Primary fibromyalgia

Primary fibromyalgia is formed for reasons not yet established and not concretized medicine, however, as a disease is considered an independent nosological unit, unlike another form of FMS secondary, which is formed against the background of the underlying pathology.

[1], [2], [3], [4], [5], [6],

Causes of the primary fibromyalgia

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

It is obvious that the primary fibromyalgia has existed since the man began to ache. Of course, reliable informative sources of antiquity have not been preserved or, at least, have not yet been found. However, symptoms similar to the symptoms of FMS - fibromyalgia, are described in the works of the father-founder of medicine - Hippocrates. The first clinical cases of fibromyalgia were officially recorded only at the end of the XIX century. Then a decade later in the scientific medical journal appeared an extended article about lumbago, authored by an outstanding English neuropathologist, also known for the study of epilepsy and Parkinson's disease. William Hovers, in addition to lumbago, described in some detail diffuse pain in the periarticular muscles, calling this syndrome - fibrositis. A little later he also put forward a version about the form of myositis, which was later called the Hovers-Welander myopathy.

In the 50s of the last century Boland's theory of the psychogenic etiology of fibromyalgia appeared, the author of the version called the disease psychogenic rheumatism, linking the formation of pain syndrome with stress and depression. For more than two decades, doctors have diagnosed FMS as a psychosomatic disease characterized by polyartralgia, common in the body and not having a certain organic pathology.

Since the 70s of the XX century, rheumatologists began to study more muscular-skeletal pains, as the prevalence of the disease began to grow. A number of publications by Smith and Moldovski have made a kind of revolution in the notion of what is primary fibromyalgia. It was these scientists who identified the relationship between the disease and sleep disturbances, and they also presented diagnostic criteria for the first time, in the capacity of which certain trigger points (tender-painful) points on the body are acting to this day.

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

Until now, primary fibromyalgia is a polyethiologic disease, since there is no single medical concept that would fit the versions and theories proposed by the 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. 
• The primary cause in the pathogenesis of fibromyalgia is a focus of pain localized at trigger points, which is subsequently generalized to typical symptoms of fibromyalgia-diffuse pain, sleep disturbance, depression, and decreased physical activity.

There is also a concept describing the imbalance of neurochemical communication, in particular the insufficiency of the level of serotonin, which, according to the authors of the version, provokes the formation of fibromyalgic syndrome. There is a theory claiming that primary fibromyalgia is a consequence of genetic disorders and is inherited.

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

[7], [8], [9], [10], [11], [12]

Symptoms of the primary fibromyalgia

Clinically, the symptomatology is manifested in the following signs and sensations: 

• Diffuse pain in certain parts of the body, which eventually becomes generalized and spreads to the whole body. 
• Reduction of all vital functions, including intellectual activity, there is physical fatigue, apathy. 
• Developed insomnia - violation of the process of falling asleep, the middle phase of sleep is broken, in the morning the patient feels tired, "broken". 
• There are signs of depression, the depressive state is aggravated with the spread of pain in the periarticular tissues. 
• An anxious state develops, until the appearance of cardiac symptoms - tachycardia. 
• There is no stability of blood pressure, it becomes labile. 
• Stiffness, rigidity of muscles. 
• The syndrome of angiospasm develops - Raynaud's syndrome. 
• The functioning of the digestive system is disrupted - constipation alternates with diarrhea. 
• In connection with violations from the central nervous system, there may be manifestations of suffocation, nocturnal apnea. 
• In women, the menstrual cycle is disrupted. 
• There are headaches, similar to symptoms of migraine symptoms. 
• Developmental disorders of the salivary and lacrimal glands on signs similar to the syndrome of Sjogren.

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

• Manifestation of muscular-fascial pain within three months. 
• Painful sensations have a symmetrical distribution: left and right, top and bottom. 
• Stiffness in three or more anatomical zones established by the American College of Rheumatology. 
• At palpation, the patient feels pain in 11 or more of the 18 points suggested by rheumatologists:
  • Occipital zone. 
  • Cervical area.
  • Middle of the trapezius muscle. 
  • Tough muscle. 
  • Area of the second rib (joint). 
  • Outer shoulder epicondyle. 
  • Upper quadrant of buttocks.
  • A large spit of the femur. 
  • The medial pad of the knee joint.

Treatment of the primary fibromyalgia

Treatment of primary, however, as well as secondary fibromyalgia - a difficult task, given the unclear etiology of the disease and the lack of a single therapeutic strategy adopted in the medical community. Obviously, primary fibromyalgia requires more attention from doctors, since the disease is still considered to be non-curable.

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

As symptomatic treatment is shown the intake of muscle relaxants, which are injected or taken orally. The use of non-steroidal anti-inflammatory drugs is possible, however, their effectiveness is short and short-lived, local anesthesia is much more effective with ointments and solutions containing novocaine or lidocaine.

Also, primary fibromyalgia involves long courses of psychotherapeutic sessions, the study of methods of autogenic training and relaxing techniques.

It will be superfluous and common sense, which is the contribution of the patient himself. Since primary fibromyalgia requires complex and long-term treatment, the patient must learn to live with his disease and not too dramatize its manifestations. In addition, common sense will help to make a more reasonable day schedule, minimize the risk of excessive physical and psychoemotional loads, but strict bed rest with fibromyalgia is a direct way to aggravating the symptoms. Competent distribution of their resources, dosage, performing simple aerobic exercises and a complex of exercise therapy, adherence to the rules of rational nutrition significantly improve not only the effect of therapeutic actions, but also the quality of life of the patient.