FIBROMYALGIA SYNDROME
Fibromyalgia syndrome (FMS) is a musculoskeletal disease characterized by widespread pain in the musculoskeletal system and specific points called tender points. It is accompanied by weakness, sleep disturbance, subjective swelling in the extremities and paresthesias. It can be seen at any age, but is more common in women between the ages of 40-60.
PHYSIOPATHOLOGY
Sleep disorders
Neurohormonal dysfunction
Psychological disorders: Psychogenic pain, psychoneuroses and personality disorders
Muscle pathologies
FACTORS INCREASING FIBROMYALGIA SYMPTOMS
Cold and/or humid weather
Unrestorative sleep
Physical and mental fatigue
Excessive high activity
Physical inactivity
FACTORS REDUCING SYMPTOMS
Hot and dry weather
Hot shower or bath
Resting sleep
Moderate activity
Stretching exercises and massage
AMERICAN COLLEGE OF RHEUMATOLOGY 1990 FIBROMYALGIA CRITERIA
1- Widespread pain history: In order for the pain to be considered widespread, it must be on both the right and left sides of the body, at or below the waist.
In addition, axial skeletal pain (neck and anterior chest wall or thoracal spine or low back pain) is mandatory.
2- Pain in 11 of 18 known tender points on finger palpation:
Occiput; Bilateral suboccipital muscle insertions
Lower cervical; Bilateral C5-C7 intertransverse regions above
Trapezium; Bilateral at the midpoint of the upper border
Supraspinatus; Bilateral muscles’ attachment points, near the midpoint on the spina-scapula
Second rib; Bilateral second costochondral junction, just outside the upper surfaces
Lateral epicondyle; Bilateral epicondyles 2 cm. distal
Gluteal; Bilateral hip upper quadrant in the anterior fold of the muscle
Greater trochanter; Bilateral trochanteric process behind
Knee; Bilateral, on the fat pad
Finger pressure should be performed with approximately 4 kg.
For a point to be considered painful, the patient must report that palpation is “painful.”
“I feel it” is not considered “painful.”
For classification purposes, patients who meet both criteria are considered to have FS.
Widespread pain must have a duration of at least 3 months.
The presence of a second clinical disorder does not exclude the diagnosis of FS.
TREATMENT
Patient education
Medical treatment: Tricyclic antidepressants
Physical therapy and rehabilitation: Hypnotherapy, EMG-biofeedback, exercise
PROGNOSIS
Remitting-Intermittent: Symptoms may disappear or recur infrequently.
Fluctuating: Symptoms do not disappear completely, but intermittently ease and relapse.
Progressive: Symptoms gradually worsen over time.
MYOFACIAL PAIN SYNDROME
Soft tissue changes due to postural disorders and/or repetitive traumas
Collagen structure differences- Hypermobility syndrome
Posture- neck pain
Neck pain, which is seen in 40% of the society, has a direct relationship with long sitting, bad posture (+)
Skov et al. found a correlation between sitting time and neck pain
Computer users, dentists, secretaries are risk group
Poor sitting position
The extended position of the neck, forward shoulder posture, weakening of deep cervical flexors and dysfunction in cervical joints cause headaches.
Tension in upper trapezius and pectorals causes pain by weakening deep cervicals.
It is seen in all ages and genders.
It especially gives symptoms in young-middle-aged women who live a sedentary life.
It is one of the most common causes of chronic pain syndromes.
Approximately 75-85% of patients who apply to pain clinics are diagnosed with this diagnosis.
Incidence;
Most common between the ages of 30-50
In older ages, stiffness and limited movement are prominent
Features;
Local pain and widespread stiffness, stiffness, numbness, weakness,
Presence of a taut band,
Trigger point, which is a classic spread of pain that occurs when palpated,
Presence of autonomous components,
Accompanied by entrapments and psychosocial dysfunction.
Myofascial pain;
Pain originating from a trigger point in the fascia of a muscle or muscle group.
Trigger point;
Small, circumscribed, localized, hypersensitive areas in muscles and connective tissues.
Trigger point formation;
Musculoskeletal system injuries
Acute and excessive loading on muscles
Genetic factors
Fatigue
Stress
Factors causing pain;
Structural disorders
Bad posture
Prolonged immobility
Vitamin B. Deficiency
Metabolic and endocrine disorders
Infections
Psychosocial factors
Clinical features;
Pain, mild to severe, aching, throbbing or burning in character
Limited movements and general fatigue
Pain is continuous or periodic. It is a persistent, debilitating and limited pain.
Since pain and additional symptoms do not fit the neurotomal distribution, diagnosis is delayed or incorrect.
Diagnosis;
History
Examination
Looking for trigger points
Looking for additional findings such as taut band, local twitch response, jump sign
Twitch response;
During the examination, palpation, sudden contraction that can be seen or palpated, causing the finger to slide on the hard band in the muscle, causes startle. Pain decreases with prolonged pressure applied on it.
Treatment;
Education
Regular exercise
Stretching and spray
Trigger point injection
Other (massage, biofeedback, TENS, medication)