지제 15 권제 2 호 (2020 년 12 월 ) The Journal of Chuna Manual Medicine for Spine & Nerves Vol 15. No. 2, December 2020, 43-54 https://doi.org/10.30581/jcmm.2020.15.2.43 JCMM ISSN 1975-535X 섬유근통에대한국내임상연구동향및중재방향 Korean Domestic Trends of Clinical Research and Direction of Intervention for Fibromyalgia Received: 23 November, 2020. Revised: 26 November, 2020. Accepted: 10 December, 2020 이정한 1,3, 금지혜 1, 우현준 1, 이창훈 2, 정종혁 2, 이명수 2 * 1 원광대학교한의과대학한방재활의학교실 2 원광대학교병원내과학교실류마티스내과 3 한국전통의학연구소 Jung-Han Lee, K.M.D. 1,3, Ji-Hye Geum, K.M.D. 1, Hyeon-Jun Woo, K.M.D. 1, Chang-Hoon Lee, M.D. 2, Chong-Hyuk Chung, M.D. 2, Myeung-Su Lee, M.D. 2 * 1 Department of Rehabilitation Medicine of Korean Medicine, College of Korean Medicine, Won-Kwang University 2 Division of Rheumatology, Department of Internal Medicine, Wonkwang University Hospital 3 Research Center of Traditional Korean Medicine Objectives The purpose of this review was to analyze the trend of clinical research related to fibromyalgia and to suggest the direction of intervention Methods We reviewed the clinical research by searching seven Korean web databases and classified the studies by the year of publication, academic field, and study. Results A total of 75 clinical studies were selected. Except for 2002, more than one study was annually published; however, the number was below 10. In the academic field, there were 34 in the medical field, 21 in the Korean medicine field, and 15 in the nursing science field. By study, there were 62 observational studies, mostly case reports and case-control studies. There were 13 experimental studies, including non-random control studies and one group pre and post-test studies. Conclusions Fibromyalgia-related clinical research requires a greater number of studies, and a study with a high level of evidence should be conducted along with various observational and intervention studies. Additionally, multidisciplinary and integrated intervention plans and research are needed. Key words Fibromyalgia, Intervention, Clinical research, Review 1. 서론 섬유근통은만성전신통증과함께피로감, 수면장애, 불안, 우울등의증상이동반되는질환으로 1), 2015년국민건강보험공단의자료 2) 에따르면국내에서섬유근통으로진료를받은사람은 2009년 41,008명에서 2014년 72,756명으로연평균 12.2% 증가하였으며, 매년여성이남성보다약 2배이상많은것으로나타났다. 또한건강보험진료비지급자료를분석한내용을보면건강보험에서섬유근통진료에지급된총진료비는 2009년약 51억원에서 2014년약 143억원으로증가하여연평균 23.0% 증가한것을알수있다. 섬유근통은난치성만성질환의일종으로진단에이르는데평균 5년이소요되고전체환자의 25% 만이진단 되고있어적절한진단기준을사용하여조기에진단을하는것이중요하다 3,4). 또한, 치료에있어서섬유근통은아직까지발병기전과병태생리가완전히밝혀지지않아통상적인진통제나진정제등의약물로만은치료되지않는다. 이와관련하여약물요법이외운동요법, 인지행동치료, 침치료등의한의치료등다양한치료방법들을시도하고는있으나주로환자가호소하는증상을완화시키는것이주가되고있다 5). 섬유근통관련기존의국내연구들을살펴보면, 의학계에서는주로섬유근통의진단과치료에대해외국의현황과추세등을다루는종설논문이나 6-8) 섬유근통환자에게동반되어나타나는증상에대한관찰연구등 9,10) 이대부분이며. 한의학계에서는치료효과와관련된증례논문 11) 이다수로섬유근통의진단과치료에있어서 *Corresponding to Myeung-Su Lee, Division of Rheumatology, Department of Internal Medicine, Wonkwang University Hospital, 895, Muwang-ro, Iksan-si, Jeollabuk-do, 54538, Rep. of Korea TEL. +82-63-859-2661, FAX. +82-63-855-2025, E-mail. ckhlms@hanmail.net Copyright 2020. KSCMM All Rights Reserved.
