Recent advances in pharmacological interventions of chronic prostatitis/chronic pelvic pain syndrome

Recent advances in pharmacological interventions of chronic prostatitis/chronic pelvic pain syndrome

Persistent prostatitis/power pelvic ache syndrome sort III is expounded to irritative void-ing, sexual dysfunction and pelvic ache. Persistent prostatitis/power pelvic ache syn-drome weakens the standard of life and poses hostile psychological results on the pa-tients. A variety of therapies, together with botulinum neurotoxins, anti-inflammatories, alpha-blockers, phytotherapy, 5α-reductase inhibitors, phos-phodiesterase sort Four inhibitor, phosphodiesterase sort 5 inhibitor, monoclonal anti-body, anticholinergics, gabapentin, pregabalin are used clinically. These therapies em-phasise on easing the signs in particular areas with out curing the elemental trigger the place the end result of the therapy just isn’t utterly passable.

This assessment article explains the current pharmacological therapies of power prostatitis/power pelvic ache syndrome intimately and gives a future perspective to deal with this situation. Descriptive-correlational and cross-sectional quantitative examine. Performed in a hospital in central Portugal, between January and June 2013. A comfort pattern of 307 power sufferers was chosen. The variables collected by way of the questionnaire had been: age, intercourse, marital standing, employment standing, month-to-month revenue, notion of household functioning (Smilkinstein), medical pathology, spirituality (Pinto and Pais-Ribeiro) and diploma of struggling (McIntyre and Gameiro). The mission was permitted by the hospital’s ethics committee.

The contributors signed an knowledgeable consent type. The worldwide struggling of power sufferers studied on the hospital stage is average (M=3.01), on a scale of 1 to five, with the psychological dimension being probably the most affected (M=3.18). Aged sufferers undergo extra bodily and have extra constructive experiences. Girls current better socio-relational and psychological struggling. Then again, individuals who reside alone, with a month-to-month revenue of lower than 300 euros, with a low stage of training, with the notion of belonging to a dysfunctional household and with neurological pathology, undergo probably the most. A number of linear regression confirmed that spirituality is considerably inversely correlated with struggling. Beliefs are liable for 6.0% of the defined variance of struggling and hope / optimism for 3.3%.

Acute Stroke Look after Sufferers with Persistent Kidney Illness

Persistent kidney illness is a standard comorbidity in sufferers presenting to emergency departments with acute ischemic stroke. There are quite a few concerns that should be taken under consideration within the acute analysis and administration of those sufferers. CKD sufferers could have completely different stroke shows in comparison with the final inhabitants that will make analysis tougher. With the increasing use of endovascular thrombectomy for acute ischemic stroke, extra contrasted research are being employed as a part of the acute analysis, significantly within the identification of sufferers with massive vessel occlusion and demonstration of salvageable penumbra.

Though affected person outcomes with reperfusion therapies comparable to intravenous alteplase and endovascular thrombectomy aren’t as sturdy as these seen inside the common inhabitants, the accessible information helps utilization of those therapies amongst CKD sufferers. This text offers a assessment of the elements that should be thought of within the acute administration of the CKD affected person presenting with acute ischemic stroke. We searched Scopus, PubMed, Cochrane, and Internet of Science databases until August 2020 and up to date the search in December 2020 utilizing related key phrases. All search outcomes had been screened for eligibility.

We extracted the info from the included articles and pooled them as imply distinction (MD) with a 95% confidence interval (CI), utilizing Overview Supervisor software program (ver. 5.4). Quite the opposite, pulmonary N-cadherin, Vimentin and α-SMA, three of mesenchymal biomarkers, have been elevated in COPD sufferers with larger circulatory Cd. In vitro experiments revealed that Cd publicity repressed miR-30 ranges and promoted EMT in BEAS-2B cells.  For many sufferers with renal dysfunction, research comparable to CT angiography and perfusion should still be carried out regardless of issues of acute kidney damage.

