Fibromyalgia overview: Difference between revisions
| Line 9: | Line 9: | ||
==Classification== | ==Classification== | ||
DSM 5 divides fibromyalgia into four groups based on the differences in psychological and autonomic nervous system profiles among affected individuals. Fibromyalgia has been classified into extreme sensitivity to pain but no associated psychiatric conditions, fibromyalgia and comorbid, pain-related depression, [[depression]] with concomitant fibromyalgia syndrome and fibromyalgia due to [[somatization]].<ref name=" | [[DSM]] 5 divides fibromyalgia into four groups based on the differences in psychological and [[autonomic nervous system]] profiles among affected individuals. Fibromyalgia has been classified into extreme sensitivity to [[pain]] but no associated psychiatric conditions, fibromyalgia and comorbid, [[pain]]-related [[depression]], [[depression]] with concomitant fibromyalgia syndrome and fibromyalgia due to [[somatization]].<ref name="pmid2306288">{{cite journal |vauthors=Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P |title=The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee |journal=Arthritis Rheum. |volume=33 |issue=2 |pages=160–72 |year=1990 |pmid=2306288 |doi= |url=}}</ref><ref name="pmid24379886">{{cite journal |vauthors=Fitzcharles MA, Shir Y, Ablin JN, Buskila D, Amital H, Henningsen P, Häuser W |title=Classification and clinical diagnosis of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines |journal=Evid Based Complement Alternat Med |volume=2013 |issue= |pages=528952 |year=2013 |pmid=24379886 |pmc=3860136 |doi=10.1155/2013/528952 |url=}}</ref><ref name="pmid23748251">{{cite journal |vauthors=Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choinière M, Ko G, Moulin DE, Panopalis P, Proulx J, Shir Y |title=2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary |journal=Pain Res Manag |volume=18 |issue=3 |pages=119–26 |year=2013 |pmid=23748251 |pmc=3673928 |doi= |url=}}</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
Revision as of 20:29, 27 July 2017
|
Fibromyalgia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Fibromyalgia overview On the Web |
|
American Roentgen Ray Society Images of Fibromyalgia overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Fibromyalgia (FM) is a disorder characterized by the presence of chronic widespread pain and tactile allodynia. The criteria for such an entity have not yet been thoroughly developed. The recognition that fibromyalgia involves more than just pain has led to the frequent use of the term "fibromyalgia syndrome." It is not contagious, and recent studies suggest that some people with fibromyalgia may be genetically predisposed. The disorder is not directly life-threatening. The degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission; however, the disorder is generally perceived as non-progressive.
Historical Perspective
The term fibromyalgia was not used until 1976 when Dr. P.K. Hench used it to describe fibromyalgia symptoms. Many names, including "muscular rheumatism," "fibrositis," "psychogenic rheumatism," and "neurasthenia" were applied historically to symptoms resembling those of fibromyalgia. The term fibromyalgia was coined by researcher Mohammed Yunus as a synonym for fibrositis and was first used in a scientific publication in 1981. Fibromyalgia is derived from the Latin fibra (fiber) and the Greek words myo (muscle) and algos (pain). The first clinical, controlled study of the characteristics of fibromyalgia syndrome was published in 1981, providing support for symptom associations. In 1984, a connection between fibromyalgia syndrome and other similar conditions was proposed and in 1986, trials of the first proposed medications for fibromyalgia were published. A 1987 article in the Journal of the American Medical Association used the term "fibromyalgia syndrome" while saying it was a "controversial condition." The American College of Rheumatology (ACR) published its first classification criteria for fibromyalgia in 1990, although these are not strictly diagnostic criteria.[1][2]
Classification
DSM 5 divides fibromyalgia into four groups based on the differences in psychological and autonomic nervous system profiles among affected individuals. Fibromyalgia has been classified into extreme sensitivity to pain but no associated psychiatric conditions, fibromyalgia and comorbid, pain-related depression, depression with concomitant fibromyalgia syndrome and fibromyalgia due to somatization.[2][3][4]
Pathophysiology
The exact cause of fibromyalgia is unknown. In fact, it is not due to a singular factor but is due to a multiplicity of causes. Fibromyalgia does not start as a result of some trauma such as a traffic accident, major surgery, or disease. Some evidence shows that Lyme disease may be a trigger of fibromyalgia symptoms. There are various hypotheses put forth describing the pathogenesis of fibromyalgia suggesting that more than one clinical entity may be involved, ranging from a mild, idiopathic inflammatory process to clinical depression[5][6]
Causes
The exact cause of fibromyalgia is unknown. Possible causes or triggers of fibromyalgia include physical or emotional trauma, abnormal pain response - areas in the brain that are responsible for pain may react differently in fibromyalgia patients, sleep disturbances and infections, such as a viral infections. [7][8]
Differentiating Fibromyalgia from other Diseases
