Evaluation Of Non-drug Self-management System And Clinical Research On Comprehensive Therapy For Patients With Fibromyalgia Syndrome

Fibromyalgia syndrome(FMS)is a common rheumatic disorder characterized by generalized pain,fatigue and insomnia,often accompanied by anxiety,depression and cognitive impairment.At present,there is no definite conclusion on the pathogenesis of FMS in modern medicine.In terms of treatment,the emphasis is on health education and disease management.On this basis,a comprehensive therapy combining physical therapy,physical exercise,psychological therapy and drug therapy should be recommended.In disease management,although there are various methods proposed,they lack the systematic evaluation necessary to provide a definitive conclusion.In recent years,Chinese medicine has been playing an important role in the treatment of FMS with the increasing research of FMS locally.However,there is still an apparent lack of specific treatment methods and principles of traditional Chinese medicine,in terms of the prescription rules and formulas used,which hinders further research on this disease.Therefore,it is an urgent problem to explore a safe and effective clinical comprehensive treatment scheme with fewer side effects for the treatment of fibromyalgia syndrome.Purpose:1.Analyze the Chinese literature on the treatment of fibromyalgia syndrome with formulas,based on the software of"TCM inheritance assistance platform2.5",to discover the basic medication characteristics and prescription principles of formulas in the treatment of FMS as well as the compatibility rules.2.In order to evaluate the efficacy and safety of non-drug management programs in self-management of FMS patients in a more comprehensive,systematic and scientific way,and to provide a feasible program for long-term self-management of patients and evidence-based medical evidence for future studies.3.To evaluate the clinical efficacy of low-frequency therapeutic instrument combined with oral Chinese medicine in the treatment of fibromyalgia syndrome on the basis of providing a non-drug self-management program,and to explore the optimal clinical treatment programMethod:1.Data mining:According to the formulated standard of inclusion,the collected literatures on prescription and treatment of FMS were screened and a database was established,and the compatibility rules were mined by software.2.Systematic evaluationA comprehensive search of 4 domestic and 2 foreign databases was conducted from the date of database construction to March 2018.Randomized controlled trials of non-drug management protocols were collected and the literature was screened according to the inclusion criteria.The included studies were analyzed using the Revman 5.3 analysis software provided by the Cochrane collaboration.Meta-analysis was used to analyze studies concerning subjects,interventions,control measures and outcome indicators,and conclusions were drawn.3.Clinical researchPatients with fibromyalgia syndrome with liver qi stagnation and spleen deficiency between March 2018 and December 2018 were randomly divided into three groups.Low-frequency therapeutic apparatus combined with internal Chinese medicine(low-frequency+Chinese medicine group)was used in the experimental group 1,low-frequency therapeutic apparatus combined with oral Chinese medicine based on non-drug self-management scheme was used in the experimental group2(comprehensive group),and low-frequency therapeutic apparatus was used in the control group(low-frequency group).By using McGill pain questionnaire,WPI and SS score,The 17-item Hamilton Depression Rating Scale(HAMD 17)and FIQR(modified fibromyalgia syndrome impact questionnaire),the main symptoms and signs of pain and stagnation before and after treatment in the three groups were compared.Result:1.Data mining results1.1 Commonly used Chinese medicines:radix paeoniae alba(BaiShao),radix bupleuri(ChaiHu),angelica sinensis(DangGui),poria cocos(FuLing),licorice root(GanCao),and ligusticum chuanxiong(drugs used more than 30 times are listed in descending order);1.2 Targeted meridian:liver meridian,spleen meridian and heart meridian are the most frequently targeted meridians in choosing of the medicines.1.3 Four qi and five flavors:in the induction of four qi and five flavors of traditional Chinese medicine,the temperature-induced drugs account for 45%,the cold-induced drugs account for 25%,and the neutral-induced drugs account for 24%.Astringent accounted for 31%,sweet for 30%and bitter for 29%.1.4 Common compatibilities:the compatibility combinations used more than 20 times are:radix paeoniae alba(BaiShao)-radix bupleuri(ChaiHu),radix angelicae sinensis(DangGui)-radix paeoniae alba(BaiShao),radix angelicae sinensis(DangGui)-radix bupleuri(ChaiHu),radix bupleuri(ChaiHu)-poria(FuLing),radix angelicae sinensis(DangGui)-poria(FuLing),radix paeoniae alba(BaiShao)-poria(FuLing),radix angelicae sinensis(DangGui)-radix paeoniae alba(BaiShao)-radix bupleurn(ChaiHu),radix chuanxiong(ChuanXiong)-radix angelicae sinensis(DangGui).1.5 Evolution of new prescriptions:based on the entropy clustering of complex systems,seven new prescriptions were