Recent advances in pharmacological interventions of chronic prostatitis/chronic pelvic pain syndrome

The Relationship Between the Wholesome Weight loss plan Index, Persistent Illnesses, Weight problems and Way of life Danger Components Amongst Adults in Kaunas Metropolis, Lithuania

A wholesome and balanced weight-reduction plan is a crucial issue contributing to total well being and wellness. The purpose of this examine was to develop a Wholesome Weight loss plan Index (HDI) rating and assess its affiliation with numerous power illnesses and way of life threat elements. A cross-sectional survey included 1,111 adults aged 18 years and older. Data on dietary habits was collected utilizing a questionnaire. Extra demographic, socioeconomic and way of life threat elements information had been additionally collected. Sixteen meals teams had been used to develop the HDI rating for the residents of Kaunas metropolis, Lithuania primarily based on the nationwide suggestions

World Well being Group (WHO) and different steerage on a nutritious diet. We used logistic regression fashions to evaluate the affiliation of the HDI rating with power illnesses, weight problems and way of life threat elements. We discovered that each women and men had been missing the optimum consumption of the bottom parts of a wholesome diet-fruits and greens, starchy carbohydrates, and proteins. We additionally noticed vital associations between the HDI rating and several other outcomes comparable to hypertension, arrhythmia, bodily exercise, and weight problems. The recommended HDI rating may function a helpful instrument in assessing and enhancing dietary habits helpful for selling well being and stopping many illnesses.

In addition to pulmonary dysfunctions, sufferers with power obstructive pulmonary illness (COPD) additionally incessantly have systemic comorbidities. Amongst these, sarcopenia is related to worse pulmonary perform and medical outcomes. Sufferers with acute exacerbated COPD (AECOPD) have elevated systemic irritation, which may intensify muscle dysfunction. Subsequently, the current examine aimed to guage the prevalence of sarcopenia in AECOPD sufferers and assess the related elements and their prognostic worth. As a secondary purpose, we additionally assessed the efficiency of calf circumference (CC) to diagnose this situation.



Validation of impaired Transient Receptor Potential Melastatin 3 ion channel activity in natural killer cells from Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis patients.

Syndrome of chronic fatigue / myalgic encephalomyelitis (CFS / ME) is a complex multifactorial disease of unknown cause with multi-system events. Although the etiology of CFS / ME remains elusive, immunological dysfunction and specifically low cytotoxic activity in natural killer (NK) cells is the result of more consistent laboratory.

The transient receptor potential (TRP) superfamily of cation channels play a central role in the pathophysiology of immune diseases and are therefore potential therapeutic targets. We have already identified single nucleotide polymorphisms in the genes of the TRP in NK peripheral cells of patients of CFS / ME.

We also described the changes in biochemical and signaling pathways calcium disturbances in NK cells of patients with CFS / ME. In particular, we have previously reported a decrease in the cation channel TRP function subfamily member melastatin 3 (TRPM3) in isolated NK cells from patients CFS / ME compared to healthy controls after modulation with pregnenolone sulfate and ononetin using a patch-clamp technique.

In this study, we aim to confirm the previous results describing a TRPM3 activity with disabilities in a new cohort of patients with CFS / ME using a technical whole cell patch clamp after modulation by agonists TRPM3 reversible, the pregnenolone sulfate and nifedipine, and an effective antagonist TRPM3, ononetin. Indeed, no formal research has commented on the use of pregnenolone sulfate or nifedipine to treat CFS / ME patients when there is evidence that clinicians prescribe calcium channel blockers to improve different techniques of cell patch clamp symptoms.

Whole was used to measure activity in TRPM3 isolated NK cells from twelve healthy controls age and sex and CFS patients / ME, after activation with pregnenolone sulfate and nifedipine and inhibition ononetin .

We have confirmed a significant reduction in the amplitude of currents after TRPM3 sulfate stimulation pregnenolone in isolated NK cells from another cohort of patients with CFS / ME compared to healthy controls.

The ionic currents evoked by pregnenolone sulphate TRPM3 way were again modulated significantly by ononetin in isolated NK cells from healthy controls compared to patients CFS / ME. In addition, we used nifedipine, another agonist reversible TRPM3 to support the previous results and found similar results confirming a significant loss of activity TRPM3 channel activity CFS / ME was patients.

Impaired TRPM3 validated in isolated NK cells from patients with CFS / mE using different techniques of whole-cell patch clamp pharmacological tools and as the gold standard for ion channel research. This survey also establish channels TRPM3 as prognostic marker and / or a potential therapeutic target for CFS / ME.

Validation of impaired Transient Receptor Potential Melastatin 3 ion channel activity in natural killer cells from Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis patients.
Validation of impaired Transient Receptor Potential Melastatin 3 ion channel activity in natural killer cells from Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis patients.

Evaluation of four clinical laboratory parameters for the diagnosis of myalgic encephalomyelitis.

myalgic encephalomyelitis (ME) is a complex and debilitating disease that often present initially with flu-like symptoms, accompanied by debilitating fatigue. Currently, there are no biomarkers objectives or laboratory tests that can be used for diagnosis unequivocally ME; Therefore, a diagnosis is made when a patient encounters a series of criteria for inclusion and exclusion of costly and subjective. The purpose of this study was to evaluate the utility of four clinical parameters in the diagnosis ME.

