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🏥 | Active anesthesiologist Mioshin's fight against fibromyalgia "The hellish days of being alive without seeds of hope...

Photo Mio Shin (C) Nikkan Gendai

Active anesthesiologist Mioshin's struggle with fibromyalgia "The hellish days of living without seeds of hope...

If you write the contents roughly
Fibromyalgia is a disease that causes insomnia, headaches, depression, and other symptoms due to chronic, strong pain that occurs throughout the body for more than three months.

Mioshin (Anesthesiologist/37 years old) = Chronic Fatigue Syndrome/Fibromyalgia → Continue reading

 Daily Gendai Healthcare

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Fibromyalgia(Seikin Tsusho,British: Fibromyalgia, abbreviation:FM) is a disease that causes severe pain throughout the body.in English,syndromeFibromyalgia Syndrome: short forFMSalso written[1].unexplained whole bodypainwith the main symptom[2].Pain may be enthesoitis or筋肉,jointand so on,Trunk,Limbssevere pain that spreads throughout the body from[3].It is not an emerging disease and was previously called "non-arthritic rheumatoid arthritis", "psychogenic rheumatoid arthritis", "soft tissue rheumatoid arthritis", "fibromyalgia syndrome", etc.[1].

with similar symptoms,Chronic fatigue syndrome,Irritable bowel syndrome,Chemical hypersensitivity,Sick house syndrome,Temporomandibular disorders,Interstitial cystitis,Gulf War Syndrome, complex regional pain syndrome,Ehlers-Danlos Syndromeetc., but they are different disease concepts.[4].


In 1990, the American College of Rheumatology defined the disease concept, proposed highly useful classification criteria, and spread the disease name of "Fibromyalgia Syndrome".[1]. In 2010, new diagnostic criteria were created that included the evaluation of pain symptoms and accompanying symptoms.[5].

Affected women are much more common than men, and the incidence is high in middle-aged and elderly people in the prime of life.Prevalence in the U.S. is approximately 20% of adults over the age of 2[2].Although it is a rheumatic disease with a relatively large patient population, estimated at 200 million including mild cases, it is not recognized by Japanese medical institutions.As a result, very few patients are receiving proper medical care, and many are either undiagnosed or misdiagnosed.Doctor shoppingRepeatedly, as a result, it has become a situation of being sick for a long time.disappointed in medical careFolk remediesand so on.In this way, the medical environment for fibromyalgia in Japan is problematic[6].


The cause is unknown,Doctornormal blood tests do not show any abnormalities[2].CTscan,MRINo abnormalities can be found by inspection.Also, as of 2015, there is no specific test that can diagnose the disease.Diagnosis is very difficult in many cases, but a simple method of distinguishing by tender points is known[7].

In a paper published in October 2018, 10 people with fibromyalgia and 31 healthy peoplePositron tomography of the brain compared with (PET)Glial cellsThis indicates that the activation ofGyrusconsistent with the degree of inflammation in[8].


The main symptoms
Chronic pain throughout the body and tenderness in anatomically distinct areas[1].
Concomitant symptoms
Physical symptoms[1][4]
Slight fever below 38°C, fatigue, malaise, finger stiffness, finger swelling, joint pain, Raynaud's phenomenon, night sweats, irritable bowel syndrome, palpitations, dry symptoms, dyspnea, dysphagia, interstitial cystitis-like symptoms Symptoms, irregular menstruation, dysmenorrhea, weight fluctuation, photosensitivity, cold intolerance, temporomandibular joint disorder, hypotension, various allergic symptoms, mitral valve prolapse, itching, etc.
Neurological symptoms[1][4]
Numbness of limbs, tremor of fingers, dizziness, tinnitus, deafness, visual impairment
Psychiatric symptoms[1][4]
Depressive symptoms, anxiety, irritability, sleep disturbance (hypersomnia, insomnia), concentration loss, attention loss, amnesia, discomfort upon awakening

Severe pain in the skeletal muscles is the main symptom of fibromyalgia, but there are several ways to express its severity, such as “pain like exploding gunpowder in the body” and “pain like a vise”. "Pain like being stabbed with an awl" "Pain like shards of glass flowing (inside the body)"[9].In addition to pain symptoms, it is accompanied by various physical symptoms.as a common symptomSleeping disorderare mentioned. It is said that 9% of patients have sleep disorders.[10].As for how pain causes sleep disturbance, there is a characteristic pattern in which, when sleeping in the same position, pain occurs due to one's own weight and wakes up in the middle of the night.It is said that sleep disturbance and pain are closely related, and a vicious cycle is observed in which sleep disturbance causes stress, then pain, and further sleep disturbance.for that reason,Mental careis considered important[10].

Although it is said that this disease is not the direct cause of death, the pain in the whole body is tremendous, and it is possible that the suffering of pain indirectly drives the patient to death. Former Nippon Television announcer who died on February 2007, 2 at the age of 2:Kimie Osugireportedly committed suicide over the illness[11](However, some have questioned the causal link between jumping and fibromyalgia.[12]).As will be described later, the symptoms of this disease are greatly affected by the patient's stress and mental state, and there are many clinical cases in which improvement of the nervous and mental state improves the symptoms.The cause of this disease is unknown, and because it is difficult for others to understand the reason for the patient's pain, it is often a disease of laziness orMalingeringThis is likely to be misunderstood by those around them, and this is thought to further increase the stress on patients.depressionWe need an understanding of the disease around us, as we do with the disease.The prevalence of suicidal ideation in fibromyalgia patients was reported to be 32.5%[13].


