Fibromyalgia syndrome (FMS) is a chronic musculoskeletal system disease of unknown cause, characterized by widespread body pain and the presence of tender points in certain anatomical areas. The annual diagnosis rate varies between 2-8%, it is more common between the ages of 40-60 and in women (85-90%). It is more common in those with low education and socioeconomic levels
The most common and characteristic symptoms of fibromyalgia syndrome are widespread pain, morning stiffness, waking up tired in the morning and sleep disturbance. In many patients, various problems such as sleep disturbance, fatigue, stiffness, drowsiness, depression, dry mouth, dry eyes, irritable bowel syndrome, dysmenorrhea (painful menstruation), urethral syndrome, palpitations, memory and cognitive disorders can be seen together with chronic widespread pain.
In 1990, ACR (American College of Rheumatology) defined the classification criteria of this disease as widespread body pain lasting at least three months and pain on palpation with 4 kg of pressure in at least 11 of 9 pairs of sensitive points on the right and left of the body. (It is the pressure that causes the nail bed to whiten when pressed with a finger on a hard surface).
In 2010, ACR published new diagnostic criteria and the number of tender points was not taken as a criterion; widespread body pain and symptom severity were taken into account. Fibromyalgia Syndrome, like other central pain syndromes, shows a strong familial predisposition. The incidence of Fibromyalgia Syndrome in individuals with first-degree relatives with Fibromyalgia Syndrome has increased 8.5 times compared to the normal population.
Environmental factors such as mechanical and physical traumas and psychosocial stress factors are among the causes of FMS. The most frequently detected physical traumas in patients with FMS are acute illness, physical injury, surgery, and motor vehicle accidents; Common psychosocial factors are chronic stress, emotional trauma, and emotional, physical or sexual abuse. Although it has been reported that 14-23% of fibromyalgia patients experience symptoms after physical injury, trauma or surgical intervention, a direct relationship between physical trauma and chronic pain has not been demonstrated. Also, patients with FMS Psychiatric disorders such as depression and anxiety are more common in the general population. Since the dominant symptom in fibromyalgia is muscle pain and stiffness, many studies have focused on changes in muscle tissue. The most striking finding in muscle biopsy studies is local anoxia (tissue deprivation of oxygen). . In this regard, some researchers have focused on microcirculation disorder. However, there are no consistent and detectable findings in either muscle biopsies or superficial EMG studies. Fibromyalgia, which is the most common syndrome among musculoskeletal diseases accompanied by chronic pain, has a significant health impact in terms of loss of workforce, treatment costs and psychological problems it creates in the patient. is the problem. It is known that there is a significant deterioration in the quality of life of FMS patients and their mental health is also affected. These problems also affect people's social and business lives, and can bring a significant economic burden due to loss of work force as well as health expenses.
In Fibromyalgia. Diagnosis:
Despite increasing knowledge about fibromyalgia syndrome, the lack of a diagnostic laboratory test or biomarker creates various difficulties in diagnosis. Physical examination of patients with fibromyalgia syndrome does not detect objective joint swelling, muscle weakness or abnormal neurological findings. Joint tenderness may be detected due to widespread pain. The presence of tender points is important in physical examination. Tender points can be revealed by palpation using 4 kg of manual pressure. 4 kg of pressure is the pressure that causes the nail bed to whiten when pressed with a finger on a hard surface. The first criteria to help diagnose fibromyalgia syndrome were put forward by the 1990 ACR. These classification criteria are based on the detection of widespread body pain and tender points.
1990 ACR (American College of Rheumatology) Fibromyalgia Classification Criteria:
1- Pain in the four quadrants, including the right and left halves of the body, the upper and lower halves of the waist, and in the axial skeleton (neck or back or lumbar spine or chest) for more than 3 months.
2- Defined At least 11 out of 18 tender points Feeling pain at a pressure below 4 kg with river palpation. For the diagnosis of FMS, the patient must meet both of the above-mentioned criteria.
However, in FMS, not only the absence of pain; New diagnostic criteria were published by ACR in 2010, since symptoms such as fatigue, sleep disorder, depression, anxiety disorder, and cognitive disorder that may accompany it are not included in these criteria. The 2010 ACR ancillary diagnostic criteria are based on a 'widespread pain score' based on the number of painful body parts and a 'symptom severity score' based on sleep disturbance, fatigue, cognitive symptoms and somatic symptoms.
2010 ACR Diagnostic Criteria:
Widespread Pain Score:
It includes the number of body parts where the patient felt painful in the last week. The patient's painful areas in the last week (Total score: 0-19)
Jaw (right-left) Shoulder girdle (right-left) Arm (right-left) Forearm (right-left)< br /> Hip (right-left trochantaric region) Thigh (right-left)
Leg (right-left) Back Waist
Chest Abdomen
Widespread Pain Score:
It includes the number of body parts where the patient felt painful in the last week. Areas where the patient has had pain in the last week (Total score: 0-19)
Symptom Severity Score: (0: None, 1: Mild, 2: Moderate, 3: Severe) (Total score 0-12 )
Fatigue
Waking up tired
Cognitive symptoms
Somatic symptoms
Somatic symptoms:
Muscle pain , muscle fatigue, weakness-fatigue, dizziness, insomnia, obsession, headache, abdominal pain/cramp, drowsiness, depression, irritability, loss of appetite, nausea, heartburn, oral aphtha, loss of taste sensation, irritable bowel syndrome, constipation (Constipation). ), diarrhea, chest pain, blurred vision, fever, dry eyes, dry mouth, itching, wheezing, Reynaud's phenomenon, rash, tinnitus, hearing loss, seizure, dyspnea (shortness of breath), photosensitivity ( sensitivity to light), easy bruising, hair loss, dysuria (painful urination), polyuria (frequent urination), bladder spasm.
1. Symptoms have been present at the same level for 3 months, and there is no other disorder that could explain the pain
2. Widespread pain score ≥7 and the symptom severity score should be ≥5 or the widespread pain score should be 3-6 and the symptom severity
score should be ≥9.
For the diagnosis of FMS, the patient must meet both of the above-mentioned criteria.
Fibromyalgia Treatment
The main goal in the treatment of fibromyalgia syndrome is to reduce pain, reduce symptoms and increase functionality. Since patients have many complex symptoms and accompanying conditions, treatments that include physical, cognitive, behavioral and educational approaches should be applied by a multidisciplinary team. Each patient should be evaluated individually and an individualized treatment should be planned according to their symptoms.
Patient Education: The most important factor in fibromyalgia treatment is patient education. The first condition is to explain to the patient what his illness is and gain his trust. It is very important for cooperation to explain that the disease is real and that there may be severe pain, but that these are not life-threatening and do not cause cosmetic problems.
Pharmacological Treatments: The patient should use the medicine recommended by his doctor, at the recommended dose and frequency.
Non-Drug Treatments:
Aerobic exercises, Stretching Exercises, Physical Therapy Modalities, Cognitive Behavioral Therapies, Interdisciplinary and Multidisciplinary approaches.
Physiotherapy in Fibromyalgia:< br /> Massage: performed to relax muscles
Hot and cold applications,
Ultrasound
Electrical stimulation
Magnetic field treatments; reduces muscle spasm.
Pain is reduced with Tens therapy.
Exercise Therapy
In addition to the modalities listed above, dry needle, cupping massage, acupuncture, myofascial massage, which they receive with special training from Specialist Physiotherapists and Specialist Doctors. Techniques such as relaxation are methods that have been used frequently recently and give very good results.
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