In this study, we used logistic regression and classification and regression tree analysis to conduct a retrospective survey of four clinical laboratories in ME 140 cases and 140 healthy controls.

The correlations between covariates were between [- 0.26, 0.61]. The best model included serum levels of the soluble form of CD14 (sCD14), serum levels of prostaglandin E2 (PGE2) and serum levels of interleukin-8, with coefficients of 0.002, 0.249 and 0.005, respectively, and p-values ​​of 3 × 10-7 1 × 10-5 and 3 x 10-3, respectively.

Our results show that these parameters may help doctors in their diagnosis of ME and may shed more light on the pathophysiology of this disease.

Assessing cellular energy dysfunction in CFS/ME using a commercially available laboratory test.

Assessing cellular energy dysfunction in CFS/ME using a commercially available laboratory test.

The mitochondrial energy score (TSS) protocol developed by the group Myhill, is marketed as a diagnostic test for chronic fatigue syndrome / myalgic encephalomyelitis (CFS / ME). This study evaluated the reliability and reproducibility of the test, currently provided by private clinics, to assess its potential to be developed as an NHS accredited laboratory test.

We reproduced the ESM protocol using neutrophils and peripheral blood mononuclear cells (PBMC) of patients with CFS / ME (10) and healthy controls (13). The protocol was then repeated in PBMCs and neutrophils from healthy controls to investigate the effect of the delayed sample processing time used by the group Myhill.

Experiments using the established protocol showed no difference between patients CFS / ME and healthy controls in one of the components of the MES (p ≥ 0.059). Delaying treatment blood samples within 24 hours (and in the period of 72 hours cited by Myhill group) significantly altered number of parameters used to calculate the MES in both neutrophils and PBMCs.

The MES test was not required reliability and reproducibility of a diagnostic test and should therefore not be proposed as a diagnostic test for CFS / ME. The differences observed by Myhill group may be reduced to differences in processing time between sample cohorts.

Advances in ME/CFS: Past, Present, and Future.

The precursor of what is now known as myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS) has been described by the Public Health Service of the United States in 1934. At present, we do not yet know the cause and / or how to detect by routine clinical laboratory tests.

Accordingly, the nature of the disease ME / CFS has been overlooked and the disease was wrongly stigmatized by such a psychosomatic or somatoform illness. These misperceptions of the disease have led to the exploration of insufficient research of the disease and a minimum of care for patients absent.

A report by the Institute of Medicine in 2015 declared the disease ME / CFS a disease that affects up to 2.5 million Americans and rebuked the US government for doing little to research the disease and support patients .

Clinicians currently treating the disease state be more devastating than HIV / AIDS. A comparison of the stories of the two diseases, a review of the current status of the two diseases, and a list of accomplishments that would be required for ME / CFS to achieve the same level of treatment and currently care of patients with HIV / AIDS is provided.

Modification of Immunological Parameters, Oxidative Stress Markers, Mood Symptoms, and Well-Being Status in CFS Patients after Probiotic Intake: Observations from a Pilot Study.

Modification of Immunological Parameters, Oxidative Stress Markers, Mood Symptoms, and Well-Being Status in CFS Patients after Probiotic Intake: Observations from a Pilot Study.

The present study discusses the effects of a combination of probiotics can stimulate the immune system of patients with chronic fatigue syndrome / myalgic encephalomyelitis (CFS / ME). For this purpose, patients diagnosed according to the criteria of Fukuda and treated with probiotics were analyzed by clinical and laboratory evaluations, before and after probiotic administration.

Probiotics have been chosen taking into account the possible pathogenic mechanisms of ME / CFS syndrome, which was associated with an impaired immune response, dysregulation of Th1 / Th2 ratio, and high oxidative stress with exhausted antioxidant reserves due to severe mitochondrial dysfunction. And a oxidative immune dysfunction may be related to inflammation of low grade chronic gastrointestinal (GI) in the lamina propria and surface of the intestinal mucosa associated with dysbiosis, intestinal permeability, bacterial translocation, and immune dysfunction and oxidative.

Literature data show that bacterial species are capable of modulating immune system function and oxidative and that certain probiotics administration can improve the mucosal barrier function, modulation of cytokine release proinflammatory in patients SFC / ME. This study is a preliminary investigation to verify the safety and efficacy of a certain combination of probiotics in patients CFS / ME.