  • Pain levels and types of pain change with weather, temperature, humidity, environment, stimuli from the five senses, and physical and mental stress.The pain often shifts, but the pain never stops.
  • Symptoms vary greatly from person to person, and while mild symptoms may allow the patient to continue working, severe cases are said to have the same level of pain as terminally ill cancer patients. be.When the symptoms become severe, just touching the hair or nails causes pain, and the patient becomes unconscious and bedridden.Normal daily activities (eating, shopping, bathing, changing clothes, walking, turning over in bed, etc.), even breathing and swallowing become difficult.
  • visual, auditory (Sensitivity), the five senses of touch, taste and smell are markedly hypersensitive.As a result, even the slightest sound, light, or light touch can cause pain.Chemical and alcohol intolerance can worsen allergy symptoms.
  • Burning or cold sensation, chills, piercing pain (stinging pain), scarification pain,AllodyniaPerceptual abnormalities such as
  • Many patients have markedly decreased muscle strength and exercise capacity, severe muscle fatigue, muscle spasms, decreased ability to move, joint pain and swelling, in severe cases unable or unable to stand up without assistance, distance previously walked. symptoms such as inability to walk.
  • Ankylosing spondylitis,Seronegative spondyloarthritisreported to have a high frequency of fibromyalgia as a comorbidity in patients with[14][15].

Physical symptoms other than pain

Over 90% of FMS patients feel tired[2].with similar illnessChronic fatigue syndrome(CFS, but CFS is a disease associated with fatigue, not pain) or (SEID)[2]. There are many cases of complications before and after the onset of FMS.Some doctors consider it to be the same disease as fibromyalgia because there are parts in common with symptoms[16]. The main symptom of CFS is severe fatigue, both physical and mental.[2].Fatigue becomes stronger after exercise and mental activity, and it is difficult to recover from rest and sleep.Insomnia, hypersomnia, easy to have clear dreams.The degree of fatigue ranges from barely working, to severe enough that some patients cannot even turn over.

Psychiatric symptoms

along with sleep disordersDepressionThere are many cases of the condition. Approximately 30% of FMS patientsMajor depressionalso diagnosed[2].This is especially true when the onset of pain is triggered by accumulated stress in relationships, divorce, or bereavement of close relatives.[10].In the field of psychiatry, chronic pain of unknown cause is included in the category of somatoform disorders.[17]Diagnosis also works against them, leading to misdiagnosis and underdiagnosis.Psychiatric symptoms often improve with pain relief.This means that pain is the main cause of fibromyalgia, not psychiatric symptoms.[17].Restless legs syndromeoccurred in 70.7% of patients, approximately 20% of whom were severe[17].

Onset factors are classified into external factors and internal factors for analysis.

internal factor
stressand genetic predisposition[18].
  • Living environment stress such as divorce, bereavement, separation, dismissal, financial hardship, etc.[18].
  • genetic predisposition.However, the degree of heritability depends on the so-called monogenic diseasesGenetic diseasenot as big asType 2 diabetesIt is the extent of multifactorial genetic diseases such asNon-hereditary onset factors are also called triggers, and are events that lead to the state of fibromyalgia.
External factor
External factors includeTrauma,手術,Virus infectionAre listed.
  • Fibromyalgia caused by car accidents is said to account for 3% of all patients, but due to the low awareness of fibromyalgia, it is a problem that it tends to be treated unfavorably in Japanese justice and administration. ing[19].as an external onset factorVirus infectionIn addition, some percentage of people with fibromyalgia have multipleMycoplasmaThere are reports of infection[20].As another trigger,Tooth extractiondental procedures such asvertebraltrauma or surgery,Whiplashsignificant physical disability such aspanic disorderAre listed[18].As it progresses, the 18 tender points are exceeded and severe pain radiates throughout the body, including enthesitis of tendons, fasciae, and joints.[21].The pain is time-varying and often takes the form of attacks.The first pain triggers the next pain[21].As the severity increases, the pain becomes more extensive, attacks last longer, and become more intense, regardless of the innervated area, and the patient's quality of life is significantly reduced.[22].Triggers that are particularly complex in a social sense are car accidents andCervical cancer vaccineis.The HPV vaccine-associated neuroimmune syndrome (HANS) has been proposed by the Intractable Disease Treatment Research Promotion Foundation to summarize fibromyalgia-like symptoms caused by cervical cancer vaccines.[23][24][25].


According to a national epidemiological survey conducted by a research group of the Ministry of Health, Labor and Welfare, 2003 patients were diagnosed with fibromyalgia in 2,600, and 3,900 patients were diagnosed with the Japan Rheumatism Foundation registered physicians. remarkably few patients.Furthermore, a population survey was conducted and the prevalence rate per population was 2.2% in metropolitan areas, 1.2% in rural areas, and 1.7% overall.Close to prevalence of about 2% in the US and Europe[26].A detailed investigation suggests that the reason why the prevalence rate rises is that there are many undiagnosed and misdiagnosed cases due to low awareness.

In 2009, the number of patients who consulted the Japan Rheumatology Foundation registered physicians was again surveyed, and it was 11,000.[26], the diagnostic rate is slightly improved.It is also said that rheumatologists avoid treating fibromyalgia[27].

Gender differences, age distribution, familial occurrence, etc.

Reports from Europe and the United States show a female:male ratio of 8 to 9:1.In Japan, the female:male ratio is 4.8:1.The average age is 51.5 years.The age distribution was wide, with 4.8% being of pediatric age.The estimated age of onset is 43.8 years on average.For familial occurrence, family history was 4.1%[27].It took an average of 4.3 years from onset to make a definitive diagnosis, but half were diagnosed within a year.[28].An average of 3.9 clinical departments were visited until a definitive diagnosis was made.Doctor shoppingThere is a current situation ofIt is said that there are more than a few cases in which medical care is neglected without diagnosis.[28].

Disease type classification

It is often accompanied by diseases such as rheumatic diseases as the underlying disease.Fibromyalgia was once classified as primary when it occurs alone, and secondary when it accompanies another disease, but no distinction is made at present.The ratio of fibromyalgia alone to concomitant cases is 3:1.Rheumatoid arthritis is the most common underlying disease[28].