44 The Journal of Chuna Manual Medicine for Spine & Nerves Vol 15. No. 2, December 2020 통계적으로유의미한일정규모이상의임상연구나의학적근거의위계가높은연구는부족한실정이다. 이에저자는본연구를통해 2000년이후부터현재까지섬유근통관련국내임상연구를중심으로연구동향을분석하여향후중재방향에대한조명과중재연구를위한기초자료를제공하고자하였다. 으로검토하였으며, 초록의내용이불분명하거나본연구와의적합성여부가불분명할경우추가적으로원문을읽고분석하였다. 이과정에서임상연구가아닌문헌과섬유근통과관련이없는문헌, 중복검색된문헌을제외하였다. 최종적으로선정된문헌에대해서는연도별분석및학계별분석, 연구유형및내용으로나누어분석을진행하였다. 2. 대상및방법 1) 연구대상 섬유근통관련문헌검색을위해국내전자데이터베이스중 한국의학논문데이터베이스 (KoreaMed), 의과학연구정보센터 (KMBase), 국가과학기술정보센터 (NDSL), 한국학술정보 (KISS), 전통의학정보포털 (OASIS), 학술연구정보서비스 (RISS), 한국과학기술정보연구원 (KISTI) 를기본대상으로하여검색하였다. 검색어로 섬유근통, 섬유근육통, 섬유염, 섬유조직염, 근섬유염, Fibromyalgia, Fibromyositis, Fibrositis, Myofibrositis 등의단어를조합하여 2020년 10월 31일까지검색을시행하였다. 2) 연구방법 2000년이후발표된임상연구중제목과초록을중심 3. 결과 1) 연구대상선정결과 7개의국내전자데이터베이스에서검색한결과총 9639개의문헌이검색되었다. 이후임상연구가아닌문헌과섬유근통과관련이없는문헌, 중복검색된문헌을제외하여최종적으로 75개의논문을분석대상으로선정하였다 (Appendix Ⅰ). 2) 발표연도별분포최종선정된 75편의논문을연도별로분석한결과, 2000년 5편의연구를시작으로현재까지 2001년을제외하고매년 1편이상의논문이발표되었으며, 특히 2016년에는가장많은 7편의임상연구가발표되었다 (Fig. 1). Fig. 1. The number of the theses sorted by published year.
섬유근통에대한국내임상연구동향및중재방향 45 Fig. 2. The number of the published theses according to the academic field. Fig. 3. The number of the published theses according to the types of observational studies. 3) 발표학계별분포발표된연구들을학계별로분류하였을때총 75편중의학계에서발표한연구가 34편 (46%) 로가장많았으며, 한의학계가 21편 (28%), 간호학계가 15편 (20%) 등으로그뒤를이었고, 물리치료학등의보건학계에서 3편 (4%), 치의학계, 통합의학계에서 1편씩게재되었다 (Fig. 2). 4) 연구유형별분포선정된임상연구논문을연구설계에따라분류하였을때, 총 75편의연구중관찰연구가 62편이었으며실험연구가 13편으로조사되었다. (2) 실험연구중재를대상자에게가한뒤전후비교를하거나대조군과의비교를통해효과여부를확인하는중재연구가 13편이었다. 자세히분류해보면, 비무작위대조군연구가 7편이었으며, 실험군내에서치료전, 후를비교하는단일군원시실험연구가 6편, 무작위대조군연구가 1편이었다. 사용된중재로는자조관리프로그램, 치료적마사지및운동요법, 그리고약물요법등이었으며, 임상시험의결과를나타내는지표로는통증평가, 피로도평가, 건강상태및신체활동정도, 혈청호르몬수준, 베타엔돌핀수준, 그리고 f-mri 활성도등이있었다 (Table Ⅰ). (1) 관찰연구관찰연구중증례보고가 28편 (45%) 으로가장많았으며, 그다음으로는환자대조군연구가 20편 (32%) 을차지하였다. 그외에는상관관계연구가 5편 (8%), 섬유근통평가도구의타당도와관련된방법론적연구가 4편 (7%) 이었으며, 서술적조사연구 3편 (5%), 단면조사연구가 2 편 (3%) 이었다 (Fig. 3). 4. 고찰및결론 섬유근통은 1904년 Gowers 25) 에의해기술된 섬유조직염 (fibrositis) 라는단어에서유래된용어로전신근육통과피로감을특징으로하는비염증성, 비관절성의만성근골격계통증질환이다 26). 전체인구의 2~4% 가앓