The results suggest that probiotics can alter the state of well-being as well as inflammatory and oxidative indexes in patients CFS / ME. No adverse effects were observed except for one patient who shows a surge in symptoms, although all inflammatory parameters (ie, cytokines, fecal calprotectin, ESR and immunoglobulins) have been reduced after taking probiotics.

The reactivation of the symptoms of fatigue in this patient, whose clinical history reported the onset of CFS / ME following mononucleosis, may be linked to an abnormal stimulation of the immune system as suggested by a recent study describing an exaggerated immune activation associated to chronic fatigue.

Modification of Immunological Parameters, Oxidative Stress Markers, Mood Symptoms, and Well-Being Status in CFS Patients after Probiotic Intake: Observations from a Pilot Study.
Modification of Immunological Parameters, Oxidative Stress Markers, Mood Symptoms, and Well-Being Status in CFS Patients after Probiotic Intake: Observations from a Pilot Study.

Rethinking ME/CFS Diagnostic Reference Intervals via Machine Learning, and the Utility of Activin B for Defining Symptom Severity.

biomarker discovery applied to myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS), a debilitating disease inconclusive etiologies identified several cytokines potentially to fill a role as a marker quantitative blood / serum for laboratory diagnostics, activin B with a recent addition.

We further explored the potential serum activin B as ME / CFS biomarker, alone and in combination with a series of routine tests results obtained by pathology laboratories. Previous results from the pilot study showed that activin B was significantly higher for ME / CFS participants compared with healthy participants (controls). All participants were recruited by CSA Discovery and ranked by the criteria of Canada / international consensus. for ME / CFS cohort A significant difference in serum activin B was also detected for ME / CFS and control cohorts recruited for the study, but the median levels were significantly lower.

Random Forest (RF) modeling identified five markers blood test routine pathology that collectively predicted ME / CFS in ≥62% compared with rest time weighted (WST) severity classes. Further analysis revealed that the inclusion of activin B Pathology marker panel has improved the forecast slight to moderate ME / CFS cases.

The correct application prediction WST class modeling FRG, new reference intervals were calculated for activin B and markers associated pathologies where clearance urinary creatinine 24, urea serum and serum activin B showed the best potential as diagnostic markers. While serum activin B results remained statistically significant for new cohorts of participants, activin B was also found useful in improving the prediction of the severity of symptoms, as shown by WST class.

What is fibromyalgia?

Some basics about fibromyalgia

Fibromyalgia is a chronic disease characterized by diffuse pain or burning sensations from head to toe accompanied by deep fatigue.

 Etymologically, the term fibromyalgia consists of “fibro” for fibrosis, “myo” formuscles and “pain” for pain. This term would therefore indicate a painful fibrosis of the muscles, however fibrosis is not a lesion found in this disease.

Recognized in 1992 by the World Health Organization, it is a common disease in medical practice. It was also called: idiopathic polyalgic syndrome diffuse (SPID), chronic muscular rheumatism (1901), psychogenic rheumatism (1960), fibrosite (1983), and rheumatism of the soft tissues… Fibromyalgia is distinguished from the chronic fatigue syndrome with which it shares several signs.

How many people have the disease?

Affecting 2 to 5% of the population, fibromyalgia is therefore not a rare disease. Its frequency varies according to the population considered.

Who can get it?

Mainly women between 30 and 50, in the proportion of 4 women for a man. Fibromyalgia has also been diagnosed in children.

Is it present everywhere in the world?

Worldwide, there are wide disparities in the distribution of fibromyalgia. Western countries are the most affected. The disease remains anecdotal in the third world. It is also an urban disease that is encountered less often in rural areas. We cannot exclude the possibility that the diagnosis will be made less often in certain regions where the number of people affected seems low.

What is it due to?

The cause of fibromyalgia is unknown. It is known that there is an abnormality in the pain response which is increased. There is an awareness of the central nervous system, attested by functional imaging tests. However, it is not known whether this awareness is the cause or the consequence of the disease. Many factors have been successively incriminated. The finding that many cases of fibromyalgia occurred after a violent emotional shock, a significant trauma (traffic accidents with whiplash) for example), or a viral disease, has raised in turn the question of the impact of these events in the onset of the disease.

Furthermore, the association of pain with sleep disturbances and depression have led to the possibility of a deficiency in neurohormones, especially serotonin. Neurohormones are substances present in minute quantities in the nervous system involved in functions such as sleep, mood and pain but also in various sensory functions, motor and cognitive. These imbalances are probably at the origin of the importance of pain experienced when there is no damage to organs or tissues or any biochemical disorder that can cause them. Finally, the existence of “mother-daughter” cases could suggest the intervention of other factors not yet identified.