A cluster analysis was proposed and classified into four types: hypertonic, depressive, enthesitis, and mixed.#DiscussionSee alsoVGKC autoantibodies have been identified in some cases of hypertonic type[29].

Diagnostic criteria

Differential disease

Exclude the following diseases:

Severity classification

Severity varies from patient to patient and from time to time.A draft proposal for severity classification (stage classification) has been proposed as an objective evaluation method.It is classified as I to V based on the combination of clinical symptoms and the intensity of symptoms, and nearly 30% are said to be stage III or higher.[30].

Draft Classification of Fibromyalgia Severity (Stage)[31]
Stage classificationclinical picturefrequency
Stage IPain in 18 or more of the 11 tender points in the American College of Rheumatology classification criteria, but does not significantly interfere with activities of daily living44.0%
Stage IIThe pain spreads to the ends of the fingers and toes, followed by insomnia, anxiety, and depression.difficulty in daily life31.0%
Stage IIISevere pain persists, and severe pain spreads throughout the body with minor stimuli such as stimuli to nails and hair, and changes in temperature and humidity.difficult to live on one's own9.8%
Stage IVDue to the pain, she is unable to move on her own and is almost bedridden.Inability to sleep or sit in the same position for long periods of time due to pain caused by one's own weight9.1%
stage VIn addition to severe pain all over the body, symptoms appear throughout the body such as bladder and rectal disorders, dry mouth, dry eyes, and urinary tract infections.Normal daily life is impossible6.1%

American College of Rheumatology Fibromyalgia Classification Criteria (1990)

Classification criteria created by the American College of Rheumatology (ACR) in 1990[32][33][34].

It is abbreviated as ACR1990 hereafter.

Despite many criticisms of this old standard, it is a widely used classification standard internationally.In practice, it is also stated that there are cases that do not meet the classification criteria, and that there are no criteria for excluding cases that do not meet the classification criteria from fibromyalgia.[35].

Fibromyalgia Classification Criteria (ACR1990)[36]
1. Extensive history of pain
DefinitionExtensive areas include right/left body, upper/lower body, body axis (cervical spine, anterior chest, thoracic spine, lumbar spine)
2. Pain in 18 or more of 11 tender points by finger palpation
DefinitionBilateral occiput, lower cervical spine, upper edge of trapezius muscle, supraspinatus muscle, 2nd rib, lateral epicondyle of the elbow, buttocks, greater trochanter, knee joint
For finger palpation, press with a force of 4 kg (just enough to turn the operator's nail white)

Determination of tender points: Acknowledgment of pain complaints (verbal, behavioral)

JudgmentWidespread pain persisting for more than 3 months and meeting both of the above criteria.A second disease may be present.

The usefulness of ACR1990 for Japanese cases was verified, and as a result, diagnostic sensitivity was 75.9%, diagnostic specificity was 97.4%, and usefulness was 86.9%, indicating that it is an excellent diagnostic standard. was verified[37].

According to ACR1990, even those with so-called secondary fibromyalgia that accompany the onset should be diagnosed as fibromyalgia regardless of the disease type.[37].

Proposed American College of Rheumatology Preliminary Diagnostic Criteria (2010)

Consists of the following three items[38].

  1. Defined spread of chronic pain (widespread pain index: WPI) and clinical symptom severity (SS) score above a certain level.
  2. Clinical signs should be maintained at the same level as at diagnosis for 3 months.
  3. No other medical condition that could explain chronic pain.

Fibromyalgia can be diagnosed when these three items are satisfied.It will be abbreviated as ACR3 hereafter, but only an overview is given as it is too complex to deal with here.

It is stated that the ACR2010 Preliminary Diagnostic Criterion does not replace the ACR1990 Classification Criterion.This is because non-inflammatory rheumatic diseases are used as control diseases. In addition to ACR2010, other criteria related to the diagnosis of fibromyalgia, such as ACR2010 Revised Criteria (2011) and J-FIQ, are known.[39], which is too complicated to deal with here.

As of 2015, the FAS2010 based on ACR31 is the most commonly used evaluation form and questionnaire for fibromyalgia in Japan.[40].

Other inspection means

Until now, it has been difficult for patients to specifically communicate their pain, but in 2007 OSACHI and Nipro launched PainVision.Current perception threshold testerReleased[41].This is a device that quantifies and presents a graph of a patient's pain by giving the patient electrical stimulation that can create pain-like sensations.By quantifying and visualizing the degree of pain, which was previously difficult to convey to doctors, the patient and doctor can share the amount of pain the patient feels, thereby reducing the patient's psychological burden. It is expected thatHowever, there are still few hospitals that have this device, and other hospitalsFace scaleetc.

As of 2015, it is a method in the research stage,T cellsis the index ofHokkaido Universityannounced by the research group of[42].


Although not aimed at Japanese people,EuropeBy Rheumatology Society and European Pain Societyevidence2016 Diagnostic Treatment for Level AalgorithmThere is[43].After an accurate diagnosis is made, provide educational information, and if the effect is insufficientPhysical therapyand if it is still not effective, give individual treatment[43].What is physical therapy?Drug therapycombined with individualized step-by-stepExercise therapy, hyperthermia,acupunctureAnd so on[43].According to European guidelines,aerobic exercisetherapy,Qigong,yoga,太極拳Such as瞑想Exercise (so far exercise therapy), acupuncture,Spa therapyrecommended,Biofeedback,CapsaicinTherapy,chiropractic,Homeopathy,relaxationis not recommended[44].Exercise therapy has a strong scientific basis and can be recommended[44].Acupuncture has moderate scientific evidence and can be suggested, and limited weak evidence suggests other integrative medicines.[45].. Other,diet remedyCan be mentioned[44].

Individual treatments are as follows:

Cognitive-behavioral therapy and exercise therapySelf careIt is also an advantage that it can be implemented as[46][47] Chronic pain#self careSee also.

