mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2014-2-76-82mrj-546Research ArticleОБЗОРЫREVIEWSТерапия синдрома фибромиалгии на современном этапеCurrent therapy of fibromyalgia syndromeЧичасоваН.В.ChichasovaN.V.1@ru.ruИголкинаЕ.В.IgolkinaE.V.1@ru.ruФГБУ «Научно-исследовательский институт ревматологии им В.А. Насоновой» РАМН, Москва, РоссияРоссияV.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow, RussiaRussian Federation201408052014827682Copyright © Чичасова Н., Иголкина Е., 20142014Чичасова Н., Иголкина Е.Chichasova N., Igolkina E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/546

В статье приводятся данные о патогенетически значимых параметрах, участвующих в восприятии боли при фибромиалгии (ФМ): повышенная чувствительность или плотность допаминовых D2-рецепторов, усиление болевого сигнала в связи с увеличением уровня субстанции Р и недостаточная его модификация, обусловленная низким уровнем серотонина, феномен аллодинии, психосоматический компонент. Приведены новые классификационные критерии ФМ и оценка тяжести симптомов, входящих в эти критерии. Показано, как изменилась терапия боли при ФМ за последнее десятилетие: уменьшение использования периферических анальгетических средств, трициклических антидепрессантов, возрастание частоты назначения ингибиторов обратного захвата серотинина (дулоксетина, милнаципрана) и прегабалина. Продемонстрированы эффективность и удовлетворительная переносимость прегабалина при боли. Проведено сравнение эффективности и переносимости дулоксетина, милнаципрана и прегабалина по данным 17 рандомизированных контролируемых исследований. 

The data on pathogenetically significant parameters that are involved in pain perception in fibromyalgia (FM) patients (increased sensitivity or density of dopamine receptors D2, enhanced pain signal due to the elevated substance P level or insufficient modification of the pain signal caused by low serotonin level; allodynia phenomenon; and the psychosomatic component) are reported.

New classification criteria of FM and assessment of severity of the symptoms included in these criteria are presented. The changes that have taken place in therapy of FM pain over the past decade are demonstrated: less frequent use of peripheral analgesics, tricyclic antidepressants; more frequent use of serotonin reuptake inhibitors (duloxetine, milnacipran) and pregabalin. The effectiveness and fair pain tolerability of pregabalin are demonstrated. The effectiveness and tolerability of duloxetine, milnacipran, and pregabalin are compared using the data of 17 randomized controlled trials. 

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The authors declare that there are no conflicts of interest present.