Is it contagious?

It is absolutely not contagious.

What are its manifestations?

Before the installation of fibromyalgia, there would be a long (or very long) period of “Warning signs”. Very unspecific, these signs are often found only when afterwards, once the diagnosis of fibromyalgia has been made. It is essentially about:

1 – abnormal fatigue on exertion

2 – muscle discomfort, body aches, tingling, fatigue

3 – tedious standing position

4 – intolerance to cold, heat

5 – various digestive disorders (stomach pain, irritable bowel)

6 – irritable bladder

7 – sleeping troubles

Once declared, fibromyalgia is characterized by diffuse pain, fatigue intense, sleep disturbances, associated with different manifestations of gait psychosomatic.


This is the main symptom. Always present, it mainly affects regions close to the spine: the nape of the neck, the shoulders, the inter-scapular region (between the 2 shoulders), shoulder blades, lower back, hips.

It can also reach knees, soles, glutes and hands with swelling, the face with a feeling of tightness or having toothache. The sick complain of having “sore everywhere”. This pain varies depending on the time of day, the stress level and physical activity. It is associated with diffuse stiffness and is characterized by specific pain points sensitive to touch. Dull or sometimes acute (see both), type of burns, stings, tingling or muscle numbness, it is described differently depending on the person.

It can also evolve from one type of pain to another and from one location to another or gradually generalize in the same person. It can be painful to the point of hindering the accomplishment of daily gestures. The sensitive points, on the other hand, sometimes very painful on pressure, interest well defined areas which allow to evoke the diagnosis

Tiredness (asthenia)

With pain, this is the most constant symptom. Often very intense in the morning, it can occur at the slightest effort and become debilitating. It’s more of a “feeling of total loss of strength “, of fatigue which has social and professional repercussions can be considerable. Standing still is particularly painful, a sign particularly characteristic. The psychological impact, on a person who has always been active and “good living”, can be very important.

Sleep disturbances

The main characteristic of sleep in fibromyalgia is that it is little or not repairing. Patient wakes up as tired, if not more, than when layer. Most often sleep is “restless” and responds only slightly to the various treatments established. Like pain, sleep disturbances do not improve over time without treatment.

Psychological disturbances

This is mainly about anxiety and a depressed state. Pessimism and catastrophism y are often associated. Here again the question arises of the chronology of the disorders: is the depressive syndrome prior to fibromyalgia or reactive, secondary to wandering and the ineffectiveness of the different treatments? Patients often attach their anxiety disorder that accompanies their incomprehensible state of health. It should be noted that a large number of people were very active and dynamic before the disease, without showing any signs of depression. Fibromyalgia and depression can be considered as two different diseases, albeit related and often associated.

Other disorders

A set of apparently disparate disorders and signs are reported by ill. If they help bring the diagnosis to light, they can also bring the sick to different consultations.

  1. migraine and tension headache
  2. difficulty concentrating and memory impairment
  3. hypersensitivity to noise, light, and odors
  4. intestinal transit disorders, such as diarrhea or constipation, or alternation of both (which can wrongly evoke irritable bowel syndrome).
  5. urinary problems (frequent urination) or period pains (dysmenorrhea) are also observed.
  6. thermoregulation disorders: abnormal intolerance to cold and heat.
  7. restless legs syndrome with nocturnal impatience is also sometimes associated.

To varying degrees, some signs of Gougerot-Sjögren Dry Syndrome (dry eyes, dry mouth, dry skin …) can appear at the same time as fibromyalgia. It is easy to see, given the multiple combinations that these symptoms can take, that patients consult as well in gastroenterology, psychiatry, rheumatology as in internal medicine

How to explain the symptoms?

The origin of the pain is unknown. The various mechanisms mentioned did not allow to establish precisely the causes of this rather singular painful model. It could be an abnormal perception of pain that makes stimulation normally painless either perceived as painful (allodynia) or an abnormal perception of the intensity of pain that makes pain of low intensity perceived as very painful (Hyperalgesia).

– Is the pain primarily muscle?

To date, no objective muscular anomaly has allowed us to accept this hypothesis.

– Is the pain of psychogenic origin?

For this theory, we evoke the fact that there are sometimes, in fibromyalgia families, some known cases of depression. Occasional regression of symptoms under antidepressants and the frequent association of fibromyalgia with other well-known diseases psychosomatic mechanism (functional colopathy for example) would also be in favor of this assumption. These elements are, however, inconsistent and do not support the thesis of psychosomatic origin. In addition, the favorable action of antidepressants may be due to one of the pharmacological properties of these drugs, which also have an action on pain in non-depressed patients.