Exercise therapy

Depending on the fibromyalgia patient, by exercise therapy,Healthand improve sleeppain,fatiguecan reduce[48][49].Especially for some patientsaerobic exercisestrong evidence that is effective[50].long termUnderwater exercisealso proved effective in the sense that it combined resistance training with aerobic exercise.[51].

Move your muscles and joints dailystretchshould be心 臓,lungexercise is necessary to maintain adequate function.Exercise management methods called SMART goals have been proposed for chronic pain patients. Specific = definite, Measurable = measurable, Achievable = achievable, Realistic = realistic, and Timeframe = set deadline.Set this goal and adjust the pace distribution finely.In chronic pain patients, it is said that the skill of pacing based on self-judgment determines the success or failure of exercise.Once you become physically active, you should also have a rest and adjustment plan in case the pain worsens.Based on these assumptions, it is said that not moving just because there is pain is the worst choice.[52].However, it is important to try to be 'moderate' because it is against the premise to not be able to do it by self-judgment or to overdo it.Many fibromyalgia patients are originally perfectionists and it is said that ``too much'' is prohibited only for hard workers[53].

As a specific menu,walk, Tai Chi, as much as you canRadio gymnastics/Tv gymnastics, very light yoga, etc.[54].In addition, it is desirable to start walking with water training,walkingIn patients incapable ofGumBite hard,Take a deep breathRhythmic exercise that does not put a strain on the legs and lower back has been proposed, such as doing[55].

Drug treatment

In Japan, in 2012Pregabalinwas approved for the first time in Japan as a treatment for pain associated with fibromyalgia.then in 2015Duloxetine insurancebecame applicable.

Recommended by guidelines

In the "Fibromyalgia Treatment Guidelines 2017" by the Japanese Society for Fibromyalgia, in the chapter "Drug Treatment"evidence(scientific evidence) and recommendations and agreement rates for each drug are presented.Evidence is graded A if there is strong evidence of conviction, C if there is limited conviction, D, the lowest if there is little conviction, separately, strongly recommend, offer, do not offer, strongly recommend and do not , split without recommendation[56].

Antiepileptic drugThen,Pregabalin TheRandomized controlled trial (RCTs), European guidelines and CochraneSystematic reviewIt is also recommended in Japan, and the Japanese guidelines also recommend it with evidence A and an agreement rate of 100%.[57].Other antiepileptic drug candidates are slow-releaseGabapentinEvidence B, agreement rate 71%[57].

AntidepressantThen,DuloxetineThis has also been confirmed by multiple RCTs, with evidence A and an agreement rate of 100%[58].A comparative study with other therapeutic agents such as pregabalin and a comparative study from an economical point of view are required.[58].Other antidepressants have weaker analgesic effectsAmitriptyline, Although it has a good reputation overseas, it is not covered by insurance and the amount that can be prescribed is small.milnacipranis considered evidence A, and no other antidepressants are recommended[58].Sleep problems improve with pregabalin, duloxetine, and amitriptyline[43].Other psychotropic drugs not recommended[59].

OpioidThen the weak opioidTramadolis recommended with evidence A and a consensus rate of 92.9%, but gastrointestinal symptomsSide effectsToo many[60].other opioids,Non-steroidal anti-inflammatory drug (NSAIDs),Analgesicsno recommendation for[61].

GlucocorticoidEvidence A shows that it is not effective in , and is not recommended.Nerve block,Trigger pointNot recommended by evidence C in treatment,NeurotropinIn Evidence D, the evidence for efficacy is weak, but it is safe, so it can be proposed,Crude drug,Herbal medicineEvidence D, but can be suggested, no other drug therapy recommended[62].

According to the 2013 guidelines:Requires careful individual determination of the optimal dose of each drug[63].Gradually increase the prescribed dose of each drug to the upper limit while monitoring side effects and analgesic effects[63].Efforts to attempt dose reduction or discontinuation are necessary because initially effective but after 1 year or more, pain often does not worsen with discontinuation[63].The analgesic effect of antidepressants is independent of the antidepressant effect[64].

Opinion on drug therapy

There is also disagreement about whether to use opioids.According to my expert opinion, tramadol orTram setTo use[65].However, in 2014, the American Neurological Association issued a statement outlining the rise in deaths from opioids.[66], found that the risks far outweigh the benefits of opioid use in chronic non-cancer pain conditions such as fibromyalgia.[67].

According to the International Pain Society (NeuPSIG) 2015Meta-analysisAlthough side effects are not considered, opioids are the third choice for the treatment of adults with a weak recommendation, according to[68].

Although this is the opinion of an individual specialist, a fibromyalgia specialist who was involved in the creation of the 2013 guidelines said that side effects andDrug price, and considering the strength of the evidence and avoiding the same type of drug, it is said that 2015 types of medication are being tried in order in 11 in the following order of priority.[69]. 11 types of priority (Stamen): neurotropin, amitriptyline,Dextromethorphan,Nortriptyline,MecobalaminFolic acidin combination with ethyl icosapentate,Lafutidine,milnacipran, gabapentin, duloxetine, pregabalin,Venlafaxine.

Draft drug therapy based on disease type classification

The following is a tentative proposal, and the treatment results when following this have not been verified, and the recommendation is low.[43].The Fibromyalgia Clinical Practice Guidelines 2013 by the Japanese Society for Fibromyalgia includes a draft proposal for setting treatment policies by dividing patients into three main categories based on their pathology.[70].#Severity classificationSee also.

