原发性纤维肌痛综合征

作者就原发性纤维肌痛综合征(PFS)近来发表的有关文献作一综述,以供参考。 一、概念 PFS是指不存在病毒感染、甲状腺机能低下症、外伤、类风湿关节炎、结缔组织病等基础病,而有广泛性肌骨骼痛、多处僵硬和在称为触痛点的一些特定部位有明显压痛又无关节风湿病的一种疾病。有人曾称为纤维织炎,但纤维织炎包括了由外伤和感染引起的肌骨骼痛及有局部触痛肌的筋膜痛综合征(MPS),而且有PFS缺乏的炎症现象,故多数学者认为将此病称纤维织炎是不恰当的,应叫做PFS。     

热矿泥治疗纤维肌痛综合征的临床分析

目的针对热矿泥的治疗作用可广泛影响纤维肌痛综合征发病机制的理论基础,探析热矿泥治疗纤维肌痛综合征的疗效及在改善主要症状方面的作用,期望为本病的治疗提出一种有效的方法。方法对满足ACR1990年纤维肌痛综合征分类标准,并除外热矿泥禁忌证的26例患者给予38～42℃热矿泥埋敷治疗,15min/次,1次/d,20次为一疗程,每患治疗2～3疗程。分别对治疗前后的主要症状进行评分,依治疗后与治疗前得分减少的百分比评价疗效。结果 5项主要症状评分均明显下降（P〈0.01）,总体评价,有效率92.3%。结论热矿泥可从多方面明显改善纤维肌痛综合征患者的大部分症状,提高患者的工作能力和生活质量,不良反应少,是治疗纤维肌痛综合征的有效方法。     

自血光量子法治疗原发性纤维肌痛综合征1例

从改善血液流变学角度出发,采用自血光量子血治疗原发性纤维肌痛综合征(PFS)至今无文献报告.笔者对1例不能耐受阿米替林的PFS患者用自血光量子血治疗,同时对自血光量子血治疗PFS的机理进行探讨,现予报告.     

原发性纤维肌痛综合征102例误诊分析

我们统计了89例2005—01—2010-11我院及外院首诊误诊的纤维肌痛综合征（PFs）病例,并对其进行回顾性分析,探讨PFs误诊的原因,以提高首诊诊断的准确率。现报告如下。     

星状神经节阻滞结合药物治疗纤维肌痛综合征临床观察

目的探讨氟哌噻吨＋美利曲4-（黛力新）＋阿普唑仑＋星状神经阻滞治疗纤维肌痛综合征（FS）的临床疗效。方法30例患者随机分为A组（黛力新＋阿普唑仑），B组（黛力新＋阿普唑仑＋星状神经阻滞组），观察疗效。果A组优良率76．9％，B组优良率达86．7％，B组疗效明显优于A组。结论星状神经节阻滞结合药物治疗优=纯药物治疗，疗效满意，不良反应少，值得临床推广应用。     

纤维肌痛综合征诊治进展

纤维肌痛综合征,也称纤维肌痛症,是较为常见的风湿性疾病,好发于40岁以上女性人群,以全身弥漫性疼痛为主要特征,常伴有疲劳、睡眠障碍、情绪紊乱和认知功能障碍等多种非特异性临床症状,严重影响着患者的身心健康。在我国,纤维肌痛综合征“鲜为人知”,在医疗界和人民大众中得不到足够的认识,患者在多个科室之间辗转求治,往往导致正确诊断和治疗的延迟,加大了患者的精神和经济负担。本文对本病的历版诊断/分类标准和最新治疗管理方法及其推荐意见予以介绍和解读,以期促进我国纤维肌痛综合征诊治水平的提高。     

纤维肌痛综合征概述

纤维肌痛综合征是一种病因不明的慢性疼痛性疾病,其特征为广泛性肌肉骨骼疼痛、僵硬及全身性疲劳。根据观察,此病似乎与丧失恢复性睡眠、神经生化异常、交感神经系统失控、局部组织因素、机体创伤和病毒感染及精神因素等有潜在的关系,其治疗至今是个难题。因此,最佳的治疗是采取综合措施,例如:教育、药物疗法、锻炼等。其中教育病人和躯体锻炼是长期治疗的两个最重要方法。     

臭氧治疗纤维肌痛综合征58例

2004年3月-2006年1月我科收治的纤维肌痛综合征患者58例，均符合美国风湿病协会（ACR）纤维肌痛综合征分类诊断标准，男13例，女45例；年龄34—69岁，平均46．8岁,病程1—5年，平均2．3年临床表现为全身性疲劳、睡眠障碍或肢体展僵。58例患者分为臭氧组28例，药物组30例，2组一般资料比较差异无显著性意义。臭氧组用10ml注射器抽取浓度为25％的臭氧1—2ml，压痛点注射，隔日1次；药物组口服阿米替林50mg，每日分2次服用。治疗过程中2组均配合心理治疗。     

Posttraumatic stress disorder in fibromyalgia syndrome: Prevalence,temporal relationship between posttraumatic stress and fibromyalgia symptoms,and impact on clinical outcome