– Is there an involvement of neuromediators?

Serotonin (or 5 hydroxytryptophan) is a substance produced by neurons

(neuromediator) having a “pain-relieving” action. It is also involved in the regulation of sleep and mood. Its role has been highlighted in certain disorders psychiatric (anxiety and depression in particular) and in migraine. Several works have shown a decrease in the blood level of fibromyalgia sufferers, without it being necessarily associated with depression. We have also shown an increase  substance P, neuromediator of pain.

– Or an involvement of the endocrine system?

In fibromyalgia, despite maintaining a normal hormonal stress response, sometimes notes a disruption of the secretion of hormones (corticoids) by the adrenal glands (glands located above the kidneys) and a decrease in the level of hormone growth. This can be the cause of fatigue and poor exercise tolerance. These abnormalities can also be cause or consequence of the disorder.

What is its evolution?

Fibromyalgia is a condition that develops over many years. There are great variability of manifestations and their evolution over time is different from a person to the other.

– Quality of life: the fact that the demonstrations are very non-specific means that there are almost always a diagnostic wandering (up to 18 years in some studies) which can to be very discouraging. In addition, pain and fatigue do not always respond well different treatments. A state of depression, or even a depressive state, if they can be absent at the start, can also gradually settle in or worsen. All of this contributes to the overall deterioration in the quality of life for people with fibromyalgia. That said, the comfort found among those around them and others confronted with the illness is a great help not to get discouraged and try the different options offered by the doctor. Fighting isolation remains a fundamental asset in this disease. Fibromyalgia is not life threatening because it does not compromise the organs vital.

– Autonomy: The pains, sometimes rebellious to usual treatments and great tiredness gradually hinder physical activity which is, therefore, gradually reduced. In the most severe cases, the reduction in activity in turn affects the ability of the patient, who sometimes becomes unable to meet the most basic needs. Deconditioning with effort (the less the subject does, the less he can do) is proven by oxygen consumption tests. However fibromyalgia does not lead to paralysis, neither in the wheelchair, nor in the loss of intellectual capacity, and all cases are not as severe.

– Severity: In a certain number of cases fibromyalgia becomes debilitating without it

there are visible lesions. Fatigue for less and less effort and the anxiety that accompanies this state makes it very serious. However, you should know that not all patients reach this state

The diagnosis

How is fibromyalgia diagnosed?

This disease has long been overlooked. It is still refuted by many doctors who see in the association of different symptoms only an expression of the wide range psychosomatic conditions. Since 1992 it has been recognized by the WHO as a rheumatic disease (rheumatism unspecified).

The main difficulty lies in the absence of any biological, radiological anomaly or detectable histology. We still often speak of “invisible disease” or pain without organic. The diagnostic criteria are clinical and are currently limited to those established in 1990 by the American College of Rheumatology (CAR). These combine with the table of diffuse chronic pain (as defined below), tenderness to palpate minus 11 of the 18 points previously defined. Chronic pain is defined by a course of development of at least 3 months.

The pain is diffuse if it involves the right and left sides of the body and sits above and below the waist. Skeletal pain from head to toe must also be present. This purely clinical diagnosis will only be made by the doctor after elimination of all other organic cause of symptoms (myopathy, chronic rheumatism of another nature, myositis …). In addition, he will have to distinguish fibromyalgia from chronic fatigue syndrome which is a very similar disease. Certain forms of fibromyalgia are associated with other diseases, particularly inflammatory rheumatism. This is the case for example of rheumatoid arthritis where, despite response to treatment, patient continues to experience pain from fibromyalgia secondary.

The pressure sensitive points are as follows: suboccipital, lower cervical, trapezius, at the level of the scapula, the second ribs (at the insertion of the rib on the sternum), epicondyles (elbows), glutes, large trochanters (femurs) and knees. Sometimes people who suffer from fibromyalgia don’t notice the extreme sensitivity of these points that when a doctor presses in these places (see figure). These criteria for diagnosing fibromyalgia are widely criticized because they are too limited and too reducers. Many symptoms, common in this disease, are not taken care of account. This is the case for headaches (headache), fatigue with the slightest effort, feelings of ants in the body and extreme intolerance of the cold at the extremities. Gynecological pain is also ignored, as well as intolerance to pressures on all muscle masses, intolerance to hard seats, hypersensitivity feet, standing very painful. In addition, the evaluation of the different symptoms uses measurement scales that are often inappropriate for fibromyalgia because they are sophisticated for other diseases. l What are the complementary exams?