46 The Journal of Chuna Manual Medicine for Spine & Nerves Vol 15. No. 2, December 2020 Table Ⅰ. Detail of Experimental Studies No. Author(yr) n Intervention Control Outcomes Measurement Results Study Design 1 Han(2002) 12) 41 Self-help program None 1) Symptom 2) Self-efficacy 3) Physical disability 2 Kim et al.(2004) 13) 83 Therapeutic massage program None 1) Pain rating scale (MPQWL, VRS, VAS-I, VAS-U) 3 Kim, et al.(2006) 14) 37 symptomatic treatment None 1) Chalder s fatigue scale 2) BPI-K 3) SDS 4) SAS 4 Han, et al(2007) 15) 65 Tai-Chi self-help program None 1) Symptom 2) Daily life activity & Mobility 3) Life satisfaction 1), 2), 3) 6 weeks, 8 months 1), 2) Promoted 3) has showed significantly worse 1) before treatment, 1) showed significant 1, 2, 3, 4 weeks decrease and after 4 weeks 1), 2), 3), 4) 0, 4 weeks 1), 2), 3) 0, 8 weeks 1), 2), 3), 4) decreased Only results of 2) was statistically significantly correlated with the improvement of fatigue. One group pre&post test One group pre&post test One group pre&post test 1), 2), 3) decreased One group pre&post test 5 Cho & Han(2007) 16) 40 A: Self-help program B: None(19) 1) Self-efficacy for 6 weeks through 2) Symptom small group 3) Activity disturbance meeting(21) 1), 2), 3) 0, 6 weeks 1) increased 2), 3) reduced compared to the control group None quivalent control group pre&post 6 Kim, et al(2007) 17) 13 A: Therapeutic massage group(6) 7 Kim & 6 Therapeutic massage Moon(2007) 18) group B: None(7) 1) Epimephrine, Norepinephrine 2) CBC 3) VAS None 1) FIQ 2) SF-MPQ 8 Lee, et al(2011) 19) 48 A: Cryotherapy and Tai B: None(23) 1) FIQ values chi self-help 2) Tender point program group (25) 3) Physical impairment 4) Feel good 5) work missed 6) do work, pain, fatigue, rested, stiffness, anxiety, depression 1), 2), 3) 0, 4 weeks 1), 2) 0, 4 weeks 1), 2), 3), 4), 5), 6) 0, 2 weeks No statistically significant difference in 1) & WBC of 2) but statistically significant difference in RBC, Hemoglobin, Thrombocyte of 2) and 3) 1), 2) showed sigmificant differences 1), 3), 4), 5), 6) showed significant improvement by the comparison group 2) showed no significant differences Randomized controlled study One group pre&post test Pre&post quasi-experimenta l non-random 9 Kang, et al(2014) 20) 17 A: MLN group(10) B: PGB group(7) 10 Bidari, et al(2016) 21) 45 A: FM patients(30) B: Healty group(15) 11 Lee, et al(2014) 22) 50 A: Patients with combined Fibromyalgia and Myofascial pain syndrome(29) B: Patients with MPS (21) 12 Cho, et al(2018) 23) 24 A: IV ATP injection group C: Healthy group(9) B: None 1) NPS 2) FIQ 3) WPI 4) SS 5) FSS 1) fmri image with blocked-ed pressure-pain