evolved.Paeony root(BaiShao),radix cyperi(ZhiXiangfu),Fried jujube kernel(SuanZaoren),huai wheat(HuaiXiaomai),liquorice(Gancao);Dangshen,jujube,coptis chinensis(HuangLian),scutellaria baicalensis(Huangqin),ginger,rhubarb(DaHuang);Wei ling xian,papaya(MuGua),psoralea(BuGuzhi),angelica dahuricae(BaiZhi);Rhizoma corydalis(YanHusuo),gardenia(ZhiZi),neem(ChuanLianzi),radix paeoniae rubra(ChiShao),poria cocos(FuLing),atractylodes macrocephala(Baizhu);Astragalus membranaceus(HuangQi),Tuber Fleeceflower Stem(YeJiaoteng),Silktree Albizia Bark(HeHuanpi),Fried jujube kernel(ChaoSuanzaoren),gardenna(ZhiZi),Toosendan Fructus(ChuanLianzi);Root of Doubleteeth Pubescent Angelica(DuHuo),gentiana macrophylla(QinJiao),notopterygium(QiangHuo),myrrh(Moyao);Root of Doubleteeth Pubescent Angelica(DuHuo),divaricate saposhnikovia root(FangFeng),notopterygium(QiangHuo),Dipsacus asperoides(ChuanDuan).2.Systematic review results:A total of 11 non-drug self-management studies were included in this study,including 10 in English and 1 in Chinese.A total of 580 cases were included.All 11 references mentioned random grouping,5 reported the generation of random sequences,4 reported random occult,1 reported the blind method of subjects and researchers,1 reported the blind method of outcome evaluation,2 did not do intentional treatment analysis,and 2 did not register the trial scheme.All of 11 studies,except for 2 meta-analyses,the rest can only be described qualitatively.3.Clinical research results3.1 General information and baselineThere were no statistically significant differences in age and course of disease among the 86 subjects3.2 SF-MPQ scoreThe change values were compared in pairs before and after treatment.There were differences between the two groups(P<0.05).The low-frequency+TCM group was higher than the control group,and the comprehensive group was higher than the control group(P<0.0167).During the follow-up period,the low-frequency+TCM group was higher than the control group,and the comprehensive group was higher than the control group(P<0.0167).3.3 HAMD(17)scoresThe change values were compared in pairs before and after treatment.There were differences between the two groups(P<0.05).The low-frequency+TCM group was higher than the control group,and the comprehensive group was higher than the control group(P<0.0167).During the follow-up period,the low-frequency+TCM group was higher than the control group,and the comprehensive group was higher than the control group(P<0.0167).3.4The FS scoreThe change values were pairwise compared before and after treatment.There were differences between the two groups(P<0.05).The low-frequency+TCM group was higher than the control group,the comprehensive group was higher than the control group,and the comprehensive group was higher than the low-frequency+TCM group(P<0.0167).During the follow-up period,the low-frequency+TCM group was higher than the control group,the comprehensive group was higher than the control group,and the comprehensive group was higher than the low-frequency+TCM group(P<0.0167)3.5 FIQR scoreThe change values were compared in pairs before and after treatment.There was a difference between the two groups(P<0.05).The comprehensive group was higher than the control group,and the comprehensive group was higher than the low-frequency+traditional Chinese medicine group(P<0.0167).During the follow-up period,the low-frequency＋TCM group was higher than the control group,and the comprehensive group was higher than the control group(P<0.0167).Conclusion:1.Data mining conclusionsAt present,recipe treatment of FMS focuses on regulating the liver and regulating the spleen,and xiaoyao powder and guizhi decoction are commonly used.The herbs used are radix paeoniae alba(BaiShao),bupleurum(ChaiHu),angelica(DangGui),poria(FuLin),licorice(GanCao),ligusticum chuanxiong and guizhi,etc.2.Conclusion of systematic evaluation2.1This system review results suggest that it is advantageous to improve the symptoms of FIQ score,VAS score and the overall periods for 36℃ treatment with conventional therapy,improve the young’s tai chi chuan joint health education,aerobic exercise combined strength and flexibility training,guided imagery in combination with conventional nursing care.However,all of these schemes cannot be recommended for various reasons.2.2According to the characteristics of the research team,the actual situation of surrounding patients,and combining the above conclusions,the research team will formulate a non-drug self-management program for fibromyalgia syndrome patients under the guidance of experts,that is,a self-management program for patients coordinated by health education called Yang tai chi.3.Clinical research conclusions3.1 On the basis of non-drug self-management program,low-frequency therapeutic instrument combined with oral Chinese medicine is effective in relieving pain,improving depressive state and improving patients’ quality of life.3.2The non-drug self-management scheme can improve the durability of efficacy.3.3Traditional Chinese medicines for soothing the liver and strengthening the spleen are effective in improving the pain and depression of patients with fibromyalgia.