Fibromyalgia Syndrome: Review of Clinical Presentation, Pathogenesis, Outcome Measures and Treatment

Seattle Rheumatology Associates, Washington 98104, USA.
Journal of Rheumatology Supplement 09/2005; 75(supplement 75):6-21.
Source: PubMed


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.

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    • "The books, written by physicians and FM researchers, were consistent with the standard medical advice and were the practical guidelines recommended as the best treatment for people with FM. The FM health intervention was created as an alternative program for this pilot study that is as rigorous as the forgiveness intervention, not as a placebo program, because there is currently no existing stateof-the-art treatment that has been proven to cure FM (see Mease, 2005). Aerobic exercises and pain management interventions were shown to decrease depression and anxiety in people with FM (Gauffin et al., 2013; Mist, Firestone, & Jones, 2013), which indicates that the elements of the FM health intervention could be comparable with the psychosocial elements of the forgiveness intervention and may generate comparable psychosocial outcomes. "
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    ABSTRACT: This pilot study compared the efficacy of a forgiveness intervention with a fibromyalgia (FM) health intervention on women with FM who have experienced emotional, physical, or sexual abuse, and emotional or physical neglect, in childhood by one of their parents. Eleven women with FM between the ages of 21 and 68 were randomized to the forgiveness intervention (n = 5) or the FM health intervention (n = 6), and completed the once-weekly individualized program for 24 weeks. The participants completed measures assessing forgiveness, overall FM health, depression, anger, anxiety, self-esteem, and coping strategies at the pretest, the posttest, and the 12-week follow-up test. They also completed the forgiveness intervention and FM health intervention final tests at the posttest, which assessed their knowledge on forgiveness and FM health. The forgiveness intervention participants had greater improvements in forgiveness (p < .001) and overall FM health (p = .046) from the pretest to the posttest, and in forgiveness (p = .018) and state anger (p = .027) from the pretest to the follow-up test than the FM health intervention participants. Moreover, the forgiveness intervention participants scored higher on the forgiveness final test than the FM health intervention participants (p < .001), and the FM health intervention participants scored higher on the FM health final test than the forgiveness intervention participants (p < .001). The results indicate that the forgiveness intervention was potentially helpful in improving forgiveness and overall FM health, and in decreasing state anger of this particular sample of women with FM.
    09/2014; 1(3):203-217. DOI:10.1037/scp0000025
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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). "
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    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 · 1.97 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. "
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    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.
    Current Topics in Behavioral Neurosciences 03/2014; 20. DOI:10.1007/7854_2014_294
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