FIBROMYALGIA - CHARACTERISTICS AND PROOF OF PAIN

Abstract

Fibromyalgia is a disease that remains unrecognized due to ignorance and misinterpretation of symptoms. This article presents a clinical case from the medical practice of Fibromyalgia, while characterizing the pain syndrome and the necessary tests to prove the diagnosis. The clinical case concerned a patient with lumbar pain syndrome who did not respond to non-steroidal anti-inflammatory drugs. No connection has been established with the diseases provided for in the differential diagnosis, such as disc herniation, acute arterial insufficiency, rheumatoid arthritis. The laboratory tests performed are normal, except for a slight increase in AST of about 200 U / l, as well as high CRP values. No instrumental studies such as endophotonic emission computed tomography (SPECT), positron emission tomography (PET), magnetic resonance imaging (MRT) and electroencephalogram (EEG) were performed. The case describes a modified symptom in the elderly. Modified symptoms are experienced differently by patients. In this case, our own (from the doctor’s experience) paradigm was used for diagnosis. The paradigm consists of four main steps, which are: description of the specifics of each symptom; two aspects of the diagnosis: what is and what is not; the symptoms form a whole which represents the diagnosis with a logical connection and sequence and analysis of small deviations and nuances - a way of accurate diagnosis. The burning nature of the pain, the presence of painful nodules in the lumbar and scapular areas bilaterally, point to myositis. Various non-steroidal anti-inflammatory drugs have been administered in various forms (oral, topical and injectable), with no effect. As a last resort, a tricyclic antidepressant, amitriptyline, was included, which showed that the pain disappeared within a month. The presence of a mental component in the field of rheumatic disease, the effect of amitriptyline pain and the presence of sore spots at the predilection sites, led to the disease “Fibromyalgia”. Diagnosis of fibromyalgia is necessary to comply with two conditions clinical analysis of pain with the detection of painful points and instrumental nuclear magnetic resonance imaging to demonstrate dysfunction of the central nervous system and electroencephalogram for sleep disorders. To improve the diagnostic process, it is necessary in practice to apply tests of hormones and neurotransmitters.