PHYSICAL

FIBROMYALGIA REHABILITATION
FIBROMYALGIA

Fibromyalgia is a common and

chronic disease of unknown etiology,

characterized by widespread pain

and soreness, abnormal pain

management, sleep disturbances,

fatigue and, often, psychological

disorders, as well as other

symptoms.
Fibromyalgia is a disorder of

central sensitization or

abnormal

central processing of

nociceptive pain .
 Etiology:
Statistics: fibromyalgia is often grouped a strong genetic association with
with arthritis-related conditions, there is fibromyalgia.
Complex genes include genes involved in
no obvious inflammation or damage to the serotonin and catecholamine
joints, muscles or other tissues. pathways. Changes in any of these
pathways can change pain sensitivity.
Additional genetic markers were identified
by large-scale scanning.
Pathogenesis

Central processes:
Dysregulation of dopaminergic neurotransmitters
Hypersensitivity to NMDA (ionotropic glutamate receptor, selectively
binding N-methyl-D-aspartate) receptors
Hypothalamic-pituitary axis dysfunction
Biochemical disorders:
Increased levels of nerve growth factor in the cerebrospinal fluid
Increasing the level of substance P in the cerebrospinal fluid
Decreased ATP levels in erythrocytes
Decreased growth hormone levels
Decreased serotonin levels
Clinical Pain associated with fibromyalgia is usually described as
picture : diffusely radiating from the axial skeleton over large
areas of the body, mainly involving muscles and joints.
Fatigue and poor sleep are usually present.
Cognitive problems ("fibrous fog") cause memory and
thinking disorders.
A significant number of cross-sections among chronic
pain disorders, central sensitivity syndromes (eg, CFS,
irritable bowel syndrome [IBS], post-traumatic stress
disorder [PTSD]), and anxiety disorders.
Systemic inflammatory diseases (eg, rheumatoid
arthritis, chronic hepatitis C, and systemic lupus
erythematosus [SLE] can be complicated by
fibromyalgia.
Diagnosis

More than 3 months of diffuse musculoskeletal pain along

with the other symptoms mentioned above indicate
fibromyalgia.
18 tender points (nine pairs) on the body as defined by
the American College of Rheumatology (ACR). The
examiner places the pad of the thumb of his dominant
hand on each point, pressing perpendicularly and
gradually increasing the pressure for 4 seconds to a
pressure of 4 kg. The patient is asked if there is pain. Pain
in more than 11 points.
Diagnosis
 TREATMENT

Steroids are useful only for patients with concomitant inflammatory processes.
Selective estrogen receptor modulators (CERMs) may be useful in postmenopausal
women.
For the treatment of fibromyalgia use a number of non-drug treatments, namely:
increase physical activity;
biological feedback;
meditation;
acupuncture;
ultrasound therapy;
massage, etc.
TREATMENT

Any treatment

Among non - drug treatments , three groups

program is likely to

last for many years .

can be identified depending on their Its purpose is to

effectiveness in the treatment of help the patient

fibromyalgia : maintain pain

1 st - highly effective techniques : cognitive - control and achieve

.
behavioral psychotherapy , patient
a high quality of life

, ,
It is shown that

education multidisciplinary treatment about 25% of

increased physical activity ; patients with

2 nd - techniques with medium effectiveness : fibromyalgia after

hypnotherapy , biological feedback , the first full course

, ;
of treatment were

balneotherapy acupuncture in remission for at

3 rd - ineffective : manual therapy , massage , least 2 years .

electrotherapy .
TREATMENT

There are four main areas in the treatment of

fibromyalgia :
reducing the severity of peripheral pain , including

muscle pain ;
CA prevention ;
normalization of sleep disorders ;
treatment aimed at comorbidities , including depression .
A comprehensive multimodal approach to the treatment of

fibromyalgia, including both pharmacological and non-drug methods,

is needed.

Exercise provides both subjective and objective improvement in pain

and general well-being.

Deconditioning is a major contributing factor to pain.

Heat and massage provide symptomatic

relief for many forms of chronic pain ,

including fibromyalgia .
Trigger point injections , acupuncture ,
 '
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