Fibromyalgia - Wikipedia, the free encyclopedia. Fibromyalgia (FM) is a medical condition characterised by chronic widespread pain and a heightened pain response to pressure. Other types of chronic pain are also frequently present. Recommendations often include getting enough sleep, exercising regularly, and eating a healthy diet.
While fibromyalgia can last a long time, it does not result in death or tissue damage. Females are affected about twice as often as males. Rates appear similar in different areas of the world and among different cultures. Fibromyalgia was first defined in 1.
Although mental disorders and some physical disorders commonly are co- morbid with fibromyalgia . A 2. 00. 7 review divides individuals with fibromyalgia into four groups as well as . Fibromyalgia is often associated with anxiety and depressive symptoms. Although fibromyalgia is classified based on the presence of chronic widespread pain, pain may also be localized in areas such as the shoulders, neck, low back, hips, or other areas. Many sufferers also experience varying degrees of myofascial pain and have high rates of comorbid temporomandibular joint dysfunction.
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However, several hypotheses have been developed including . In these vulnerable individuals, psychological stress or illness can cause abnormalities in inflammatory and stress pathways which regulate mood and pain. Eventually, a sensitisation and kindling effect occur in certain neurons leading to the establishment of fibromyalgia and sometimes a mood disorder. In simple terms, it can be described as the volume of the neurons being set too high and this hyper- excitability of pain processing pathways and under- activity of inhibitory pain pathways in the brain results in the affected individual experiencing pain. Some neurochemical abnormalities that occur in fibromyalgia also regulate mood, sleep, and energy, thus explaining why mood, sleep, and fatigue problems are commonly co- morbid with fibromyalgia. As the hippocampus plays crucial roles in maintenance of cognitive functions, sleep regulation, and pain perception, it was suggested that metabolic dysfunction of the hippocampus may be implicated in the appearance of these symptoms. Accordingly, a study that employed functional magnetic resonance imaging to evaluate brain responses to experimental pain among people with fibromyalgia found that depressive symptoms were associated with the magnitude of clinically induced pain response specifically in areas of the brain that participate in affective pain processing, but not in areas involved in sensory processing which indicates that the amplification of the sensory dimension of pain in fibromyalgia occurs independently of mood or emotional processes.
Some research suggests that these brain anomalies may be the result of childhood stress, or prolonged or severe stress. Dopamine is a catecholamineneurotransmitter with roles in pain perception and natural analgesia. There is also strong evidence for a role of dopamine in restless leg syndrome. Moreover, people with fibromyalgia have an abnormal sleep pattern involving stages 3 and 4 of non- REM sleep during which growth hormone is predominantly secreted.
Growth hormone is important in maintaining muscle homeostasis, and it has been suggested that low levels may be responsible for delayed healing of muscle microtrauma in fibromyalgia. Chronic overactivity of these neurons could disrupt normal function of the pituitary- adrenal axis and cause an increased stimulation of hypothalamic somatostatin secretion, which, in turn, could inhibit the secretion of other hormones. The first findings reported were decreased blood flow within the thalamus and elements of the basal ganglia and mid- brain (i. People also exhibit neural activation in brain regions associated with pain perception in response to nonpainful stimuli in such areas as the prefrontal, supplemental motor, insular, and cingulate cortices. Evidence of hippocampal disruption indicated by reduced brain metabolite ratios has been demonstrated by studies using single- voxel magnetic resonance spectroscopy (1. H- MRS). Grey matter loss appears to increase 9.
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A subsequent study demonstrated gross disruption of dopaminergic reactivity in response to a tonic pain stimulus within the basal ganglia with a significant positive correlation between the defining feature of the disorder (i. In most cases, people with fibromyalgia symptoms may also have laboratory test results that appear normal and many of their symptoms may mimic those of other rheumatic conditions such as arthritis or osteoporosis. The most widely accepted set of classification criteria for research purposes was elaborated in 1. Multicenter Criteria Committee of the American College of Rheumatology. These criteria, which are known informally as .
Diagnosis is no longer based on the number of tender points. It should be noted that the number of tender points that may be active at any one time may vary with time and circumstance.
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A controversial study was done by a legal team looking to prove their client's disability based primarily on tender points and their widespread presence in non- litigious communities prompted the lead author of the ACR criteria to question now the useful validity of tender points in diagnosis. The WPI counts up to 1. The SS rates the severity of the person's fatigue, unrefreshed waking, cognitive symptoms, and general somatic symptoms. The revised criteria for diagnosis are: WPI .
The diagnoses were revised when electromyographic studies revealed myotonic discharges in some of the muscles. Genetic analysis of the skeletal muscle chloride channel which is the underlying cause of myotonia congenita revealed that both patients had mutations in this gene. Over 1. 30 mutations in this gene have been described and the phenotype is very variable which may account for the difficulty in the initial diagnosis.
Developments in the understanding of the pathophysiology of the disorder have led to improvements in treatment, which include prescription medication, behavioural intervention, and exercise. Indeed, integrated treatment plans that incorporate medication, patient education, aerobic exercise and cognitive- behavioural therapy have been shown to be effective in alleviating pain and other fibromyalgia- related symptoms.
The FDA also approves milnacipran, but the European Medicines Agency refused marketing authority. A small number of people benefit significantly from the SNRIs duloxetine and milnacipran and the tricyclic antidepressants (such as amitriptyline) however many people experience more adverse effects than benefits. Some medications have the potential to cause withdrawal symptoms when stopping so gradual discontinuation may be warranted particularly for antidepressants and pregabalin. Gabapentin is of a significant benefit in about 3.
However, it is commonly associated with adverse effects. Many will have no or trivial benefit, or will discontinue because of adverse events. As of 2. 01. 5 no opioid is approved for use in this condition by the FDA. They strongly advise against using strong opioids. They discourage the use of strong opioids and only recommend using them while they continue to provide improved pain and functioning. Healthcare providers should monitor people on opioids for ongoing effectiveness, side effects and possible unwanted drug behaviours. It is as effective as a combination of codeine (another mild opioid) and paracetamol but produces less sleepiness and constipation.
However, this medication was not approved by the FDA for the indication for use in people with fibromyalgia due to the concern for abuse. Depressed mood was also improved but this could not be distinguished from some risks of bias. These programs also employ counseling, art therapy, and music therapy. These programs are evidence- based and report long- term total pain resolution rates as high as 8. Most people with fibromyalgia report that their symptoms do not improve over time. An evaluation of 3. FM symptom severity and function.
Hench used it to describe these symptoms. In 1. 98. 4, an interconnection between fibromyalgia syndrome and other similar conditions was proposed. A study of almost 2. Humana members enrolled in Medicare Advantage and commercial plans compared costs and medical utilizations and found that people with fibromyalgia used twice as much pain- related medication as those without fibromyalgia. Furthermore, the use of medications and medical necessities increased markedly across many measures once diagnosis was made.
Frederick Wolfe, lead author of the 1. He argues that data indicating it is not psychological has been ignored or manipulated. Rheumatologists define the syndrome in the context of . On the other hand, psychiatrists often view fibromyalgia as a type of affective disorder, whereas specialists in psychosomatic medicine tend to view fibromyalgia as being a somatic symptom disorder.
However, there is extensive research evidence to support the view that the central symptom of fibromyalgia, namely pain, has a neurogenic origin. These controversies don't engage healthcare specialists alone; some patients object to fibromyalgia being described in purely somatic terms. Retrieved 1. 6 March 2. Retrieved 1. 5 March 2.
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