stimulation 2) statistical analysis of paired t-test and two sample t-test 1), 2) pre & post stimulation 1) beta-endorphin level 1) basal, end of the exercise schedule 1) FIQ 2) SF-36 3) MPQ 4) Hand grip strength 1), 2), 3), 4) Pre-TPI in A, B, C group 3), 4) Post TPI in A, B group 1), 2), 3), 4), 5) 0(Initial), 1(1st injection), 2(final injection) weeks 1) BOLD signal of B group was higher than A group at several regions including anterior cingulated and insula 2) BOLD signal of A group decreased in several regions including insula and Thalamus. So A, B group have different medicaition effects 1) A group had lower levels than B in both status [Pre status] 1), 2), 3), 4) showed significant differences between A group and B, C group. But no significant difference between B and C group [Post status] 3) Decreased, 4) Increased In Group A & B, negative correlation was found between 3) and 4) 1), 2), 4), 5) were significantly decreased Non-randomized controlled pre&post study Non-randomized controlled pre&post study Non-randomized controlled pre&post study One group pre&post test 13 Lim (2018) 24) 43 A: Yoga self-help management group (21) B: None(22) 1) Health status 2) BDI 1), 2) 0, 8 weeks 1) had significantly improved 2) A was lower than B group Non-randomized controlled pre&post study
섬유근통에대한국내임상연구동향및중재방향 47 고있으며, 류마티스내과에내원하는환자의 10~20% 를차지하는비교적흔한질환으로주로 30-50세사이에호발하며남성보다여성에서 9배정도많은것으로알려져있다 27). 섬유근통의임상양상을보면만성전신통증과함께피로감, 수면장애, 인지기능장애, 우울및불안, 두통등이동반된다. 만성전신통증은신체의좌, 우측부위와상하부위에서 3개월이상지속되는통증으로흔히옮겨다니기도하며, 통증강도의기복이있다. 또한, 이상감각이동반될수도있으며, 무감각이나저림, 작열감과같은신경통증같은양상을보이기도한다. 피로감은만성전신통증과함께가장흔한증상중하나로보고되고있으며, 수면장애역시섬유근통환자의 76-96% 에서나타나고있는것으로보고되고있다. 섬유근통환자의 70-90% 에서인지기능장애가보이는데주로작업기억이나언어유창성등에서저하가발견된다. 우울증및불안증은 30-50% 에서동반되며, 두통또한 50-80% 에서동반되는것으로나타나고있다 28,29). 이러한섬유근통의원인은명확하게알려져있지않으나유전적소인, 근육과힘줄에반복적인미세외상, 수면장애, 자율신경이상, 호르몬이상, 중추신경계의통증조절이상등을원인으로보고있다. 이중중추신경계에서통증처리과정에서의변화에문제가있어발생한다는가설이가장많은인정을받고있는데, 이것은중추신경계통증조절이상으로인해신체내통증전달물질간의불균형이생겨통증억제역할을하는신경전달물질은감소되고통증전달물질은증가되어되어통증을느끼게된다고보는것이다. 또한, 섬유근통환자는정상인에비해통증역치가감소되어있으며, 통증자극시뇌로부터시작되는하행억제경로가척수반응을억제하는데있어서제대로작동하지않는보고가있다 30-32). 섬유근통의진단기준으로는 1990년에발표한미국류마티스학회 (American College of Rherumatology, ACR) 의분류기준이가장널리사용되어왔다 33). 3개월이상지속되는광범위한통증과함께 18군데특정해부학적위치를 4 kg의압력으로압박하였을때 11군데이상에서압통이있으면섬유근통으로진단한다. 이러한진단기준은많은환자를대상으로한연구에서유용성이증 명되었으나대부분의의사가압통점을검사하는방법에익숙하지않고, 일부연구자는압통점검사없이증상에의해서만진단하는것을선호하기도한다 34). 