Primary fibromyalgia

Primary fibromyalgia is formed for reasons that have not yet been established or specified by medicine, but as a disease it is considered an independent nosological unit, in contrast to another form of FMS - secondary, which is formed against the background of the underlying pathology.

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Causes primary fibromyalgia

The names of primary FMS may vary, since there is still no systematization of etiological causes, however, starting in 1977, thanks to the developments of Smith and Moldovsky, the diagnostic criteria for fibromyalgia began to be systematized, which were subsequently clarified twice - in 1981 (Yunus criteria) and finally - in 1990 by the American College of Rheumatologists.

It is obvious that primary fibromyalgia has existed since humans began to get sick. Of course, reliable informative sources from antiquity have not survived or, at least, have not yet been found. However, symptoms similar to those of FMS – fibromyalgia, are described in the works of the founding father of medicine – Hippocrates. The first clinical cases of fibromyalgia were officially recorded only at the end of the 19th century. Then, a decade later, a detailed article about lumbago appeared in a scientific medical journal, the author of which was an outstanding English neuropathologist, also known for studying epilepsy and Parkinson's disease. William Gowers, in addition to lumbago, described diffuse pain in the periarticular muscles in sufficient detail, calling this syndrome fibrositis. A little later, he also put forward a version of a form of myositis, which was later called Gowers-Welander myopathy.

In the 1950s, Boland's theory of the psychogenic etiology of fibromyalgia appeared; the author of the version called the disease psychogenic rheumatism, associating the formation of pain syndrome with stress and depression. For more than two decades, doctors diagnosed FMS as a psychosomatic disease characterized by polyarthralgia, spread throughout the body and without a specific organic pathology.

Beginning in the 1970s, rheumatologists began to study musculoskeletal pain more thoroughly as the disease's prevalence began to grow. A series of publications by Smith and Moldovsky revolutionized the understanding of what primary fibromyalgia is. These scientists identified the relationship between the disease and sleep disorders, and they were the first to present diagnostic criteria, which to this day include certain trigger (tender - painful) points on the body.

In 1981, the Americans Yunus and Masi proposed a unified terminology describing the syndrome disease, from that moment on, the disease was called fibromyalgia and its forms were defined - primary fibromyalgia, as well as secondary. In 1993, at a conference held in Copenhagen, fibromyalgia, including primary fibromyalgia, was officially recognized by the entire world medical community as a separate nosological unit, as well as the most common factor provoking chronic muscle diseases.

Primary fibromyalgia is still a polyetiological disease, since there is no single medical concept that would accommodate the versions and theories proposed by researchers. Summarizing the diversity of etiological variants, they can be systematized into two main categories:

• The primary cause in the pathogenesis of the disease is a change in the sequence of perception of pain sensations.
• The primary cause in the pathogenesis of fibromyalgia is a pain focus localized in trigger points, which subsequently generalizes into typical symptoms of fibromyalgia - diffuse pain, sleep disturbance, depression, decreased physical activity.

There is also a concept that describes an imbalance in neurochemical communication, in particular, a deficiency in serotonin levels, which, according to the authors of the version, provokes the formation of fibromyalgia syndrome. There is a theory that primary fibromyalgia is a consequence of genetic disorders and is inherited.

The remaining concepts, which include the traumatic factor, endocrine and infectious nature of the disease, relate more to the second form of FMS – secondary fibromyalgia.

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Symptoms primary fibromyalgia

Clinically, the symptoms are manifested in the following signs and sensations:

• Diffuse pain in certain areas of the body, which over time becomes generalized and spreads throughout the body.
• A decrease in all vital functions, including intellectual activity, physical fatigue and apathy appear.
• Insomnia develops – a disturbance in the process of falling asleep, the middle phase of sleep is disrupted, in the morning the patient feels tired, “broken down”.
• Signs of depression increase, the depressive state worsens with the spread of pain in the periarticular tissues.
• An anxious state develops, up to the appearance of cardiological symptoms – tachycardia.
• There is no stability in blood pressure, it becomes labile.
• Stiffness, rigidity of muscles.
• Angiospasm syndrome develops – Raynaud's syndrome.
• The functioning of the digestive system is disrupted - constipation alternates with diarrhea.
• Due to disturbances in the functioning of the central nervous system, there may be manifestations of suffocation and sleep apnea.
• Women experience menstrual cycle irregularities.
• Headaches appear, the symptoms of which are similar to those of migraine.
• Disorders of the salivary and lacrimal glands develop with symptoms similar to Sjogren's syndrome.

According to the criteria proposed by the American College of Rheumatology, the following manifestations can be considered diagnostic symptoms:

• Manifestation of myofascial pain for three months.
• The painful sensations are distributed symmetrically: left and right, top and bottom.
• Stiffness in three or more anatomical zones defined by the American College of Rheumatology.
• During palpation, the patient feels pain in 11 or more of the 18 points suggested by rheumatologists:
  • Occipital region.
  • Cervical region.
  • Middle of the trapezius muscle.
  • Supraspinatus muscle.
  • The area of the second rib (articulation).
  • Lateral epicondyle of the humerus.
  • Upper quadrant of the buttocks.
  • Greater trochanter of the femur.
  • Medial cushion of the knee joint.

Treatment primary fibromyalgia

Treatment of primary, as well as secondary fibromyalgia is not an easy task, given the unclear etiology of the disease and the lack of a single therapeutic strategy accepted in the medical community. It is obvious that primary fibromyalgia requires more careful attention from doctors, since the disease is still considered incurable.

Among the most effective and efficient drugs for the treatment of fibromyalgia, rheumatologists name tricyclic antidepressants and anticonvulsants, which affect the excitability of brain structures and somewhat reduce the threshold of pain perception. SSRIs - selective serotonin reuptake inhibitors are still considered ineffective in the treatment of FMS drugs, but they are prescribed as drugs that improve the overall neuropsychiatric state. Also, in the last five years, the method of treating fibromyalgia with the drug Lyrica (pregabalin), approved by the International Association for the Study of Pain, has become widespread.

As a symptomatic treatment, muscle relaxants are indicated, which are administered by injection or taken orally. The use of non-steroidal anti-inflammatory drugs is possible, however, their effectiveness is low and short-term; local anesthesia with ointments and solutions containing novocaine or lidocaine is much more effective.

Primary fibromyalgia also requires long courses of psychotherapeutic sessions, study of autogenic training methods and relaxation techniques.

Common sense, which is a contribution from the patient himself, will also be useful. Since primary fibromyalgia requires complex and long-term treatment, the patient needs to learn to live with his disease and not overly dramatize its manifestations. In addition, common sense will help to more reasonably draw up a daily schedule, minimize the risk of excessive physical and psycho-emotional stress, but strict bed rest for fibromyalgia is a direct path to worsening symptoms. Competent distribution of your resources, dosed activity, performing simple aerobic exercises and a set of therapeutic physical training, adherence to the rules of rational nutrition significantly improve not only the effect of therapeutic actions, but also the patient's quality of life.