Fibromyalgia must be differentiated from other diseases that present with pain, fatigue and sleep disturbance, and symptoms of cognitive dysfunction and psychiatric disease such as rheumatoid arthritis, SLE, chronic fatigue syndrome, spondyloarthritis, polymyalgia rheumatica.[7][8][9][10][11]
Epidemiology and Demographics
The prevalence of fibromyalgia in the United States was reported to range from 500-5000 per 100,000 persons. Females are more commonly affected than males with a ratio of 9:1. 20-50 year age group is more commonly affected. Fibromyalgia has no racial predilection.[12]
Risk Factors
Common risk factors in the development of fibromyalgia are stressful or traumatic events, such as car accidents, post-traumatic stress disorder (PTSD), and repetitive injuries. Injury from repetitive stress on a joint, such as frequent knee bending, illness (such as viral infections), family history and obesity.[8]
Natural History, Complications and Prognosis
Fibromyalgia is a long-term disorder. If left untreated, chronic pain could cause permanent changes in how the body perceives pain. Complications that can develop as a result of fibromyalgia are marked functional impairment, depression, anxiety, insomnia, obesity, and allodynia. Factors associated with poor outcomes are female gender, low socioeconomic status, being unemployed. Even with appropriate treatment, symptoms of fibromyalgia improve other times, the pain may get worse and continue for months or years.[10]
Diagnosis
Diagnostic Criteria
The most widely accepted set of diagnostic criteria for fibromyalgia was elaborated in 2010 by the Multicenter Criteria Committee of the the American College of Rheumatology. A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:[13][14][15][16]
- 1) Widespread pain index (WPI) > 7 and symptom severity (SS) scale score >5 or WPI 3–6 and SS scale score >9.
- 2) Symptoms have been present at a similar level for at least 3 months.
- 3) The patient does not have a disorder that would otherwise explain the pain.
History and Symptoms
The defining symptoms of fibromyalgia are chronic, widespread pain and tenderness to light touch.
Physical Examination
A physical examination helps not only to confirm the diagnosis of fibromyalgia but to rule out other systemic diseases. A careful physical examination also helps in identifying associated conditions. The tender-point examination is the most important aspect of the physical examination and other aspects of the examination are typically normal in fibromyalgia patients
Laboratory Findings
Blood and urine tests are usually normal. However, tests may be done to rule out other conditions that may have similar symptoms.
Fibromyalgia X-ray findings
There are no Xray findings associated with fibromyalgia.
CT
There are no CT findings associated with fibromyalgia.
MRI
There are no MRI findings associated with fibromyalgia.
Ultrasound
There are no ultrasound findings associated with fibromyalgia.
Other Imaging Findings
There are no other imaging findings associated with fibromyalgia.
Other Diagnostic Studies
There are no other specific diagnostic findings associated with fibromyalgia.
Treatment
There is no universally accepted treatment or cure for fibromyalgia, and treatment typically consists of symptom management. Treatment options include medications, patient education, aerobic exercise and cognitive behavioral therapy which have been shown to be effective in alleviating pain and other fibromyalgia-related symptoms.
Medical Therapy
Medical therapy includes analgesics, antidepressants, skeletal muscle relaxants, anticonvulsants and anti-anxiety medications [17]
Psychotherapy
Although there is no universally accepted cure, some doctors have claimed to have successfully treated fibromyalgia when a psychological cause is accepted. As the nature of fibromyalgia is not well understood, some physicians believe that it may be psychosomatic or psychogenic.Cognitive behavioral therapy has been shown to improve the quality of life and coping in fibromyalgia patients and other sufferers of chronic pain.[18][19]
Surgery
Surgical intervention is not recommended for the management of fibromyalgia.
Primary prevention
There is no established method of prevention of fibromyalgia.
Secondary prevention
There are no specific secondary preventive measures available for fibromyalgia. However, proper treatment and lifestyle changes can help reduce the frequency and severity of symptoms. Secondary preventive measures for fibromyalgia include adequate sleep, reducing emotional and mental stress, regular exercise, following a balanced diet and monitoring one's own symptoms.[20][21][22]
References
- ↑ Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome
- ↑ 2.0 2.1 Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P (1990). "The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee". Arthritis Rheum. 33 (2): 160–72. PMID 2306288.
- ↑ Fitzcharles MA, Shir Y, Ablin JN, Buskila D, Amital H, Henningsen P, Häuser W (2013). "Classification and clinical diagnosis of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines". Evid Based Complement Alternat Med. 2013: 528952. doi:10.1155/2013/528952. PMC 3860136. PMID 24379886.
- ↑ Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choinière M, Ko G, Moulin DE, Panopalis P, Proulx J, Shir Y (2013). "2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary". Pain Res Manag. 18 (3): 119–26. PMC 3673928. PMID 23748251.