  • Hypertonic type
Skeletal muscleIt is characterized by severe pain and difficulty in moving the body.Many increase muscle strengthstiff person syndromeSimilar to.Sjogren's syndromesometimes resembles
pregabalin, gabapentin,Clonazepamantiepileptic drugs such asPilocarpinehydrochloride, etc.
  • enthesitis type
Psychiatric symptoms are few and the onset trigger isTrauma,RheumatismIt is caused by a sexually transmitted disease.
pregabalin,Sulfasalazine, NSAIDs,Prednisoloneetc.Anti-inflammatory agentor analgesics.
  • depression type
This is when symptoms are caused by psychogenic factors.
milnacipran, duloxetine,Tricyclic antidepressantand antidepressants such as pregabalin.
  • Duplicate type
The first to the third are duplicated.Duplicate types are moderated according to the weight of symptoms.

How to classify these categories and change the drugs usedScientific basisThere is criticism that it is not a world standard treatment because there is no[71].


Cognitive behavioral therapy(CBT) and relatedPsychotherapy,Behavior therapycan provide some relief from fibromyalgia symptoms[72][73].The greatest advantage is that CBT can be performed in combination with exercise therapy.[74][75].

of 1,119 casesMeta-analysisThe results showed "strong evidence that combination therapy has short-term effects on key symptoms of fibromyalgia."[76] 2010A systematic review of 14 studies was reported in , and CBT wasSelf-efficacyimproved coping with pain and pain, and reduced the number of post-treatment visits, but no significant effect on pain, fatigue, sleep, or improvements in well-being was also reported.Depression is also improved, but thisbiasmay be indistinguishable from hazards including[77]. Multidisciplinary approaches, including CBT, are often used and considered the 'gold standard' for chronic pain syndromes such as fibromyalgia.

negative thoughts orstressA living environment with a lot of stress affects pain,Chronic painis often associated with, and meditation, relaxation, and distraction techniques are said to help reduce pain[78].

Relationship with temporomandibular disorders and dental treatment

fibromyalgia isTemporomandibular disordersoften accompanied by[79].Some claim to treat fibromyalgiaDentistryThere is also.OrthodonticsIt is a treatment method that greatly changes the bite and jaw position by shaving and shaving teeth, and for patients who did not suit these treatments, it is impossible to return to the original state.InvasionDue to the strong sexuality and stressful treatment, sufficient caution is required when receiving treatment[80].

Chronic painThere is a correlation between the severity of a patient's symptoms and jaw pain[81]for,chinpain treatment may be useful in the treatment of fibromyalgia.However, treatment of jaw pain is considered as an initial treatment from the viewpoint of safety.Oral cavitySprint is recommended,occlusal adjustment- Orthodontics not recommended[82].Fibromyalgia patients are often particularly sensitive to stimuli, and there is an opinion that it is better not to touch the bite.[83].On the other hand, there is also a report that oral splint alone could control the symptoms of fibromyalgia.[84].

In this way, specialized dental treatment for physical conditions such as fibromyalgia and chronic pain, which is different from general dental treatment, is being performed.[85].

Other treatments

smokingto intensify symptoms,Non smokingis recommended[86][87].


As a chronic disease, fibromyalgia is long lasting and difficult to recover from.It is said that the patient will remain stable for 1 to 2 years after the onset of symptoms, and then recover and improve.After that it's not always good. After 1 year, only 1.5% were cured, 51.9% improved, 37.2% remained stable, and 2.6% worsened.In many cases, there is little change from the time of onset.Recovery is also seen in pediatric cases.The frequency of hospitalization is stated to be 1% in one year[88].

functional prognosis

Fibromyalgia is not a direct cause of death.Activities of daily living(ADL) progresses with decline.About half of the patients managed to maintain their ADL after one year, but the remaining half showed some decline in ADL, and 1% showed a significant decline. 27.2% are on leave of absence from work or school[89].生活 の 質Regarding (QOL), fibromyalgia is considered to be bad,Rheumatoid arthritislower than (RA), butSystemic lupus erythematosusdescribed as having a QOL similar to that of (SLE)[89].

juvenile fibromyalgia

Social withdrawal・Since many children who did not attend school were diagnosed with this disease, it is speculated that future research will reveal that the actual number of juvenile fibromyalgia patients is even higher.[90].The problem with juvenile fibromyalgia is that children refuse to go to school, saying things like "I have a stomach ache" or "I don't want to go to school," but their parents ignore it.In fact, even if the person is really suffering from symptoms, it is just a stomachache, and it becomes chronic without being understood as being lazy. and cases diagnosed with fibromyalgia have been reported.The minimum age of onset in Japan is 6 years old.In addition, there are cases in which even though they were afflicted with a serious illness soon after birth, they were simply sick for many years.

On July 2013, 7, the cause of the outbreak of juvenile fibromyalgia wasCoenzyme Q10being deficient inTokyo Institute of TechnologyFaculty of Applied BiologyYokohama City UniversityReportedly discovered by a research team with the Pediatrics Department of Medicine[91].Juvenile-onset fibromyalgia tends to be distinguished from juvenile-onset adult-onset fibromyalgia due to differences in onset patterns.[90][25].

public security system

Intractable diseaseNot designated, all of the estimated 200 million patient population are less than 1% of the population per disease (as of 0.15)Intractable disease lawcannot be designated.Therefore, a request to limit the severity and aim for designation as an intractable disease is being considered.[92]. However,Ankylosing spondylitisOnly in the case of comorbidity with a disease designated as an intractable disease, only treatments for fibromyalgia that overlap with that disease can be subsidized.

As a public guarantee system,High-cost medical treatment system,Medical system for elder senior citizens,Disability pension,Disability Comprehensive Support Act,Physical disability certificate,Mental disability certificateAnd so on[92][93].However, with regard to the Comprehensive Support Law for Persons with Disabilities and the Handbook for the Physically Disabled, since pain is an invisible disability, the degree of disability cannot be proven, and in reality it is nearly impossible to use. At present, many patients have no choice but to obtain a health and welfare notebook for the mentally handicapped.However, there are disadvantages such as the limited support that can be received with the mental disability insurance welfare booklet, and there is a movement to actively acquire a physical disability certificate.

The problem of not being seen as a disabled person due to the invisible disability of pain is a serious problem related to the system.[Note 1].


