MODERN METHODS AND TREATMENT OF FIBROMYALGIA SYNDROME

Аннотация

One of the most widely discussed currently various models of chronic pain syndrome is fibromyalgia (FMA), a symptom complex characterized by chronic diffuse musculoskeletal pain, the presence of pain points, depression, sleep disorders, morning stiffness, asthenia. FMA refers to a common form of pathology - 2-6% in the population (up to 10%, according to some authors) which undoubtedly determines the relevance of its study. Women suffer significantly more often (80-90%) than men (10-20%) Key words: fibromyalgia, fibromyositis, neurology. Introduction. The term "fibromyalgia" comes from Latin. fibro (tendons and ligaments), Greek. myo (muscles) and algos (pain). It first appeared in the literature in 1981, after the publication of the diagnostic criteria of the disease proposed by M. Yunus. Before that, many terms were used: fibromyositis, neuroosteofibrosis, tendon myopathy, soft tissue rheumatism. All of them emphasized the role of inflammatory changes in muscles as the cause of pain. During the evolution of views on the nature of the disease (when the absence of inflammatory changes in muscle tissue was established), FM was "displaced" beyond the limits of purely rheumatological pathology. Currently, FM is an interdisciplinary problem and is studied within the framework of various medical specialties: rheumatology, neurology, endocrinology, psychiatry. However, due to tradition, FM patients are most often represented in rheumatology practice. At the same time, there is a paradoxical situation when the actual diagnosis of FM is practically absent in the daily practice of a rheumatologist, since FM is still not well known to Russian doctors and is often not recognized by them as an independent disease. In many cases, rheumatologists (as well as neurologists) evaluate the condition of FM patients in accordance with the leading comorbid manifestations (diagnose "widespread osteochondrosis", "chronic myofascial syndrome", "osteoarthritis", "tension headaches", "panic attacks", etc. D.), underestimating the role and importance of mental disorders and stress in these patients. On the other hand, psychiatrists also do not diagnose FM, because they do not analyze the somatic condition of patients (they do not examine sensitive points, etc.). Such medical ignorance is a problem (and even a danger) for patients who need timely and adequate treatment. The predominance of PMA among people of the most working age, the duration of pain, and negative emotional experiences associated with pain manifestations lead to a significant decrease in the quality of life of patients, which manifests itself in limited communication and the inability to fully participate in social life. Treatment: The aim of treatment is to control the manifestations of FM to the maximum extent possible. Drug therapy Analgesic drugs. Since pain is the leading symptom, patients are often prescribed painkillers, in addition, patients themselves, as a rule, have long-term experience of their use. Such drugs include analgin, paracetamol, and a synthetic analgesic of central action — tramadol. The effect is short-term. Morphine alkaloids are poorly tolerated and are not used in the treatment of FM. 73 YOSH OLIMLAR ILMIY-AMALIY KONFERENSIYASI in-academy.uz/index.php/yo Nonsteroidal anti-inflammatory drugs. Although FM is not an inflammatory rheumatic disease, sometimes local NSAID therapy is used in the form of ointments or gels with dimethyl sulfoxide, as well as local injections in combination with anesthetics (in particular, lidocaine). Ketorolac, diclofenac, naproxen, etc. are used. Steroids. Drugs of this group are ineffective, however, they are sometimes used as a local injection into a painful point. Tranquilizers. The use of benzodiazepines in FM is not indicated, since they cause a reduction in stage IV sleep and may contribute to an exacerbation of the symptoms of the disease. Antidepressants. Antidepressant therapy is actually aimed at eliminating serotonin deficiency. These drugs are also effective in the treatment of sleep disorders, pain and asthenia. Of the group of tricyclic antidepressants, amitriptyline is most often used, usually at an initial dose of 10 mg per night, the dose can gradually be increased to a maximum of 50 mg. The drug also has many side effects: it contributes to weight gain, the appearance of xerostomia, headaches. Imipramine is used less often. Currently, more modern antidepressants are used — serotonin reuptake inhibitors: sertraline, fluoxetine, paroxetine, duloxetine, citalopram. The results of their use in the treatment of FM are still contradictory. The disadvantage of using these medicines is that they can cause insomnia, anxiety, nervousness, which is why they should be prescribed only in the morning. It has been proven that in order to obtain a therapeutic effect in patients with FM, the appointment of lower doses of antidepressants is required than for the treatment of depression. Treatment should begin with a