What will they serve? Biological, radiological, and possibly hormonal examinations help to eliminate certain diagnoses (this is called differential diagnosis).

Can we confuse this disease with others? Which ones? How to make the difference ?

Yes, we may have to eliminate different diseases such as adrenal insufficiency, in which the adrenal cortex (which normally secrete glucocorticoids) no longer perform their function. Certain anxiety, depressive states, so-called disorders “Thymics” where mood swings are frequent can also resemble Fibromyalgia. In addition, all muscle, joint and tendon pain (chronic arthritis, systemic lupus erythematosus, polymyositis, GougerotSjögren syndrome, etc.) can be confused with fibromyalgia. Gynecological pain, menstrual pain, migraine are common in women and do not always think of another possible cause. Irritable bowel, pelvic pain caused by inflammation of the bladder (cystitis), personality disorders, hypochondriac or simulator, hidden drug use, and chronic fatigue syndrome are often discussed well before concluding at the diagnosis of fibromyalgia.

Can we detect this disease in people at risk before it happens?

There is no obvious risk factor apart from the notion of painful childhood (violence, abandonment, sexual assault) sometimes found in patients and the concept of physical (accident, fall, surgery, etc.) or mental (shock, bereavement, serious event) stress family or professional…) in the immediate history. In some cases, none of these factors are not found. Genetic aspects

What are the risks of transmission to children?

No risk of transmission has been demonstrated even if mother-daughter cases exist. l What are the risks for other family members? There does not appear to be any particular risk to other family members, even if the occurrence of more than one case in the same family has been very rarely reported.

Treatment, care & prevention

Is there treatment for fibromyalgia?

The origin of the pain in fibromyalgia is not known. Therefore, there does not exist, at currently, a treatment that will cure the disease permanently. Treatment is basically aimed at relieving the symptoms that vary a lot from a person to the other. It uses physical rehabilitation and various drug treatments. Psychological care and support are also very important. Physical rehabilitation or reactivation, which must be particularly emphasized consists of a progressive re-training with the effort by fractional physical exercises and “soft” (medium intensity) where the notion of “pleasure” must remain present and the regularity of putting. A supervised aerobic exercise program would benefit improvement in physical capacity and in symptom improvement (reduction of pain and pressure point sensitivity). Stretching (postural stretching), water aerobics and swimming in a pool (at 28 ° minimum) often provides real relief. More simply and in an accessible manner to each person with fibromyalgia, walking daily is advised. Of progressive duration, as far as the patient’s condition allows without going as far as painful fatigue, it can be beneficial.


Among the painkillers (pain relievers) used in fibromyalgia, tramadol hydrochloride is the only one to have shown an action against pain. Nonsteroidal anti-inflammatory drugs are not very effective, and corticosteroids are contraindicated. The Morphine derivatives are much discussed because they have adverse effects. In all cases, be aware that the response of pain to different drugs is variable from one patient to another. The doctor may need to modify the treatment depending on this answer. Anticonvulsants (gabapentin for example) are very often prescribed to decrease the pain of fibromyalgia patients. The use of anesthetics (lidocaine, ketamine) has been proposed, but it remains very limited due to the side effects that can only be administered in intensive care settings. They cannot be considered as a treatment for disease.

Moderate dose antidepressants have a double action: on pain and on depressive syndrome. Indeed, they can have an action on pain even in the absence of depressive syndrome. The most used is still amitriptyline which would give the best results. Tolerance to this drug is often reduced in fibromyalgia sufferers who have hyperactivity to stress, anxiety or depression. Hypnotics (sleeping pills), mainly benzodiazepines (clonazepam, bromazepam, and alprazolam), which act against anxiety and relaxes the muscles have been indicated. However, they disrupt the architecture of deep slow sleep which is already abnormal in fibromyalgia. Therefore, their use does not seem desirable. However, clonazepan, when well tolerated and given at a very low dose, may promote sleep in a number of fibromyalgia patients. A few other substances have been tested without proven efficacy. It’s about acid malique, growth hormone, 5 hydroxytryptophan, calcitonin, S-adenosyl methionine.

What benefits can be expected from treatment?

Improvement in pain can be seen although patients often complain of insufficient response to expected results. Similarly, few results are noted for fatigue.

What are the risks of treatment?

The risks vary greatly depending on the drug used. The doctor will be able to adjust the doses to allow the best effectiveness with the lowest risk of adverse effects. He never interrupt or modify a treatment without medical advice.