As a history in Japan, in 2003, the Ministry of Health, Labor and Welfare launched the "Fibromyalgia Research Group".[95]. Since 2008, it has continued as an independent research group. Since 2009, the work has been taken over from the Fibromyalgia Medical Information Center, Research Group of the Ministry of Labor.Japan Fibromyalgia Society JCFIis conducting an investigation.

awareness day

Chronic fatigue syndrome,Chemical hypersensitivityAn international event called "May 12th International Awareness Day" jointly with diseases such asawareness day 5/12Will be held in[96].

On International Awareness Day, the symbolic color of fibromyalgia ispurpleAndAwareness ribbonAsPurple ribbonIs used.


[How to use footnotes]

注 釈

  1. ^ I want to ride in an electric wheelchair.I was so envious of disabled people in wheelchairs.You can tell they are handicapped just by looking at them.I look completely normal, so when I sat in a priority seat on a train, I was put on my feet, perhaps because they were trying to harass me.on my sore leg.It was just a sore leg that didn't do anything. "If I amputate this leg, can't I live as a disabled person? I also thought.[94]


  1. ^ a b c d e f g Mifuji Matsumoto,Fibromyalgia: concept and treatment"Journal of the Japanese Society of Internal Medicine" 2006 Volume 95 Issue 3 p.510-515, two:10.2169 / naika.95.510, Japanese Society of Internal Medicine
  2. ^ a b c d e f g h i j k l m n "Patient information: Fibromyalgia (Beyond the Basics)". UpToDate (Wolters Kluwer).. http://www.uptodate.com/contents/fibromyalgia-beyond-the-basics?source=search_result&search=Fibromyalgia&selectedTitle=9~121. 
  3. ^ Fibromyalgia Clinical Practice Guidelines 2013, p. 1.
  4. ^ a b c d Mifuji Matsumoto,Functional Rheumatic Disease: Fibromyalgia"Journal of the Japanese Society of Internal Medicine" 2010 Volume 99 Issue 8 p.1837-1844, two:10.2169 / naika.99.1837, Japanese Society of Internal Medicine
  5. ^ Fibromyalgia Clinical Practice Guidelines 2013, p. Disease Concepts.
  6. ^ Fibromyalgia Clinical Practice Guidelines 2013, p. How to fill in the Fibromyalgia Clinical Practice Guidelines 2013.
  7. ^ NHK (October 2014, 12). “How to recognize fibromyalgia". April 2015, 3Browse.
  8. ^ Albrecht DS, Forsberg A, Sandström A, et al. (September 2018). “Brain glial activation in fibromyalgia - A multi-site positron emission tomography investigation”. Brain Behav. Immun.. two:10.1016 / j.bbi.2018.09.018. PMID 30223011. https://doi.org/10.1016/j.bbi.2018.09.018. 
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Depression(Depression, Depression, depression, English: depression)FeelingIs depressed and dislikes activities, which affects thoughts, behaviors, emotions, and happiness.[1].

Depressive state is a state image, meaning that the symptoms of depression are central to the mental state.

Depression is just a mood / emotion, and a depression that happens to anyone who is alive.Depression is a symptom of unknown cause.[2], When the condition is diagnosed as morbid, "depressionIt becomes a treatment target as.

Responses to bereavement, economic collapse, disasters, serious illnesses, etc. are normal, understandable pessimistic reactions.[3]..All the causes of depressionMental disorderIs not always[4].dementiaEarly symptoms and[5],HypothyroidismOrHyperactivityOther medical disorders such as can also cause depression.

Depression also occurs as a normal reaction to one of life's events, and only a few medical symptoms are subject to medical or drug therapy.[4].depressionIt is treated as depression almost every day for a few weeks, causing even more significant dysfunction.SevereIs the case[6].

In addition, since one diagnosis of depression has been made, a short-circuit diagnosis that does not consider the other tends to be made.[7]..Other mental disorders can also be the cause[6][4], Misdiagnosis has also been reported[8][9]..Easy medication tends to be given,[10][9], WHO and the UK-Japan Depression Practice Guidelines do not recommend the use of antidepressants for mild depression[11][12][13].


The word "depression" in the word "depression" means a state in which feelings are suppressed.Note that this does not mean that depression is suppressed.

It is derived from the English word "(de = down, press = press) = suppress".


In the 2017 survey婚姻Situations and loneliness are less relevant to depressive symptoms, connection with friends seems to have the greatest impact, and depressive symptoms are stronger when more isolated.[14].

Life events

In life such as unemployment and divorcestressShows the same symptoms as mild depression as a normal pessimistic reaction, but it is an understandable event and overdiagnosis and treatment are recommended to be avoided[6].

Childbirth, at life events and turning points that cause depressive symptomsMenopause, Financial problems, work problems, medical diagnosis (cancer, HIV, etc.),Bullyingproblem,Broken love, Natural disasters, social loneliness, relationship problems, jealousy, isolation, serious trauma, etc.[15][16].. WHO guidelines state that antidepressants and psychotherapy should not be considered as first choice in such cases, and that culturally appropriate responses should be discussed and supported.[13].

Traumatic accidents encountered in childhood can cause depression.But childhood trauma (especially for children)Sexual abuse) Is not always a depressive factor in adults, but is caused by following the psychological processes that lead to depression.Research is being conducted on the existence of chemical substances that cause this phenomenon in this field.[17][18].

Unequal treatment of children by parents is also considered a risk factor[19].

Kübler = Ross modelIn (acceptance of death such as fatal illness), depression is the fourth stage process.

Due to physical illness

Depression can also be caused by a variety of infectious and neurological disorders[20],Endocrine disease(male),Addison's disease,Lyme disease,Multiple sclerosis,Chronic pain,cerebral infarctionLater functional recovery[21],Diabetes mellitus[22],cancer[23],Sleep apnea,Circadian rhythmThere is something wrong.One of the earliest signs is endocrine disease (Hypothyroidism).Chronic fatigue syndromeIs often misdiagnosed as depression[24].

