Fibromyalgia: from pathophysiology to therapy.

Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, 48106, USA. tobiass@
Nature Reviews Rheumatology (Impact Factor: 9.75). 07/2011; 7(9):518-27. DOI: 10.1038/nrrheum.2011.98
Source: PubMed

ABSTRACT Individuals with fibromyalgia generally experience chronic widespread pain, which can be accompanied by further symptoms including fatigue, sleep disturbances, cognitive dysfunction, anxiety and depressive episodes. As the recognition and diagnosis of fibromyalgia has improved, the availability of therapeutic options for patients has increased. Furthermore, research into the neurobiological mechanisms that contribute to the chronic pain and concomitant symptoms experienced by patients with fibromyalgia has advanced our understanding of this debilitating disorder. In this Review, we aim to provide an overview of existing pathophysiological concepts. The roles of biological and psychological stress, genetic factors, and pain and sensory processing in the pathophysiology of fibromyalgia and related conditions are discussed. In addition, pharmacological treatments, including monoamine modulators, calcium channel modulators and γ-aminobutyric acid modulators, as well as nonpharmacological treatment options are considered.

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    ABSTRACT: Rationale and Objectives The combination of functional magnetic resonance imaging (fMRI) of the brain with multivariate pattern analysis (MVPA) has been proposed as a possible diagnostic tool. Goal of this investigation was to identify potential functional connectivity (FC) differences in the salience network (SN) and default mode network (DMN) between fibromyalgia syndrome (FMS), rheumatoid arthritis (RA), and controls (HC) and to evaluate the diagnostic applicability of derived pattern classification approaches. Materials and Methods The resting period during an fMRI examination was retrospectively analyzed in women with FMS (n = 17), RA (n = 16), and HC (n = 17). FC was calculated for SN and DMN subregions. Classification accuracies of discriminative MVPA models were evaluated with cross-validation: (1) inferential test of a single method, (2) explorative model optimization. Results No inferentially tested model was able to classify subjects with statistically significant accuracy. However, the diagnostic ability for the differential diagnostic problem exhibited a trend to significance (accuracy: 69.7%, P = .086). Optimized models in the explorative analysis reached accuracies up to 73.5% (FMS vs. HC), 78.8% (RA vs. HC), and 78.8% (FMS vs. RA) whereas other models performed at or below chance level. Comparable support vector machine approaches performed above average for all three problems. Conclusions Observed accuracies are not sufficient to reliably differentiate between FMS and RA for diagnostic purposes. However, some indirect evidence in support of the feasibility of this approach is provided. This exploratory analysis constitutes a fundamental model optimization effort to be based on in further investigations.
    Academic Radiology 01/2014; 21(3):369 - 377. · 1.91 Impact Factor
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    ABSTRACT: Fibromyalgia syndrome (FMS) is a common and intriguing condition, manifest by chronic pain and fatigue. Although the pathogenesis of FMS is not yet completely understood, predicting the future development of FMS and chronic pain is a major challenge with great potential advantages, both from an individual as well as an epidemiological standpoint. Current knowledge indicates a genetic underpinning for FMS, and as increasing data are accumulated regarding the genetics involved, the prospect of utilizing these data for prediction becomes ever more attractive. The co-existence of FMS with multiple other functional disorders indicates that the clinical identification of such symptom constellations in a patient can alert the physician to the future development of FMS. Hypermobility syndrome is another clinical (as well as genetic) phenotype that has emerged as a risk factor for the development of FMS. Stressful events, including early life trauma, are also harbingers of the future development of FMS. Functional neuroimaging may help to elucidate the neural processes involved in central sensitization, and may ultimately also evolve into markers of predictive value. Last but not least, obesity and disturbed sleep are clinical (inter-related) features relevant for this spectrum. Future efforts will aim at integrating genetic, clinical and physiological data in the prediction of FMS and chronic pain.
    European journal of pain (London, England) 03/2014; · 3.37 Impact Factor
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    ABSTRACT: Determine if women with fibromyalgia report increased bother from pelvic organ prolapse compared with women without fibromyalgia. We performed a cross-sectional study of women with symptomatic prolapse on consultation with a private urogynecology practice within a 46-month period. After matching for age, women with a diagnosis of fibromyalgia were compared with a reference group of women without fibromyalgia. Demographic, POPQ examination, medical history, and pelvic floor symptom data (PFDI, PFIQ, and PISQ-12) were collected. Our primary outcome was to compare the mean Pelvic Floor Distress Inventory (PFDI) scores of women with and without fibromyalgia. The prevalence of fibromyalgia in women evaluated for initial urogynecology consultation during the study period was 114 out of 1,113 (7 %). Women with fibromyalgia reported significantly higher symptom bother scores related to pelvic organ prolapse, defecatory dysfunction, urinary symptoms, and sexual function: PFDI (p = 0.005), PFIQ (p=0.010), and PISQ (p=0.018). Women with fibromyalgia were found to have a higher BMI (p=0.008) and were more likely to report a history of sexual abuse, OR 3.1 (95 % CI 1.3, 7.9), and have levator myalgia on examination, OR 3.8 (95 % CI 1.5, 9.1). In a linear regression analysis, levator myalgia was found to be the significant factor associated with pelvic floor symptom bother. In women with symptomatic prolapse, fibromyalgia is associated with an increased risk of levator myalgia and 50 % more symptom bother from pelvic floor disorders.
    International Urogynecology Journal 12/2013; · 2.17 Impact Factor