1990년 ACR 분류기준은통증에초점이맞춰져수면장애, 피로, 신체증상과같은섬유근통에동반되는주된증상에관한내용이빠져있어이러한증상들을진단기준에포함해야하는필요성이제기되어왔다 35). 이러한문제점들을개선하기위해 2010년미국류마티스학회에서는섬유근통의새로운진단기준을발표하였다 36). 새로운진단기준을살펴보면, 최소 3개월동안통증과신체증상이지속되고, 이러한통증을설명한만한다른질환이없는경우전신통증지수 (widespread pain index, WPI) 와증상증등도척도 (symptom severity scale, SS) 를평가하여진단하는방식으로전신통증지수 (WPI) 는신체를 19군데로구분하여통증부위를수치로계산하는것이고, 증상중증도척도 (SS) 는피로, 상쾌하지않은각성, 인지증상, 그리고일반적인신체증상의정도를 3점척도로평가하는방식이다. 전신통증지수는직접면담을통해표시하는것이가장바람직하며, 여의치않을경우환자에게체크리스트또는그림을통해표시하도록하고, 증상중증도척도는직접면담을한후평가하게되어있다. 섬유근통진단을위한검사에서영상검사나검사실검사에서이상이있는경우는거의없다. 그러나다른질환과의감별진단을위해전혈구계산 (comlete blood count), 적혈구침강속도 (erythrocyte sedimentation rate), C 반응단백질 (C-reactive protein) 등을우선확인할필요가있다. 갑상선질환이나염증성근육질환이의심되는환자에서갑상선기능검사와크레아틴키나제 (creatine kinase) 검사가각각필요하며, 병력과신체검사에서자가면역질환이의심될경우자가항체와같은혈청검사를시행한다. 또한, 우울증과불안증에대한문진이꼭필요하며, 수면장애와관련하여수면다원검사를고려할수있다. 또한자율신경계장애가의심되는경우틸트테이블검사 (Tilt-table test) 와같은객관적인검사가필요하다 8). 섬유근통의치료에있어서는아직까지증상을완화시키는것이주목적이다. 치료는약물치료와비약물치료로나뉘는데먼저환자에게섬유근통에대한이해를시키는교육이중요하다. 약물치료에있어서는섬유근통환
48 The Journal of Chuna Manual Medicine for Spine & Nerves Vol 15. No. 2, December 2020 자에서통증을억제하는신경전달물질인세로토닌과노르에피네프린이감소되어있고, 통증전달물질인 substance P가뇌척수액에서증가되어있어이러한기전에맞춰사용할필요가있으며, 통증이외의피로나불면, 자율신경기능장애와같은증상들을개선시키기위해여러가지약제들을추가적으로사용할필요가있다 37). 섬유근통에대한한약물치료로는국내에서는주로스트레스및울증등신경정신과적접근과함께주증상인통증에대한직접적인처방이사용되고있다. 비약물치료로는효과가가장입증된치료로교육, 인지행동치료, 운동이있는데모두 level A 근거수준을가지고있으며 38), 이외에도침술, 지압요법, 동종요법, 수치료, 마사지가있으나아직까지는잘설계된무작위대조군연구가많지는않다. 이에저자는섬유근통환자의치료와관련하여보다효과적이며근거중심적인중재방안을마련하고자국내특정학문분야에국한하지않고포괄적으로섬유근통관련논문을수집하여분석하였다. 2000년이후섬유근통관련임상연구는총 75편으로 2001년을제외하고는매년 1편이상이발표되었다. 그러나매년한자리수이하의연구편수로섬유근통의역학적인유병률을감안할때비교적흔한질환임에도불구하고연구물의질적수준을떠나그수에있어서절대적으로부족함을알수있다. 이에대해서는섬유근통의진단및치료와연관지어생각해볼수있는데, 섬유근통환자가진단에이르기까지평균적으로 5년이걸리고전체환자의 25% 만이진단되는점을고려하면역학적연구에서의유병률과는달리실제진료실에서는명확한진단이이루어지기가어렵고진단기준이있으나전적으로환자의특징적인증상과의사의진찰에의해서이루어지는점과관련되어있다고보여진다 39). 또한, 치료에있어서도아직까지근본적이면서명확한치료법이없고단지환자의증상을개선시키는데초점이맞추어져있어임상연구에서환자의모집과중재효과의한계로그원인을찾을수있다. 학계별로발표된연구들을살펴보면의학계에서발표한연구가 34편 (46%) 으로이중, 관찰연구가 29편, 실험연구가 5편이었다. 관찰연구로는환자대조군연구 가 16편, 증례연구가 5편, 평가도구의타당도를연구한방법론적연구가 4편, 단면조사나상관관계연구와같은조사연구가 4편이었다. 실험연구로는비무작위대조군연구가 3편이었으며, 단일군내에서치료전후를평가한단일군원시실험 2편이보고되었다. 의학계에서는발표한논문들을보면다른학계보다비교적많은연구가진행되었고다양한연구설계가시행되었다. 한의학계에서는총 75편의임상연구중 21편 (28%) 이보고되었는데모두관찰연구로서동시에증례보고였다. 의학계와비교할때연구의설계에있어서다각적접근이이루어지지않고있으며, 그증례에포함된환자수또한적은편이다. 향후국내연구및국외에서발표된연구들을토대로보다다양한연구및많은연구를진행할필요가있다고생각한다. 간호학계에서는총 15편의연구가발표되었는데, 관찰연구가 10편으로환자대조군연구 4 편, 상관관계연구 4편, 서술적조사연구 2편이었다. 