[Treatment of myalgia]

Fibromyalgia (FM) conceptualized by the American College of Rheumatology is characterized by long-lasting chronic widespread pain and stiffness of the fibro-muscular system associated with various unidentified symptoms. Since most of the patients are female and the onset and clinical course of FM involves various kinds of bio-psychosocial stress factors, it is very important to consider the psychosomatic background of the patient. The symptom of FM is not readily improved with conventional analgesic drugs, antirheumatic agents or various kinds of physiotherapy, however current guidelines recommend tricyclic antidepressants, SSRIs and SNRIs as first-line therapies to treat the multiple symptom of the FM. It is considered that antidepressants may operate the functional impairment of descending (efferent) analgesic system, in which serotonin and noradrenaline take an important role. Among 199 certified physicians of the Japanese Society of Psychosomatic Medicine, the largest number of respondents selected SSRI, SNRI and other antidepressants as first-line drugs. Because the psychological and physical exhaustion due to an irregular life style, physical strain, and accumulated fatigue may be the key stress factors for the organization of symptoms, psychosomatic approach and guidance should be conducted to enable patients to reduce stress in daily life. For the problems of personality and psychological stress, counseling and advanced psychotherapy such as cognitive behavioral therapy (CBT) should be also conducted.