A link between fibromyalgia syndrome (FMS) and posttraumatic stress disorder (PTSD) has been suggested because both conditions share some similar symptoms. The temporal relationships between traumatic experiences and the onset of PTSD and FMS symptoms have not been studied until now. All consecutive FMS patients in 8 study centres of different specialties were assessed from February 1 to July 31, 2012. Data on duration of chronic widespread pain (CWP) were based on patients’ self-reports. Potential traumatic experiences and year of most burdensome traumatic experience were assessed by the trauma list of the Munich Composite International Diagnostic Interview. PTSD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders IV symptom criteria by the Posttraumatic Diagnostic Scale. Age- and sex-matched persons of a general population sample were selected for controls. Three hundred ninety-five of 529 patients screened for eligibility were analysed (93.9% women, mean age 52.3 years, mean duration since chronic widespread pain 12.8 years); 45.3% of FMS patients and 3.0% of population controls met the criteria for PTSD. Most burdensome traumatic experience and PTSD symptoms antedated the onset of CWP in 66.5% of patients. In 29.5% of patients, most burdensome traumatic experience and PTSD symptoms followed the onset of CWP. In 4.0% of patients’ most burdensome traumatic experience, PTSD and FMS symptoms occurred in the same year. FMS and PTSD are linked in several ways: PTSD is a potential risk factor of FMS and vice versa. FMS and PTSD are comorbid conditions because they are associated with common antecedent traumatic experiences.     

Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: a randomized controlled trial

Sañudo B, Galiano D, Carrasco L, Blagojevic M, de Hoyo M, Saxton J. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: a randomized controlled trial.

Objective

To investigate the effects of supervised aerobic exercise (AE) and a combined program of supervised aerobic, muscle strengthening, and flexibility exercises (combined exercise [CE]) on important health outcomes in women with fibromyalgia syndrome (FMS).

Design

Randomized controlled trial.

Setting

Community-based supervised intervention.

Participants

Women (N=64) with a diagnosis of FMS according to the American College of Rheumatology criteria.

Intervention

Participants were randomly allocated to 1 of 3 groups: supervised AE, supervised CE, or usual-care control. Exercise sessions were performed twice weekly (45–60min/session) for 24 weeks.

Main Outcome Measures

The primary outcome measure was the Fibromyalgia Impact Questionnaire (FIQ). Exploratory outcome measures were the 36-Item Short-Form Health Survey, Beck Depression Inventory (BDI), aerobic capacity (6-minute walk test), hand-grip strength, and range of motion in the shoulders and hips.

Results

Compliance with both interventions was excellent, with women in the exercise groups attending more than 85% of sessions. A 14% to 15% improvement from baseline in total FIQ score was observed in the exercise groups (P≤.02) and was accompanied by decreases in BDI scores of 8.5 (P<.001) and 6.4 (P<.001) points in the AE and CE groups, respectively. Relative to nonexercising controls, CE evoked improvements in the SF-36 Physical Functioning (P=.003) and Bodily Pain (P=.003) domains and was more effective than AE for evoking improvements in the Vitality (P=.002) and Mental Health (P=.04) domains. Greater improvements also were observed in shoulder/hip range of motion and handgrip strength in the CE group.

Conclusion

Given the equivalent time commitment required for AE and CE, our results suggest that women with FMS can gain additional health benefits by engaging in a similar volume of CE.     

临床路径教学模式在中医护理临床教学中的应用研究

应用临床路径教学模式进行中医护理临床教学,通过具体设置每周的教学目标、教学内容、教学方法和评价方式,使中医护理临床教学标准化和程序化,以保证学生能够在限定的教学时间内全面掌握中医护理内容,提高中医护理教学质量。     

Fibromyalgia relapse evaluation and efficacy for durability of meaningful relief (FREEDOM): a 6-month, double-blind, placebo-controlled trial with pregabalin

This was a multicenter, double-blind (DB), placebo-controlled, randomized discontinuation trial to evaluate the efficacy of pregabalin monotherapy for durability of effect on fibromyalgia (FM) pain. The trial included a 6-week open-label (OL) pregabalin-treatment period followed by 26-week DB treatment with placebo or pregabalin. Adults with FM and 40-mm score on 100-mm pain visual analog scale (VAS) were eligible. During OL weeks 1-3, patients received escalating dosages of pregabalin to determine their optimal dosages. During OL weeks 4-6, patients received their optimal fixed dosages (300, 450, 600mg/d). To be randomized, patients must have had 50% decrease in pain VAS and a self-rating of "much" or "very much" improved on Patient Global Impression of Change (PGIC) at the end of OL. Double-blind treatment was with placebo or the patient's optimal fixed dosage of pregabalin. Primary outcome was time to loss of therapeutic response (LTR), defined as <30% reduction in pain (from OL baseline) or worsening of FM. A total of 1051 patients entered OL; 287 were randomized to placebo, 279 to pregabalin. Time to LTR was longer for pregabalin versus placebo (P<.0001). Kaplan-Meier estimates of time-to-event showed half the placebo group had LTR by Day 19; half the pregabalin group still had not lost response by trial end. At the end of DB, 174 (61%) placebo patients met LTR criteria versus 90 (32%) pregabalin patients. Pregabalin was well tolerated, though 178 (17%) discontinued during OL for treatment-related adverse events (AE), and more pregabalin than placebo patients discontinued for AEs during DB. In those who respond, pregabalin demonstrated durability of effect for relieving FM pain.     

