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纤维肌痛管理:基于近期循证指南的实用指南。

Management of fibromyalgia: practical guides from recent evidence-based guidelines.

出版信息

Pol Arch Intern Med. 2017 Jan 4;127(1):47-56. doi: 10.20452/pamw.3877.

Abstract

Fibromyalgia (FM) is a prevalent and costly condition worldwide, affecting approximately 2% of the general population. Recent evidence- and consensus‑based guidelines from Canada, Germany, Israel, and the European League Against Rheumatism aim to support physicians in achieving a comprehensive diagnostic workup of patients with chronic widespread (generalized) pain (CWP) and to assist patients and physicians in shared decision making on treatment options. Every patient with CWP requires, at the first medical evaluation, a complete history, medical examination, and some laboratory tests (complete blood count, measurement of C‑reactive protein, serum calcium, creatine phosphokinase, thyroid‑stimulating hormone, and 25‑hydroxyvitamin D levels) to screen for metabolic or inflammatory causes of CWP. Any additional laboratory or radiographic testing should depend on red flags suggesting some other medical condition. The diagnosis is based on the history of a typical cluster of symptoms (CWP, nonrestorative sleep, physical and/or mental fatigue) that cannot be sufficiently explained by another medical condition. Optimal management should begin with education of patients regarding the current knowledge of FM (including written materials). Management should be a graduated approach with the aim of improving health‑related quality of life. The initial focus should ensure active participation of patients in applying healthy lifestyle practices. Aerobic and strengthening exercises should be the foundation of nonpharmacologic management. Cognitive behavioral therapies should be considered for those with mood disorder or inadequate coping strategies. Pharmacologic therapies may be considered for those with severe pain (duloxetine, pregabalin, tramadol) or sleep disturbance (amitriptyline, cyclobenzaprine, pregabalin). Multimodal programs should be considered for those with severe disability.

摘要

纤维肌痛症(FM)是一种在全球范围内普遍存在且代价高昂的疾病,影响大约 2%的普通人群。加拿大、德国、以色列和欧洲抗风湿病联盟最近发布了基于证据和共识的指南,旨在帮助医生对患有慢性广泛性(全身性)疼痛(CWP)的患者进行全面的诊断评估,并协助患者和医生共同决策治疗方案。每位患有 CWP 的患者在首次就诊时都需要进行全面的病史采集、体格检查和一些实验室检查(全血细胞计数、C 反应蛋白、血清钙、肌酸磷酸激酶、促甲状腺激素和 25-羟维生素 D 水平),以筛查 CWP 是否由代谢或炎症原因引起。任何额外的实验室或放射学检查都应根据提示其他某种医疗状况的“危险信号”而定。该诊断基于典型症状群(CWP、睡眠质量差、体力和/或精神疲劳)的病史,这些症状无法用其他医疗状况充分解释。最佳治疗应从向患者提供关于 FM 的当前知识(包括书面材料)的教育开始。管理应采用分级方法,目的是改善与健康相关的生活质量。初始重点应确保患者积极参与应用健康的生活方式实践。有氧运动和力量训练应是非药物治疗管理的基础。对于那些有情绪障碍或应对策略不足的患者,应考虑采用认知行为疗法。对于那些有严重疼痛(度洛西汀、普瑞巴林、曲马多)或睡眠障碍(阿米替林、环苯扎林、普瑞巴林)的患者,可考虑使用药物治疗。对于那些有严重残疾的患者,应考虑采用多模式方案。

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