Fibromyalgia and the old dilemma: Theory vs. practice.

Abstract

The objective of this article is to review some aspects of the fibromyalgia syndrome and its mechanisms of development. We also discuss how to go from preclinical research to clinical practice. Fibromyalgia is a clinical syndrome whose main features include diffuse musculoskeletal pain, fatigue, sleep disturbances, and cognitive disorders. Russell & Larsson (2009) proposed "pronociceptive" and "antinociceptive" systems under normal conditions. Functional pain states such as fibromyalgia are derived from central disturbances in pain processing. The association with anxiety and depression is a negative prognostic factor. Distress is an important part of its physiopathology. The concomitance of other functional syndromes is a rule. The already known etiopathogenic mechanisms of fibromyalgia can be applied in clinical practice for diagnosis and rational therapeutic approaches. Pharmacological but mainly nonpharmacological measures must be applied. Although much information still needs to be obtained, the clinician presently has sufficient tools for efficiently treating fibromyalgia patients. An important aspect is that such knowledge needs to reach primary care physicians because the prevalence of fibromyalgia does not allow all patients to be treated by specialists.

Efeito de dois tratamentos de fisioterapia na fibromialgia: ensaio paralelo randomizado

“…3 Na FM, parece haver uma via disfuncional de recuperação de traumas físicos ou emocionais; 4 5 uma sensibilização central, i.e., uma amplificação da dor e de outros estímulos sensoriais (e.g. visual, auditivo) a partir de um distúrbio no processamento da dor no sistema nervoso central e; [6][7][8] alterações neuroendócrinas do eixo hipotalâmico-pituitário-adrenal e sistema nervoso autônomo 9 relacionados à dificuldade do gerenciamento do estresse. 10 O conceito de FM evoluiu consideravelmente nas últimas duas décadas e atualmente incorpora sintomas além da dor.…”