- ↑ http://www.springerlink.com/content/1271314042w8405g/ Mueller W, et al. The classification of fibromyalgia syndrome. Rheumatol Int. 2007 Jul 25
- ↑ "Late and Chronic Lyme Disease: Symptom Overlap with Chronic Fatigue Syndrome & Fibromyalgia".
- ↑ 7.0 7.1 Goldenberg DL, Burckhardt C, Crofford L (2004). "Management of fibromyalgia syndrome". JAMA. 292 (19): 2388–95. doi:10.1001/jama.292.19.2388. PMID 15547167.
- ↑ 8.0 8.1 8.2 Clauw DJ (2014). "Fibromyalgia: a clinical review". JAMA. 311 (15): 1547–55. doi:10.1001/jama.2014.3266. PMID 24737367.
- ↑ Borchers AT, Gershwin ME (2015). "Fibromyalgia: A Critical and Comprehensive Review". Clin Rev Allergy Immunol. 49 (2): 100–51. doi:10.1007/s12016-015-8509-4. PMID 26445775.
- ↑ 10.0 10.1 Häuser W, Burgmer M, Köllner V, Schaefert R, Eich W, Hausteiner-Wiehle C, Henningsen P (2013). "[Fibromyalgia syndrome as a psychosomatic disorder - diagnosis and therapy according to current evidence-based guidelines]". Z Psychosom Med Psychother (in German). 59 (2): 132–52. doi:10.13109/zptm.2013.59.2.132. PMID 23775553.
- ↑ Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P (2008). "[Definition, classification and diagnosis of fibromyalgia syndrome]". Z Rheumatol (in German). 67 (8): 665–6, 668–72, 674–6. doi:10.1007/s00393-008-0404-4. PMID 19050952.
- ↑ Vincent A, Lahr BD, Wolfe F, Clauw DJ, Whipple MO, Oh TH, Barton DL, St Sauver J (2013). "Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project". Arthritis Care Res (Hoboken). 65 (5): 786–92. doi:10.1002/acr.21896. PMC 3935235. PMID 23203795.
- ↑ Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU (2015). "Fibromyalgia diagnosis: a review of the past, present and future". Expert Rev Neurother. 15 (6): 667–79. doi:10.1586/14737175.2015.1046841. PMID 26035624.
- ↑ Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB (2011). "Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia". J. Rheumatol. 38 (6): 1113–22. doi:10.3899/jrheum.100594. PMID 21285161.
- ↑ Atzeni F, Cazzola M, Benucci M, Di Franco M, Salaffi F, Sarzi-Puttini P (2011). "Chronic widespread pain in the spectrum of rheumatological diseases". Best Pract Res Clin Rheumatol. 25 (2): 165–71. doi:10.1016/j.berh.2010.01.011. PMID 22094193.
- ↑ Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010). "The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity". Arthritis Care Res (Hoboken). 62 (5): 600–10. doi:10.1002/acr.20140. PMID 20461783.
- ↑ Selfridge, Dr. Nancy, and Peterson, Franklynn (2001). Freedom from Fibromyalgia: The 5-Week Program Proven to Conquer Pain. ISBN 0-8129-3375-3.
- ↑ <ref>Leonard-Segal, Dr. Andrea (2006). "A Rheumatologist's Experience With Psychosomatic Disorders". The Divided Mind: The Epidemic of Mindbody Disorders. ReganBooks. pp. 264–265. ISBN 0-06-085178-3.
- ↑ Sarno, Dr. John E; et al. (2006). The Divided Mind: The Epidemic of Mindbody Disorders. ReganBooks. pp. 21–22, 235–237, 264–265, 294–298, 315, 319–320, 363. ISBN 0-06-085178-3.
- ↑ Vierck CJ (2012). "A mechanism-based approach to prevention of and therapy for fibromyalgia". Pain Res Treat. 2012: 951354. doi:10.1155/2012/951354. PMC 3200141. PMID 22110947.
- ↑ Altomonte L, Atzeni F, Leardini G, Marsico A, Gorla R, Casale R, Cassisi G, Stisi S, Salaffi F, Marinangeli F, Giamberardino MA, Di Franco M, Biasi G, Arioli G, Alciati A, Ceccherelli F, Bazzichi L, Carignola R, Cazzola M, Torta R, Buskila D, Spath M, Gracely RH, Sarzi-Puttini P (2008). "Fibromyalgia syndrome: preventive, social and economic aspects". Reumatismo. 60 Suppl 1: 70–8. PMID 18852910.
- ↑ Arnold LM, Clauw DJ, Dunegan LJ, Turk DC (2012). "A framework for fibromyalgia management for primary care providers". Mayo Clin. Proc. 87 (5): 488–96. doi:10.1016/j.mayocp.2012.02.010. PMC 3498162. PMID 22560527.