실험연구는 5편으로비무작위대조군연구 3편, 단일군원시실험연구가 2편이었다. 의학계, 한의학계보다는연구편수가적은편이나연구설계에있어서는비교적다양한연구를진행하였다고보여진다. 보건학계에서는주로물리치료와관련하여 3편의연구가보고되었다. 3편모두실험연구로서단일군원시실험이 2편, 무작위대조군연구가 1편있었다. 다른학계에비해연구편수는적으나연구설계면에서볼때비교적근거수준이높은연구가진행된것을알수있다. 치의학계, 통합의학계각각 1편으로모두증례보고인관찰연구가발표되었다. 연구유형에있어서는 75편중관찰연구가 62편, 실험연구가 13편이었는데, 관찰연구에서도증례보고가 28편으로가장많았다. 증례보고는주로한의학계에서발표된것으로침, 한약, 한방물리요법, 약침요법, 추나요법등을중재로한연구들로섬유근통치료에매우다양한치료법이사용되었으며단일치료법이아닌복합치료법을사용하였다. 전신통증및정신의학적증상, 자율신경계장애관련증상과같은섬유근통의임상특징에따라치료에있어서도여러방향에서다양하게접근이시도되었다라는점에서의의가있다. 다만연구방법이근거수준에있어낮다라는한계가있다. 증례보고중에서도관심있게살펴볼연구가있었는데, 통합의학계에서발표한
섬유근통에대한국내임상연구동향및중재방향 49 연구 40) 로멀티모달류마티스복합치료 (Multimodal rheumatologic complex treatment, MRCT) 를중재로사용하였다. 독일에서는류마티스질환, 퇴행성질환및섬유근통과같은만성통증증후군환자의통증및기능장애의악화를치료하기위해 2005년에 MRCT라고하는급성입원환자치료프로그램의독특한개념이확립되었다. MRCT는류마티스전문의를포함한전문의료진이감독하는치료관리팀을구성하여통증치료, 물리치료, 작업치료, 인지행동치료, 환자와관련하여다양한형태의심리치료상담등 3개이상의치료방법을사용해야하며, 주당최소 11시간이상의치료를적용하게된다. 따라서 MRCT는환자에게주당약 22 33 개의치료단위를제공하며치료단위당약 20 30분의치료를제공한다. MRCT 입원기간에대해서는세가지옵션이정의되었으며, 입원시개인의장애및필요에따라선택할수있다 41,42). 비록근거수준이낮은연구이긴하나, 중재방법에있어서다양한치료법과환자상태에따른치료옵션그리고치료관리팀의구성등에있어서향후섬유근통의새로운중재대안으로고려해볼필요가있다. 우리나라의료현실에맞게의, 한협진을비롯한다학제간의융복합적인치료접근방법을 MRCT 프로그램을모텔로새롭게개발할수도있다. 관찰연구중환자대조군연구는 20편으로주로의학계와간호학계에서발표하였는데, 섬유근통환자에있어서심장기능이나청력의평가, 혈중지질농도, 비타민 D 수치, 삶의질등을건강군과비교한연구들로섬유근통의임상적특징이외에도다양한변이들을찾기위한시도로해석된다. 그리고피로, 수면장애, 우울등정신신경학적증상과관련하여영향을미치는요인들을분석한상관관계연구와섬유근통과관련하여평가도구의타당도를조사한방법론적연구들이있었는데, 임상증상에영향을미치는여러가지변수들에대한분석을통해효과적인치료법의모색과함께보다객관적인평가및진단을위한시도라고평가할수있다. 실험연구중에서는비무작위대조군연구가 6편, 단일군원시실험연구가 6편으로주로약물과운동, 자조프로그램, 치료적마사지등을중재로하여치료효과에대해대조군과비교평가하거나치료전, 후평가를시행하였는데중재방법, 대조군 설정, 평가도구, 결과척도, 통계방법등향후잘짜여진연구설계를계획하는데도움이될것으로생각한다. 이상의결과를종합해보면, 섬유근통관련국내임상 연구는보다적극적인연구활동이필요한시점이고, 연구방법에있어서도다양한관찰연구, 중재연구와함께근거수준이높은체계적고찰과메타분석등의연구설계가이루어져야할것으로보인다. 그리고이를통해섬유근통의치료에있어서안전성을바탕으로효과적이며, 경제적인중재방안이마련되어야할것이다. 더불어, 섬유근통의병리기전및임상특징을고려할때어느특정학문분야에국한되지않고다학제적이며통합적인중재방안과연구가필요하다고생각한다. 본연구는섬유근통과관련하여특정학계가아닌다학제적측면에서 2000년대이후지금까지진행된임상연구들의동향을살펴봄으로써기존연구들의특성과함께중재에대한장점과한계를인식하고, 이를통해섬유근통치료에있어서새로운중재방법의모색과연구방향을제시하고자하였다. 그러나, 한편으로는동향파악에있어서국내임상연구에한정된점과임상연구로국한한부분, 그리고체계적고찰이아닌단순고찰등의방법론적에서의한계를지니고있다. 이에대해향후보다광범위하고체계적인자료수집및고찰을통해섬유근통의치료에있어서효과적인중재방안과더불어근거수준이높은연구가진행되어야할것으로보인다. 감사의말씀 본연구는보건복지부통합의료연구지원사업의지원에의하여이루어진것임 ( 과제번호 HI20C1951). References 1. Häuser W, Eich W, Herrmann M, Nutzinger DO, Schiltenwolf M, Henningsen P. Fibromyalgia syndrome: classification, diagnosis, and treatment. Dtsch Arztebl Int. 2009;106(23):383-91.