What will be the consequences of treatment for life daily ?

Whether in a pain center or at home, the patient’s life must be organized around often numerous schedules and methods of taking medication  Treatment, quite often partially effective, can help improve or safeguard the autonomy of the person with fibromyalgia. In some cases unfortunately, it remains without result. Hypnotics, morphine and even antidepressants, can decrease alertness. This can affect the patient’s professional activity or even represent a danger for him and his entourage (use of machines or driving of machines). In addition to the impact of fatigue and pain on sex life, the drugs prescribed in fibromyalgia act on the brain by modifying certain substances. called neurohormones or endorphins. This contributes to impotence, frigidity or decreased sexual desire that may occur.

Is psychological support desirable?

Yes, psychological support with the help of a psychotherapist is recommended. The use antidepressants and the use of relaxation techniques may be indicated. Among psychological disorders, catastrophism (everything is going badly, everything is going to go even more wrong, I am alone and helpless, …) can be very important. Information and support on the part of the family, the entourage and other patients, through associations, are fundamental.

What are the other methods of processing this sickness ?

In the absence of an effective therapy proposed, fibromyalgia remains the breeding ground to so-called alternative therapies which are generally very expensive. This is how are proposed, biofeedback techniques, massage therapy, acupuncture, phytotherapy and other therapies. Even if some improvement in the disorders can be observed, it is necessary to know that no study has established their effectiveness.

What can you do yourself to heal?

The benefit of a healthy lifestyle (adequate sleep, especially maintenance of physical activity regular and suitable, balanced diet) is very important in fibromyalgia.

How to get followed?

Fibromyalgia comes under rheumatology consultations but the use of pain centers is quite often necessary. Depending on the treatments instituted, monitoring will be different and the doctor remains the sole judge of the type and frequency of checks.

What information should be known and communicated in case of emergency ?

It is necessary to report, in any eventual emergency, the exact nature of the medications taken and their dose. This avoids the administration of drugs whose combination is incompatible and avoids accidental overdoses.

Can we prevent this disease?

No prevention is possible. To live with l What are the consequences of the disease on life family, professional, social, school, sport? Fibromyalgia is “invisible and invincible” because it has no organic substratum detected to date nor curative treatment. It is a chronic disease and, due to its long evolution, it has its own psychological, social and family impact. Despite the significant difficulties that the disease imposes on daily life, all people attacks do not become dependent or invalid.

The patient reorganizes his activities within the new limits which are dictated to him by the disease. He can no longer “program” or “organize” his time except according to possibilities and “the energy of the moment”. The reorganization or even the reorientation of its activity professional, the maintenance of physical activity, even reduced, are essential. Isolation and psychological problems cause family problems due to the misunderstanding in which these patients find themselves. Divorced status is significantly more common than in the general population. Fatigue affects professional and social life. The cessation of activity is enough common.

Outings and leisure are gradually abandoned. The social circle of fibromyalgia sufferers is thus reduced to isolation. Sometimes a vicious circle arises in which isolation, causing a depressed state, leads to more isolation. That’s why family support, meeting other patients and also psychological support are very important to break this progression. Furthermore, the recognition of disability in fibromyalgia sufferers is often rejected because the files are treated on a case by case basis, fibromyalgia is not one of the diseases recognized as disabling. Because in fibromyalgia there are no lesions visible, the “medico-social” course of fibromyalgia sufferers is often very trying. Schooling: When normal schooling becomes impossible due to high fatigue, special measures can be put in place: correspondence courses or even home schooling.

Sport: Sport can and should be maintained. The type of sporting activity is important. Violent sports, significant efforts should be avoided. Only will be maintained regular, moderate intensity exercise that will prevent muscle wasting that results from inactivity and worsen fatigue. It seems that this is currently the most promising approach, combined with gentle physiotherapy and stretching.

Where is the research at?

Fibromyalgia remains a mystery as to its pathogenesis. Several avenues of research are explored: what role does stress play? viruses ? genetic ? neurohormones? The effectiveness of many drugs in fibromyalgia is evaluated.

Pregabalin, originally used to treat neuropathies and epilepsy, looks promising on the symptoms of fibromyalgia. Setrons, anti-emetic (anti-vomiting) drugs that inhibit serotonin receptors, have also been used with promising results by German doctors.

Fibromyalgia Research

What is Fibromyalgia?

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers think that fibromyalgia amplifies painful senses by affecting the way your brain processes pain signals.

Cell Biology research results: