in the subjective rating of fatigue. Conclusions. The results suggest that, overall, an outpatient interdisciplinary treatment program was effective in reducing many FMS symptoms. Treatment gains tended to be maintained for at least 6 months. However, there were large individual differences in response to treatment. These results suggest that identification of subgroups of FMS patients and their specific clinical characteristics may be useful for maximizing treatment efficacy.     

Effect of body weight on pain,sleep quality,and depression in patients with primary fibromyalgia syndrome

Aim of the workObesity and fibromyalgia syndrome (FMS) are two diseases, which are becoming more common and have an impact on social life. This study aimed to evaluate the effect of body weight on pain, sleep quality, and depression in patients with primary FMS and to assess its impact on the functional status.Patients and methodsThe study included 234 patients with primary FMS. The body mass index (BMI) was determined. The visual analog scale (VAS), Beck depression inventory (BDI), and the Pittsburgh sleep quality index (PSQI) were used for evaluating the patients. The Fibromyalgia impact questionnaire (FIQ) was assessed. The patients were divided into 3 groups: normal weight, overweight and obese.ResultsThe mean age of the patients was 40.3 ± 11.01 years (19–65 years); 206 (88%) were female, and 28 (22%) were males. The mean BMI was 28.8 ± 7.1 (17.7–49.1): 80 (34.2%) had a normal weight (24.4 ± 1.8), 76 (32.5%) were overweight (26.4 ± 1.6), and 78 (33.3%) were obese (37.9 ± 5.9) (p < 0.001). The FIQ, BDI, and PSQI were significantly higher in the obese patients compared to the normal and overweight (p < 0.001). The BMI, VAS, BDI, and FIQ were comparable between females and males while only the PSQI was significantly reduced in males (p = 0.004). A significant correlation was found between BMI with the PSQI, BDI, and FIQ (r = 0.11, p = 0.009; r = 0.41, p < 0.001 and r = 0.35p < 0.001 respectively).ConclusionObesity in primary FMS patients was significantly related to pain, sleep disorders, and depression. The importance of movement and weight control in FMS is emphasized.     

Dimensions of psychological dysfunction in patients with fibromyalgia: development of an Italian questionnaire

Our objective was to observe whether dysfunctional psychological dimensions of pain could be detected in fibromyalgia patients through the development of a new questionnaire. An original questionnaire composed of 51 items was given to 250 patients (185 females and 65 males, mean age 55±12.8 years) suffering from chronic fibromyalgia according to the criteria of the Multicenter Criteria Committee of the American College of Rheumatology. A Varimax computerized program of factorial analysis with orthogonal and oblique rotation of the axes was used to analyze the data. Five strong independent factors were identified: 1) catastrophizing and 2) external control beliefs (cognitive); 3) alexithymia (emotional); 4) restless behavior (behavioral); and 5) need for support (relational). Our questionnaire is a preliminary development of an Italian language psychological characterization of FM patients which may be a relevant and useful tool for the evaluation of the outcome of clinical/psychological treatment of FM.Abbreviations FM Fibromyalgia     

An open-label long-term phase III extension trial to evaluate the safety and efficacy of pregabalin in Japanese patients with fibromyalgia

Objectives

To assess the long-term safety and efficacy of pregabalin for the treatment of Japanese patients with fibromyalgia (FM).

Methods

This 53-week, open-label extension study was conducted at 20 study sites in Japan in patients with FM who had completed a preceding 16-week, placebo-controlled, double-blind trial. Patients received pregabalin, starting at 150 mg/day and increasing to a maintenance dose of 300 or 450 mg/day. The primary endpoint was safety, and secondary endpoints included measures of pain, sleep, and physical functioning.

Results

106 patients entered the trial and received at least one dose of the study drug. The most common treatment-related adverse events were somnolence, dizziness, increased weight, and constipation. There were no treatment-related serious or severe adverse events. There were five (4.7 %) discontinuations due to adverse events, of which three (2.8 %) were considered related to the study drug. Most adverse events resolved over time and could be managed without dose reduction or treatment discontinuation. Improvements in secondary efficacy endpoints of pain, sleep, and physical functioning emerged early in the study and were maintained for the duration of treatment.

Conclusions

These data indicate that the long-term treatment of Japanese FM patients with pregabalin may be both safe and effective.     

Muscle performance in fibromyalgia syndrome

The objective of the study was to examine the muscle performance, isokinetic muscle strength, muscle endurance ratio, and submaximal aerobic performance in fibromyalgia syndrome (FMS) patients, to evaluate the relation between muscle performance, pain severity, clinical findings, and physical activity level, and to compare the results with healthy control subjects. Twenty-four FMS patients and 15 control subjects participated in this study. Data were obtained about the symptoms, location and onset of pain, treatment, and associated symptoms. Patients and controls underwent an examination of isokinetic muscle strength of right quadriceps on a Cybex dynamometer, and submaximal aerobic performance tests (PWC-170) were done for all subjects. Maximal voluntary muscle strength of the quadriceps was significantly lower in patients compared with the control group. Endurance ratios showing the work capacity were not statistically different between two groups. Submaximal aerobic performance scores were higher in the control group. There was not a relation between the decreased muscle performance and clinical findings, including pain severity, number of tender points, and duration of the symptoms of FMS patients. We found a reduced quadriceps muscle strength and submaximal aerobic performance in patients with FMS, indicating that patients have impaired muscle function. Received: 17 March 1999 / Accepted: 29 July 1999     

Reliability of ACR criteria over time to differentiate classic fibromyalgia from nonspecific widespread pain syndrome: a 6-month prospective cohort study

Abstract

American College of Rheumatology (ACR) 1990 criteria, initially introduced to classify fibromyalgia (FM) syndrome, has gained popularity in research and clinical grounds for diagnostic purposes. The objectives of this study were designed to assess the consistency of ACR criteria against the time in classifying FM. This was a prospective cohort study performed in a multidisciplinary pain clinic from October 2002 to June 2005. Patients who were clinically suspected of having FM and had a normal screening laboratory evaluation were scheduled for dolorimetry. Those found to have 6 or more tender points were considered eligible and labeled as either classic or atypical FM if they did or did not, respectively, fulfil ACR criteria. The 2 groups were assessed using the Fibromyalgia Impact Questionnaire (FIQ) and compared using baseline characteristics. We reassessed dolorimetric exam and FIQ 6 months later. Of 91 patients who participated in this study, 70 completed the follow-up. Of them, 34 (49%) patients were identified as atypical, and 36 (51%) were labeled as classic FM. At first visit, the classic FM group had higher scores on sleep quality, stiffness, anxiety, depression, and total FIQ score (p < 0.05) but not for other variables. At 6 months, there was no significant difference between the 2 groups in all measured variables. Labeling shift from classic to atypical FM and vice versa occurred at a rate of 36.1 and 32.4%, respectively. This study showed the ACR 1990 criteria was not able to consistently classify affected patients with FM syndrome within a group of patients having nonspecific body pain and multiple tender points over 6 months of follow-up.     

Attentional functioning in fibromyalgia,rheumatoid arthritis,and musculoskeletal pain patients

Objectives

To investigate whether chronic pain patients have deficits in attentional functioning compared with pain‐free controls, and whether fibromyalgia patients have larger deficits in attentional functioning compared with rheumatoid arthritis and musculoskeletal pain patients.

Methods

Sixty patients (20 in each of 3 patient groups) and 20 pain‐free controls completed measures assessing pain intensity, mood, pain‐related disability, somatic awareness, and catastrophic thinking about pain. Attentional functioning was assessed using an age‐standardized, ecologically valid test battery. Analyses were made of between‐group differences.

Results

Sixty percent of patients had at least one score in the clinical range of neuropsychological impairment, independent of demography and mood. Fibromyalgia patients were more anxious and somatically aware than rheumatoid arthritis or musculoskeletal pain patients, but did not show larger attentional deficits than other patient groups.

Conclusion

All 3 groups of chronic pain patients, regardless of diagnosis, had impaired cognitive functioning on an ecologically sensitive neuropsychological test of everyday attention.