Fibromyalgia syndrome: definition and diagnostic aspects.

Unit of Rehabilitative Medicine, Hospital of Circolo, Saronno (VA), Italy.
Reumatismo 09/2011; 60 Suppl 1:3-14. DOI: 10.4081/reumatismo.2008.1s.3
Source: PubMed

ABSTRACT Ever since it was first defined, fibromyalgia (FM) has been considered one of the most controversial diagnoses in the field of rheumatology, to the point that not everybody accepts its existence as an independent entity. The sensitivity and specificity of the proposed diagnostic criteria are still debated by various specialists (not only rheumatologists), whose main criticism of the 1990 American College of Rheumatology criteria is that they identify subsets of particular patients that do not reflect everyday clinical reality. Furthermore, the symptoms characterising FM overlap with those of many other conditions classified in a different manner. Over the last few years, this has led to FM being considered less as a clinical entity and more as a possible manifestation of alterations in the psychoneuroendocrine system (the spectrum of affective disorders) or the stress reaction system (dysfunctional symptoms). More recently, doubts have been raised about even these classifications; and it now seems more appropriate to include FM among the central sensitisation syndromes, which identify the main pathogenetic mechanism as the cause of skeletal and extra-skeletal symptoms of FM and other previously defined "dysfunctional" syndromes.


Available from: Manuela Di Franco, Apr 18, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: SUMMARY Osteoarthritis (OA) is a major cause of pain and is characterized by loss of articular cartilage integrity, synovitis and remodeling of subchondral bone. However, OA pain mechanisms remain incompletely understood. Pain severity does not always correlate with the extent of joint damage. Furthermore, many people with OA continue to experience pain despite optimal use of standard therapies that target the joints, including joint-replacement surgery. There is compelling evidence that altered central pain processing plays an important role in maintaining pain and increasing pain severity in some people with OA. A key challenge is to identify this subgroup of patients with abnormal central pain processing in order to improve their clinical outcomes by developing and targeting specific analgesic treatments.
    01/2014; 4(1):45-56. DOI:10.2217/pmt.13.64
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fibromyalgia is a chronic widespread pain disorder in which, the neurogenic origin of the pain, featured by allodynia and hyperalgesia, results from an imbalance in the levels of neurotransmitters and consequently of the peripheral pro- and anti-inflammatory mediators. Whole body cryotherapy is a peculiar physical therapy known to relieve pain and inflammatory symptoms characteristics of rheumatic diseases, through the regulation of the cytokine expression. The aim of this study was to qualitatively evaluate the effects of cryotherapy on the clinical output of fibromyalgic patients. A total of 100 fibromyalgic patients (age range 17-70 years) were observed; 50 subjects were addressed to cryotherapy, while the second group (n = 50) did not underwent to the cryotherapic treatment. All subjects kept the prescribed pharmacological therapy during the study (analgesic and antioxidants). The referred health status pre- and post-observation was evaluated with the following scales: Visual Analogue Scale, Short Form-36, Global Health Status and Fatigue Severity Scale. Fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life, in comparison with the non-cryo treated fibromyalgic subjects, as indicated by the scores of the qualitative indexes and sub-indexes, that are widely recognized tools to assess the overall health status and the effect of the treatments. We speculate that this improvement is due to the known direct effect of cryotherapy on the balance between pro- and anti-inflammatory mediators having a recognized role in the modulation of pain.
    Clinical Rheumatology 05/2013; DOI:10.1007/s10067-013-2280-9 · 1.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim of this review is to underline some specific patterns of shoulder pain that are not related to musculoskeletal diseases but are manifestations of gastrointestinal, neurological, cardiological or rheumatological diseases. The most important pathologies (like gallstones, myocardial ischaemia and Parsonage-Turner syndrome...) that can manifest with shoulder pain will be presented by specialty doctors and elements for differential diagnosis will be discussed. Orthopaedic shoulder surgeons should always suspect other causes of pain, different from those related to bone, tendons and joint. If there is something unfair, patients should be referred to family doctor for further investigations in order to exclude major systemic diseases.
    MUSCULOSKELETAL SURGERY 04/2012; 96 Suppl 1(S1):S63-8. DOI:10.1007/s12306-012-0192-5