Offenbächer M, Stucki G
Department of Physical Medicine and Rehabilitation, University of Munich, Germany.
Scand J Rheumatol Suppl. 2000;113:78-85. doi: 10.1080/030097400446706.
Fibromyalgia (FM) is a syndrome of unknown etiology characterized by chronic wide spread pain, increased tenderness to palpation and additional symptoms such as disturbed sleep, stiffness, fatigue and psychological distress. While medication mainly focus on pain reduction, physical therapy is aimed at disease consequences such as pain, fatigue, deconditioning, muscle weakness and sleep disturbances and other disease consequences. We systematically reviewed current treatment options in the treatment of fibromyalgia. Based on evidence from randomized controlled trials cardiovascular fitness training importantly improves cardiovascular fitness, both subjective and objective measures of pain as well as subjective energy and work capacity and physical and social activities. Based on anecdotal evidence or small observational studies physiotherapy may reduce overloading of the muscle system, improve postural fatigue and positioning, and condition weak muscles. Modalities and whole body cryotherapy may reduce localized as well as generalized pain in short term. Trigger point injection may reduce pain originating from concomitant trigger points in selected FM patient. Massage may reduce muscle tension and may be prescribed as a adjunct with other therapeutic interventions. Acupuncture may reduce pain and increase pain threshold. Biofeedback may positively influence subjective and objective disease measures. TENS may reduce localized musculoskeletal pain in fibromyalgia. While there seems to be no single best treatment option, physical therapy seem to reduce disease consequences. Accordingly a multidisciplinary approach combining these therapies in a well balanced program may be the most promising strategy and is currently recommended in the treatment of fibromyalgia.
纤维肌痛（FM）是一种病因不明的综合征，其特征为慢性广泛性疼痛、触诊时压痛增加以及其他症状，如睡眠障碍、僵硬、疲劳和心理困扰。虽然药物治疗主要侧重于减轻疼痛，但物理治疗针对的是诸如疼痛、疲劳、身体机能下降、肌肉无力和睡眠障碍等疾病后果。我们系统回顾了纤维肌痛治疗中的当前治疗选择。基于随机对照试验的证据，心血管适能训练能显著改善心血管适能、疼痛的主观和客观指标、主观能量和工作能力以及身体和社交活动。基于轶事证据或小型观察性研究，物理治疗可能会减轻肌肉系统的负荷，改善姿势性疲劳和体位，并增强虚弱的肌肉。局部冷疗法和全身冷冻疗法可在短期内减轻局部和全身性疼痛。触发点注射可能会减轻特定纤维肌痛患者伴随触发点产生的疼痛。按摩可减轻肌肉紧张，可作为其他治疗干预措施的辅助手段开具。针灸可减轻疼痛并提高痛阈。生物反馈可能会对主观和客观的疾病指标产生积极影响。经皮电刺激神经疗法（TENS）可减轻纤维肌痛中的局部肌肉骨骼疼痛。虽然似乎没有单一的最佳治疗选择，但物理治疗似乎能减轻疾病后果。因此，在一个平衡良好的方案中结合这些疗法的多学科方法可能是最有前景的策略，目前在纤维肌痛治疗中被推荐。
