Fibromyalgia Syndrome: Review of Clinical Presentation, Pathogenesis, Outcome Measures and Treatment
ABSTRACT Fibromyalgia syndrome (FM) is a common chronic pain condition that affects at least 2% of the adult population in the USA and other regions in the world where FM is studied. Prevalence rates in some regions have not been ascertained and may be influenced by differences in cultural norms regarding the definition and attribution of chronic pain states. Chronic, widespread pain is the defining feature of FM, but patients may also exhibit a range of other symptoms, including sleep disturbance, fatigue, irritable bowel syndrome, headache, and mood disorders. Although the etiology of FM is not completely understood, the syndrome is thought to arise from influencing factors such as stress, medical illness, and a variety of pain conditions in some, but not all patients, in conjunction with a variety of neurotransmitter and neuroendocrine disturbances. These include reduced levels of biogenic amines, increased concentrations of excitatory neurotransmitters, including substance P, and dysregulation of the hypothalamic-pituitary-adrenal axis. A unifying hypothesis is that FM results from sensitization of the central nervous system. Establishing diagnosis and evaluating effects of therapy in patients with FM may be difficult because of the multifaceted nature of the syndrome and overlap with other chronically painful conditions. Diagnostic criteria, originally developed for research purposes, have aided our understanding of this patient population in both research and clinical settings, but need further refinement as our knowledge about chronic widespread pain evolves. Outcome measures, borrowed from clinical research in pain, rheumatology, neurology, and psychiatry, are able to distinguish treatment response in specific symptom domains. Further work is necessary to validate these measures in FM. In addition, work is under way to develop composite response criteria, intended to address the multidimensional nature of this syndrome. A range of medical treatments, including antidepressants, opioids, nonsteroidal antiinflammatory drugs, sedatives, muscle relaxants, and antiepileptics, have been used to treat FM. Nonpharmaceutical treatment modalities, including exercise, physical therapy, massage, acupuncture, and cognitive behavioral therapy, can be helpful. Few of these approaches have been demonstrated to have clear-cut benefits in randomized controlled trials. However, there is now increased interest as more effective treatments are developed and our ability to accurately measure effect of treatment has improved. The multifaceted nature of FM suggests that multimodal individualized treatment programs may be necessary to achieve optimal outcomes in patients with this syndrome.
- SourceAvailable from: Paula Rezende Camargo
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- "The American College of Rheumatology established, as the diagnostic criteria for FM, the widespread pain for more than 3 months, and at least 11 out of 18 active tender points, sensitive sites in which a digital pressure of 4 kg/cm 2 or less induces pain (Wolfe et al., 1990). Ten of these 18 points are located in the cervical and shoulder girdle regions (Mease, 2005). "
ABSTRACT: Background: The core feature of fibromyalgia is pain, which may play a role in various mechanisms that might lead to alterations in shoulder kinematics. Alterations in muscle activity and presence of tender points in the shoulder girdle have already been described in this population; however there is lack of evidence on three-dimensional scapular motion in women with fibromyalgia. Methods: Forty women with fibromyalgia and 25 healthy women (control group) matched in terms of age, weight and height, took part in this study. Three-dimensional scapular kinematics of the dominant arm were collected during elevation and lowering of the arm in the sagittal and scapular planes. Pain was evaluated by the Visual Analogue Scale and the Numerical Pain Rating Scale. Group comparisons were performed with one-way ANOVA for pain and two-way ANOVA for the kinematic variables (scapular internal/external rotation, upward/downward rotation and anterior/posterior tilt), with group and humeral elevation angle as categorical factors. Significance level was set at P < 0.05. Findings: Fibromyalgia women presented higher pain scores (P < 0.001) than the control group. Fibromyalgia women also presented greater scapular upward rotation (P < 0.001, both planes) and greater scapular posterior tilt (P < 0.001, both planes) than the control group. Interpretation: Women with fibromyalgia present greater scapular upward rotation and posterior tilt in the resting position and during arm elevation and lowering of the arm in sagittal and scapular planes. These alterations may be a compensatory mechanism to reduce pain during arm movement.Clinical biomechanics (Bristol, Avon) 05/2014; 29(7). DOI:10.1016/j.clinbiomech.2014.05.007 · 1.88 Impact Factor