痛风的中医药治疗现状及展望

痛风是临床上比较常见的一种代谢性疾病。中医药在辨证治疗痛风方面具有个体化、多靶点、作用持久、安全稳定等优势。近年来,随着中医药在痛风方面的研究不断深入,越来越多的临床工作者关注此方面的动态。本文主要综述了中医药在治疗痛风方面的临床治疗现状及展望。     

中医通补法治疗原发性骨质疏松症的作用机制研究

目的:探讨中医通补法对原发性骨质疏松症的作用机制。方法:观察40例原发性骨质疏松症患者,随机分为治疗组30例,用中药通补强骨汤治疗;对照组10例,用健骨钙加霜叶红治疗。结果:经一个疗程共3个月治疗,疼痛等症状改善方面,治疗组明显优于对照组(P<0.05),并能提高腰椎和股骨骨密度,其中腰椎2～4骨密度变化与对照组相比有显著性差异(P<0.05);中医证侯疗效、骨密度疗效明显优于对照组治疗,能升高血清骨钙素水平和女性患者血雌二醇水平。结论:通补强骨方能升高血雌二醇水平,抑制骨吸收,提高血清骨钙素水平,增加成骨细胞活性,从而升高骨密度,改善症状,提示其作用机制与抑制骨吸收,促进骨形成,提高骨密度有关。     

Efficacy of memantine in the treatment of fibromyalgia: A double-blind,randomised, controlled trial with 6-month follow-up

Fibromyalgia (FM) is a prevalent and disabling chronic disease. Recent studies have found elevated levels of glutamate in several brain regions, leading to hypotheses about the usefulness of glutamate-blocking drugs such as memantine in the treatment of FM. The aim of this study was to evaluate the efficacy of memantine in the treatment of pain and other clinical variables (global function, clinical impression, depression, anxiety, quality of life) in FM patients. A double-blind, parallel randomised controlled trial was developed. A total of 63 patients diagnosed with FM were recruited from primary health care centres in Zaragoza, Spain. Memantine was administered at doses of 20 mg/d after 1 month of titration. Assessments were carried out at baseline, posttreatment, and 3- and 6-month follow-up. Compared with a placebo group, memantine significantly decreased ratings on a pain visual analogue scale (Cohen’s d = 1.43 at 6 months) and pain measured with a sphygmomanometer (d = 1.05). All other secondary outcomes except anxiety also improved, with moderate-to-large effect sizes at 6 months. Compared with placebo, the absolute risk reduction obtained with memantine was 16.13% (95% confidence interval = 2.0% to 32.6%), and the number needed to treat was 6.2 (95% confidence interval = 3 to 47). Tolerance was good, with dizziness (8 patients) and headache (4 patients) being the most frequent side effects of memantine. Although additional studies with larger sample sizes and longer follow-up times are needed, this study provides preliminary evidence of the utility of memantine for the treatment of FM.     

Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial

Brininger TL, Rogers JC, Holm MB, Baker NA, Li Z-M, Goitz RJ. Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial.

Objective

To compare the effects of a neutral wrist and metacarpophalangeal (MCP) splint with a wrist cock-up splint, with and without exercises, for the treatment of carpal tunnel syndrome (CTS).

Design

A 2×2×3 randomized factorial design with 3 main factors: splint (neutral wrist and MCP and wrist cock-up), exercise (exercises, no exercise), and time (baseline, 4wk, 8wk).

Setting

Subjects were evaluated in an outpatient hand therapy clinic.

Participants

Sixty-one subjects with mild to moderate CTS; 51 subjects completed the study.

Interventions

There were 4 groups: the neutral wrist and MCP group and the neutral wrist and MCP-exercise group received fabricated customized splints that supported the wrist and MCP joints; the wrist cock-up group and the wrist cock-up-exercise group received wrist cock-up splints. The neutral wrist and MCP-exercise and wrist cock-up-exercise groups also received tendon and nerve gliding exercises and were instructed to perform exercises 3 times a day. All subjects were instructed to wear the assigned splint every night for 4 weeks.

Main Outcome Measures

We used the CTS Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) to assess CTS symptoms and functional status.

Results

Analysis of variance showed a significant main effect for splint and time on the SSS (P<.001, P=.014) and FSS (P<.001, P=.029), respectively. There were no interaction effects.

Conclusions

Our results validate the use of wrist splints for the treatment of CTS, and suggest that a splint that supports the wrist and MCP joints in neutral may be more effective than a wrist cock-up splint.