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52 The Journal of Chuna Manual Medicine for Spine & Nerves Vol 15. No. 2, December 2020 Appendix 1. Published Year and Subject, Title of Journal Year Subject Title of Journal 2000 The study on Fatigue, Pain, and Coping of Pain in Fibromyalgia and Arthritis patients Korean J Rehabil Nurs 2000 A Comparative Study on Symptoms, Living Activities, Self-efficacy and Family Support between J Muscle Jt Health Rheumatoid Arthritis Patients and Fibromyalgia Patients 2000 The Comparison of Fatigue of the Patients with Rheumatoid Arthritis, Lupus, and Fibromyalgia J Muscle Jt Health 2000 A comparison Study on Fatigue and Pain in Rheumatoid Patients-centered on AS, FM, and SLE Korean J Adult Nurs patients 2000 Lipid profile in patients with fibromyalgia and myofascial pain syndromes Yonsei Med J 2002 The long-term Effects after Self-help Program for Fibromyalgia J Muscle Jt Health 2002 Validation of a Korean Version of the Fibromyalgia Impact Questionnaire J Korean Med Sci 2002 Health-Related Quality of Life in Korean Patients with Rheumatic Diseases J Korean Rheum Assoc 2002 A Case Report of Fibromyalgia J Oral Med Pain 2003 The Factors Influencing on Depression of Patients for Fibromyalgia Syndrome J Korean Acad Nurs 2003 Auditory P300 Event-Related Potentials in Fibromyalgia Patients Yonsei Med J 2004 Quality of Marital Life in Korean Patients with Fibromyalgia J Korean Rheum Assoc 2004 Affecting Factor on Sleep Disorder in Patients with Fibromyalgia J Muscle Jt Health 2004 Effects of Pain Rating Scale in the Therapeutic Massage Program on Fibromyalgia Syndrome Research on Physical Fitness 2004 Clinical Study on 1 case of Fibromyalgia Syndromes Journal of the Spine&Joint Korean Medicine 2005 Human Parvovirus B19 Infection in Patients with Fibromyalgia J Korean Rheum Assoc 2005 Clinical Research on 1 Case of Fibromyalgia Treated by Iontophoresis The Journal of Korea CHUNA Manual Medicine for Spine & Nerves 2005 Effecting Factors on Depression in Patients with Fibromyalgia J Korean Acad Nurs 2005 Prediction Factors of Fatigue in Patients with Fibromyalgia J East-West Nurs Res 2006 Prevalence and Risk Factors of Fibromyalgia Syndrome and Chronic Widespread Pain in Two J Korean Rheum Assoc Communities in Korea - First Report in Korean 2006 Serum lipid profile in patients with fibromyalgia Korean J Med 2006 Two Case Report on the Patient with Fibromyalgia Syndrome(FMS) with Chuna and Acupuncture J Korea Chuna Manual Med Spine Nerves 2006 Fatigue Related Factors in Chronic Fatigue Patients with Chronic Widespread Pain after Treatment Korean Journal of Family Medicine (KJFM) 2006 Two case Report on the patient with Fibromyalgia Syndrome(FMS) with Chuna and Acupuncture J Sports Korean Med 2007 Dry eye in patients with fibromyalgia Korean J Med 2007 The Effect of a Tai-Chi Self-helf Program for Fibromyalgia Patient J Muscle Jt Health 2007 Temperament and Character Dimensions in Female Patients with Fibromyalgia Korean J psychosomatic med 2007 The Effect of a Self-Help Program for Patient with Fibromyalgia Korean J Health Promot 2007 The Effects of Blood Serum Hormone Level and Pain on Fibromyalgia Syndrome Patients to Therapeutic Massage Treatment 2007 The Effects of Physical activities, Social activities and Subjective Psychological Symptoms of Therapeutic Massage on Fibromyalgia Syndrome Journal of Sport and Leisure Studies Journal of Coaching Development (JCD) 2008 Physical and Psychological Status in Systemic Lupus Erythematosus according to Fibromyalgia Nursing and Health Issues 2009 Assessing the Myocardial Function of Postmenopausal Women with Fibromyalgia J Korean Rheum Assoc 2009 A Case Report of Symptomatic Character and Diagnosis of Fibromyalgia Journal of Korean Medicine (JKM) 2010 Assessment of Myocardial Function in Patients With Fibromyalgia and the Relationship to Chronic Korean Circ J Emotional and Physical Stress 2010 A Case Report of a Patient Who has Fibromyalgia and Received the Isolytic MET Therapy Journal of the Spine&Joint Korean Medicine 2011 Validation of New Symptom-Based Fibromyalgia Criteria for Irritable Bowel Syndrome Co-morbidity J Neurogastroenterol Motil Studies 2011 The Clinical Study on a case of Fibromyalgia Syndrome(FMS) Patient Case Report Journal of pharmacopuncture