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- "Pharmacologic approaches have shown some usefulness (Mease 2005). Non-steroidal anti-inflammatory drugs, some anti-depressants (tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors), and some anti-epileptics (gabapentin, pregabalin) have some benefit for pain and mixed effects on the attendant depression, insomnia, cognitive impairment, and fatigue (Mease 2005; Bennett 2007). Non-pharmacological approaches show some effectiveness in both MPS and FM. "
ABSTRACT: Chronic muscle pain remains a significant source of suffering and disability despite the adoption of pharmacologic and physical therapies. Muscle pain is mediated by free nerve endings distributed through the muscle along arteries. These nerves project to the superficial dorsal horn and are transmitted primarily through the spinothalamic tract to several cortical and subcortical structures, some of which are more active during the processing of muscle pain than other painful conditions. Mechanical forces, ischemia, and inflammation are the primary stimuli for muscle pain, which is reflected in the array of peripheral receptors contributing to muscle pain-ASIC, P2X, and TRP channels. Sensitization of peripheral receptors and of central pain processing structures are both critical for the development and maintenance of chronic muscle pain. Further, variations in peripheral receptors and central structures contribute to the significantly greater prevalence of chronic muscle pain in females.03/2014; DOI:10.1007/7854_2014_294
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- "Alternatively, the blunted response could be due to adrenal fatigue (Van Den Eede et al., 2007; Nater et al., 2008; Kumari et al., 2009). In humans, adrenal fatigue is associated with chronic high stress environments like war (post-traumatic stress disorder) or constant pain (fibromyalgia, cancer), (Fries et al., 2005; Mease, 2005; Wu et al., 2012). However, here young subjects showed a hyper-thermic stress response prior to restraint while aged animals did not, CORT levels in controls were normal or even high, while low levels of cortisol are found in PTSD (Heim et al., 2000). "
ABSTRACT: Cognitive processes associated with prefrontal cortex and hippocampus decline with age and are vulnerable to disruption by stress. The stress/stress hormone/allostatic load hypotheses of brain aging posit that brain aging, at least in part, is the manifestation of life-long stress exposure. In addition, as humans age, there is a profound increase in the incidence of new onset stressors, many of which are psychosocial (e.g., loss of job, death of spouse, social isolation), and aged humans are well-understood to be more vulnerable to the negative consequences of such new-onset chronic psychosocial stress events. However, the mechanistic underpinnings of this age-related shift in chronic psychosocial stress response, or the initial acute phase of that chronic response, have been less well-studied. Here, we separated young (3 month) and aged (21 month) male F344 rats into control and acute restraint (an animal model of psychosocial stress) groups (n = 9-12/group). We then assessed hippocampus-associated behavioral, electrophysiological, and transcriptional outcomes, as well as blood glucocorticoid and sleep architecture changes. Aged rats showed characteristic water maze, deep sleep, transcriptome, and synaptic sensitivity changes compared to young. Young and aged rats showed similar levels of distress during the 3 h restraint, as well as highly significant increases in blood glucocorticoid levels 21 h after restraint. However, young, but not aged, animals responded to stress exposure with water maze deficits, loss of deep sleep and hyperthermia. These results demonstrate that aged subjects are hypo-responsive to new-onset acute psychosocial stress, which may have negative consequences for long-term stress adaptation and suggest that age itself may act as a stressor occluding the influence of new onset stressors.Frontiers in Aging Neuroscience 02/2014; 6:13. DOI:10.3389/fnagi.2014.00013 · 2.84 Impact Factor