Iron deficiency in a survey in JapananemiaIt was associated with depression and was also associated with a stronger severity[25].

dementiaEarly symptoms need to be differentiated from lack of spontaneity due to depression[5].


When the cause is a substance (drug), in young peopleSubstance abuseTends to cause depressive symptoms in older people[3]..Depression is also caused by substance abuse[26].

Some medications given to patients are known to cause depression.steroid,interferon,Interleukin,ReserpineAre prone to drug-induced depression[27].

Mental disorder

manyMental disorderThe main complaint is depression[4].Mood disorderIs a group of illnesses that primarily complain of upset mood.This group hasdepressionIncludes (or major depressive disorder), which has been depressed for at least two weeks and has lost all recent activity motivation and joy.AlsoDysthymiaAlso included, which is a chronically depressed situation, but not severe enough to meet the criteria for depression.

Of the depressed state, "Mental disorder diagnosis and statistics manualIn 』, it is treated as a major depressive disorder almost every day or almost every day, for a few weeks, and it causes even more significant dysfunction.SevereIs the case[6].

People with depression have feelings of sadness, anxiety, emptiness, hopelessness, impatience, guilt, impatience, pain, and restlessness.They are discouraged from what was once a joyous activity, lose their appetite or overeating, have problems with concentration, memory and decision making, consider, challenge and declare suicide, and sleeplessness. , Insomnia, tiredness, energy loss, long-term body pain, digestive problems, etc.[28].

As another mood disorderBipolar disorderSymbolized by the episode that mood, cognitive function, and energy levels rise abnormally several times, but depression also occurs many times.[29]..If depressive episodes repeat seasonally with reduced daylight hours, those disorders (such as major depression and bipolar disorder) areSeasonal affective disorderare categorized.

It ’s not a mood disorder,Borderline personality disorder (BPD) also generally complains of depression.Adjustment disorderDiagnosis is used when a major event or stressor causes mental ataxia, but the emotional and behavioral symptoms do not meet the criteria for a major depressive episode.[30]..Also after traumaPost-traumatic stress disorder,Anxiety disorderIs also known to cause depression[31].


As mentioned above, there are many causes of depression.

If you are diagnosed with depression but do not improve it, you may find that you have mild dementia or other mental illness.[8].. Though it is easy to overlook other diagnoses in a thinking process in which one diagnosis is attached and the other is not taken into consideration, such short-circuiting diagnosis is apt to be made, and it is an incorrect use of diagnostic criteria.[7].

For psychological tests to diagnose depression and measure its severity(English edition,(English editionThere are various things such as[32].


Depression does not have to require specialized treatment.Depression can be a normal response to a particular life event, as well as a symptom of some medical condition, or a side effect of some medication or treatment.Treatment with a psychiatric approach (eg, mood disorders) may be helpful, especially for prolonged depression with other symptoms.[33]..Treatment approaches vary depending on the subtype of depression.

"Mental disorder diagnosis and statistics manualThe 5th edition (DSM-5) states that predictable reactions such as bereavement of a loved one due to common stress or loss are not mental disorders, and in the commentary on the diagnostic criteria for depression, bereavement or bereavement. Responses to economic collapse, disasters, serious illnesses, etc. may be understandable and normal, and depressive symptoms due to bereavement may last for 1-2 years.[3]..The World Health Organization's 2013 Acute Stress Guidelines also state that benzodiazepines should not be prescribed because bereavement does not cause mental illness in most people.[34].. (Not recommended in any case[35]

2009 yearsUK National Institute of Medical Technology (NICE) Depression Guidelines stipulate that antidepressants should not be used for less than mild depression due to poor risk / benefit ratios[11].. In 2012Japanese Society of DepressionTreatment Guidelines for Major Depression Disorders Do Not Recommend Easy Medications for Mild Depression[12].

Also, for the reduction and prevention of depressionCognitive behavioral therapyAnd programs using that technique have been shown to be effective.[36][37][38]..There, we helped identify negative automatic thinking and change it to functional thinking and self-affirming thinking based on objective and multifaceted cognition, and what was good (good side). ), Support for getting conscious of, distractions and other stress coping strategies (""Stress management) And problem-solving techniques (see "")Depression # treatment”) Will be provided to help students learn[36][37][38].. In addition,Hobbies / entertainment activitiesImplementing a change of mood through such means also has the effect of improving depression.[39].


Depression is a risk factor for later depression and has various adverse effects on schoolwork, work, and interpersonal relationships.Therefore, research on preventive interventions to prevent depression has been conducted, and a preventive program has been developed. The need to implement is indicated[38][37][40]..Also, in the prevention program, at the same time as preventing depression, which is a risk factor for depression.Anxiety disorderIn many cases, efforts are being made to prevent anxiety symptoms, which are risk factors for the disease, and the necessity has been pointed out.[40][41][42]..Depression / anxiety using classes for adolescents / adolescents / children (university students, etc.) and students (elementary / junior high / high school students, etc.) who are prone to develop depression and anxiety symptoms A symptom prevention program has been developed and implemented and its effectiveness has been demonstrated, indicating the need to position the depression / anxiety symptom prevention program within the curriculum.[38][41][37][43][42][44][45][46][40].


