Fibromyofascial pain, characterization, etiological hypothesis, application and effect of treatment

Abstract

ABSTRACT: Chronic non rheumatic neuromusculoskeletal pain affects 20% of the population worldwide, with a progressive tendency. Nowadays, its treatment is only symptomatic, poorly effective and expensive. The objective of this study was characterizing the disease under investigation that is neuromusculoskeletal pain, with a remittent initial evolution, recurrent, migratory and progressive, resistant to symptomatic treatment and that it usually shows normal biomedical testing. The etiological empirical hypothesis is that this disease would be produced by the impregnation of monosodium urate in the fascias of the connective tissue of synovias, tendons, ligaments, fascia, muscles, periostium and loose connective tissue. Then, it is proposed to treat it with anti-gout drugs, regardless of the uricemia of each patient. The effect of treatment is evaluated. Methods: Prospective study of dynamic cohort, randomized, quasi-experimental, not controlled, of patients that spontaneously and randomly consult in an integral medicine clinic, who present pain according to the case definition, and who give their informed consent. Two groups are determined: one group of already treated and the other group without diagnosis or previous treatment. The treatment was colchicine and allopurinol, besides transdermal lidocaine for persistent trigger points. Recovery rates were evaluated, and the chances of recovery for each time interval studied through descriptive analysis of recovery, together with an analysis of survival. The sensitivity of the diagnosis it is evaluated and the effect and adherence to treatment are also evaluated. Results: From the initial sample of 53 people, 4 of them discontinued treatment on the first day because drugs intolerance; remaining in treatment and control by one year a sample of 49 patients. Of these, 17 are men (34.7%) and 32 women (65.3%); mean age of 58.5 years (SD = 15.07); disease duration: 0-27 years, mean = 4.08 years (SD = 5.23). The characterization of the disease was obtained through collect and evaluate the frequency distribution of symptoms and signs in each ones in whole sample. The empirical etiological hypothesis it was obtained from a previus comparative clinical-semiological study. It was determined that the etiologic agent of this syndrome is monosodium urate, which stimulate the proprio-noci-receptors without producing inflammation. The application of anti-uricemic treatment it was determined with colchicine and allopurinol in usual doses. At the end of 1 year of treatment and follow-up of each patient, 100% of them showed no signs and symptoms presented at the beginning, at a median time of 2 months, which was evaluated by survival analysis. Adherence to treatment was 92.45% and 24.5% behaved tolerable adverse reactions. CONCLUSION: The semiological-clinical characterization of the remitting relapsing migratory progressive miofascial pain syndrome have sensitivity enough to establish the diagnosis. The empirical etiological hypothesis allowed to choose an effective treatment for all people really treated. Key words: Musculoskeletal Non Rheumatic Diseases; Fascias; Fibromyalgia; Myofascial Pain Sindrome, Gout.