섬유근통에대한국내임상연구동향및중재방향 53 Year Subject Title of Journal 2011 Impact of a Cryotherapy and Tai Chi Self-help Program on Women with Fibromyalgia Syndrome Korean J Adult Nurs 2011 Correlations between Disease Related Factors and Disturbance of Daily Living in Patients with Fibromyalgia 2011 Arterial Stiffness in Female Patients With Fibromyalgia and Its Relationship to Chronic Emotional and Physical Stress 2011 Women with Fibromyalgia Have Lower Levels of Calcium, Magnesium, Iron and Manganese in Hair Mineral Analysis 2012 OriginalArticles Applying the ACR Preliminary Diagnostic Criteria in the Diagnosis and Assessment of Fibromyalgia 2012 One Case Report of Fibromyalgia Syndrome(FMS) Patient Improved by Korean Medical Combined Treatment The Journal of the Korea Contents Association(Jour. of KoCon.a) Korean Circ J J Korean Med Sci Korean J Pain The Journal of Herbal Formula Science (Herbal Formula Science (HFS) 2013 BriefReport A Case of Postural Orthostatic Tachycardia Syndrome Associated with Migraine and Korean J Pain Fibromyalgia 2013 A Case Study of Korean Medicine Treatment for Fibromyalgia Syndrome(FMS) Journal of Korea Immuno-yachim Society 2013 Clinical Characteristics of Chronic Headache Patients With Fibromyalgia: A Hospital-based Study J Korean Neurol Assoc 2013 Effect of Acupuncture at Tender Points for the Management of Fibromyalgia Syndrome: A Case Series J Acupunct Meridian Stud 2014 A Clinical case study on Fibromyalgia syndrome treatd by Pyung-Hyung acupunture The Journal of East-West Medicine 2014 A Clinical Study on One Case of a Patient with Fibromyalgia by Chuna Therapy and Traditional Korean Medicine Treatment 2014 Comparison of the Medication Effects between Milnacipran and Pregabalin in Fibromyalgia Syndrome Using a Functional MRI: a Follow-up Study The Journal of Korea CHUNA Manual Medicine for Spine & Nerves Journal of the Korean Society of Magnetic Resonance in Medicine (JKSMRM) 2014 The Case Reports of Muscle Relaxation Pharmacopuncture for the Two Patients with Fibromyalgia The Journal of Korea CHUNA Manual Medicine for Spine & Nerves 2014 Short-Term Change of Handgrip Strength After Trigger Point Injection in Women With Muscular Pain in the Upper Extremities Annals of Rehabilitation Medicine (ARM) 2015 Quantitative analysis of nailfold capillary morphology in patients with fibromyalgia Korean J Intern Med 2015 The Overlap between Fibromyalgia Syndrome and Myotonia Congenita J Clin Neurol 2015 Fibromyalgia Syndrome Combined with Insomnia and Depression Disorder Managed with Korean J Int Korean Med Medical Treatment: A Case Report 2015 Impaired pre-attentive auditory processing in fibromyalgia: A mismatch negativity (MMN) study Clinical Neurophysiology 2016 The Clinical Study on a Case of Fibromyalgia Syndrome Patient by Korean Medicine Treatment Journal of Korean Medicine Rehabilitation (JORM) 2016 Fibromyalgia Complicated with Dystonia Successfully Treated with Deep Brain Stimulation: a Case Korean J Med Report and Review of the Literature 2016 Serotonin Syndrome following Duloxetine Administration in a Fibromyalgia Patient Case Report and J Korean Rheum Assoc Literature Review 2016 Serum Vitamin D Status in Iranian Fibromyalgia Patients according to the Symptom Severity and Korean J Pain Illness Invalidation 2016 The acute effect of maximal exercise on plasma beta-endorphin levels in fibromyalgia patients Korean J Pain 2016 Heart Rate Variability for Quantification of Autonomic Dysfunction in Fibromyalgia Annals of Rehabilitation Medicine (ARM) 2016 The Perception and Utilization patterns of Complementary and Alternative Medicines in Patients with J Muscle Jt Health Fibromyalgia Syndrome 2017 The Effect of Graston Technique and Chuna manual therapy combined with Korean Medical Treatment for fibromyalgia A Case Report The Journal of Acupuncture Research 2017 Implantable drug delivery systems with morphine in fibromyalgia:a case report Anesth Pain Med 2017 A Case of Traditional Korean Medicine for a Patient with Fibromyalgia Experiencing Whole Body J Int Korean Med Pain and Sleep and Digestive Disorders
54 The Journal of Chuna Manual Medicine for Spine & Nerves Vol 15. No. 2, December 2020 Year Subject Title of Journal 2017 A Case of Traditional Korean Medicine Patients Who Suffer from Multiple Pain and Physical J Int Korean Med Disorders Suspected of Fibromyalgia 2018 Interdisciplinary assessment-oriented treatment of fibromyalgia: a case report Integr Med Res 2018 Effect of intravenous adenosine triphosphate injection on chronic pain and fatigue in female patients with fibromyalgia 2018 Yoga Self-help Management Program for the Patients with Fibromyalgia syndrome Effect on Health status and Depression Journal of Korean Institute for Functional Medicine Journal of Digital Convergence 2019 Clinical significance of anti-dense fine speckled 70 antibody in patients with fibromyalgia The Korean Journal of Internal Medicine 2019 Fibromyalgia diagnostic model derived from combination of American College of Rheumatology Korean J Pain 1990 and 2011 criteria 2019 A Case Report on Functional Dyspepsia in a Fibromyalgia Patient with a History of Long-Term J Int Korean Med Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Use 2019 A Case Report of Fibromyalgia Improved by Korean Medical Treatment J Int Korean Med 2020 Two Cases of Korean Medicine Therapy for Fibromyalgia Syndrome Korean J Acupunct