[How to use footnotes]
  1. ^ Salmans, Sandra (1997). Depression: Questions You Have – Answers You Need.People's Medical Society. ISBN 978-1-882606-14-6 
  2. ^ Edited by Soichiro Nomura, "Finding the Differentiation of Depression", Igaku-Shoin <Psychiatric Clinical Expert>, 2014, p. 7.ISBN 978-4-260-01970-5. 
  3. ^ a b c American Psychiatric Association "DSM-5 Mental Illness Diagnosis and Statistics Manual"Japanese Psychiatry SocietyJapanese version term supervision, Saburo Takahashi,Hiroshi OhnoTranslated by Toshiyuki Someya, Shigenobu Kanba, Norio Ozaki, Masaru Mimura,Toshiya MuraiTranslation,Medical school, June 2014, 6, pp. 30, 20, 161.ISBN 978 – 4260019071. 
  4. ^ a b c d Takehiko Kasuga, Sick Family, Scattered Room: Feelings of Insufficiency and Confusion for Helpers, Igaku-Shoin, September 2001, pp. 9-113.ISBN 9784260331548. 
  5. ^ a b who, (Translation) Michio Toru, Minoru Omiyama, Yoshiro Okubo, Masafumi Nakane, Yuji Okazaki "ICD-10 Mental and Behavioral Disorders: Clinical Description and Diagnostic Guidelines" (New Edition) Igaku-Shoin, 2005, 57-58 page.ISBN 978-4-260-00133-5. ,World Health Organization (1992) (pdf). The ICD-10 Classification of Mental and Behavioral Disorders: Clinical descriptions and diagnostic guidelines (blue book)World Health Organization. http://www.who.int/classifications/icd/en/bluebook.pdf 
  6. ^ a b c d Allen Frances "Essence of Mental Illness Diagnosis-Good Use of DSM-5" Kongo Publishing, March 2014, pp. 3-53.ISBN 978 – 4772413527. 
  7. ^ a b Miyaoka et al., "The Crisis of Depression Medicine," Nihon Hyoronsha, 2014, p. 36,103.ISBN 978 – 4535984110. 
  8. ^ a b Miyaoka et al., "The Crisis of Depression Medicine," Nihon Hyoronsha, 2014, p. 45,142.ISBN 978 – 4535984110. 
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  10. ^ Miyaoka et al., "The Crisis of Depression Medicine," Nihon Hyoronsha, 2014, pp. 72-76,173, 175-XNUMX.ISBN 978 – 4535984110. 
  11. ^ a b UK National Institute of Medical Technology (2009-08). CG90: Depression in adults (Report). Pp. Chapt.1.4.4. http://www.nice.org.uk/CG90. 
  12. ^ a b Japanese Society of DepressionMood Disorder Guidelines Development Committee (2012-07-26) (pdf). Japanese Society of Depression Treatment Guidelines (Report) (2012 Ver.1 ed.). http://www.secretariat.ne.jp/jsmd/mood_disorder/img/120726.pdf. 
  13. ^ a b mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings (Report). World Health Organization. (2010). DEP. ISBN 978-92-4-154806-9. http://www.who.int/mental_health/publications/mhGAP_intervention_guide/en/. 
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  15. ^ Schmidt, Peter (2005). “Mood, Depression, and Reproductive Hormones in the Menopausal Transition”. The American Journal of Medicine 118 Suppl 12B (12): 54-58. two:10.1016 / j.amjmed.2005.09.033. PMID 16414327. 
  16. ^ Rashid, T .; Heider, I. (2008). “Life Events and Depression”. Annals of Punjab Medical College 2 (1). http://www.pmc.edu.pk/Downloads/apmc/apmc_v2n1/Life%20Events%20And%20Depression.pdf April 2012, 10Browse.. [Broken link]
  17. ^ Heim, Christine; Newport, D. Jeffrey; Mletzko, Tanja; Miller, Andrew H .; Nemeroff, Charles B. (2008). “The link between childhood trauma and depression: Insights from HPA axis studies in humans”. Psychoneuroendocrinology 33 (6): 693–710. two:10.1016 / j.psyneuen.2008.03.008. ISSN 03064530. 
  18. ^ Jonathan Hill. “Childhood trauma and depression”. Current Opinion in Psychiatry 16 (1): 3–6. http://journals.lww.com/co-psychiatry/Abstract/2003/01000/Childhood_trauma_and_depression.2.aspx April 2014, 4Browse.. 
  19. ^ Pillemer, Karl; Suitor, J. Jill; Pardo, Seth; Henderson Jr, Charles (2010). “Mothers' Differentiation and Depressive Symptoms Among Adult Children”. Journal of Marriage and Family 72 (2): 333–345. two:10.1111 / j.1741-3737.2010.00703.x. PMC 2894713. PMID 20607119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894713/. 
  20. ^ Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann. April 12, 2012. ISBN-978 1437704341
  21. ^ Saravane, D; Feve, B; Frances, Y; Corruble, E; Lancon, C; Chanson, P; Maison, P; Terra, JL et al. (2009). “Drawing up guidelines for the attendance of physical health of patients) with severe mental illness ”. L'Encephale 35 (4): 330-339. two:10.1016 / j.encep.2008.10.014. PMID 19748369. 
  22. ^ Rustad, JK; Musselman, DL; Nemeroff, CB (2011). “The relationship of depression and diabetes: Pathophysiological and treatment implications”. Psychoneuroendocrinology 36 (9): 1276-1286. two:10.1016 / j.psyneuen.2011.03.005. PMID 21474250. 
  23. ^ Li, M; Fitzgerald, P; Rodin, G (2012). Journal of clinical oncology: official journal of the American Society of Clinical Oncology 30 (11): 1187-1196. two:10.1200 / JCO.2011.39.7372. PMID 22412144. 
  24. ^ Griffith JP, Zarrouf FA (2008). “A systematic review of chronic fatigue syndrome: don't assume it's depression”. Prim Care Companion J Clin Psychiatry (2): 120-128. two:10.4088 / PCC.v10n0206. PMC 2292451. PMID 18458765. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292451/. 
  25. ^ Hidese S, Saito K, Asano S, Kunugi H (July 2018). “Association between iron-deficiency anemia and depression: A web-based Japanese investigation”. Psychiatry Clin. Neurosci. (7): 513–521. two:10.1111 / pcn.12656. PMID 29603506. 
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