Clinical Aspects and Management of Fibromyalgia Syndrome

Abstract

Fibromyalgia syndrome (FMS) is a chronic and debilitating musculoskeletal pain disorder of unknown aetiology with usual accompanying features of fatigue, sleep disturbances and stiff- ness. Its place in medical textbooks was controversial with rheumatologists holding the helm of its management for many years. Over the last decade, abnormalities have been identified at multiple levels in the peripheral, central, and sympathetic nervous systems as well as the hypothalomo-pitutary-adrenal axis stress response system. With the elucidation of these pathways of pain, FMS is known more as a central sensitivity syndrome. This led to tremendous increment in interest in both pharmacological and non-pharmacological treatment of FMS. The United States Food and Drug Administration (FDA) has also successively approved 3 drugs for the management of fibromyalgia – pregabalin, duloxetine and milnacipran. Non-pharmacological modalities showed aerobic exercise, patient education and cognitive behavioural therapy to be most effective. Overall, management of FMS requires a multi-disciplinary approach. Key words: Aetiology, Fibromyalgia-Fibromyositis Syndromes, History, Pain syndrome

Treinamento resistido de baixa intensidade promove redução da hiperalgesia mecânica e aumento da força muscular em ratos submetidos ao modelo de dor crônica muscular difusa

“…A síndrome da fibromialgia (SFM) é caracterizada como uma síndrome que envolve diversos sintomas associados a dor crônica musculoesquelética, como ansiedade, depressão, distúrbios no sono, disfunções intestinas, rigidez nos músculos e aumento da fadiga [1][2][3][4] . Esse estado patológico promove desordens no sistema nervoso central por meio do aumento de estímulos nociceptivos a longo prazo, resultando em sensibilização [3][4][5][6] .…”

“…A síndrome da fibromialgia (SFM) é caracterizada como uma síndrome que envolve diversos sintomas associados a dor crônica musculoesquelética, como ansiedade, depressão, distúrbios no sono, disfunções intestinas, rigidez nos músculos e aumento da fadiga [1][2][3][4] . Esse estado patológico promove desordens no sistema nervoso central por meio do aumento de estímulos nociceptivos a longo prazo, resultando em sensibilização [3][4][5][6] . A etiologia da SFM permanece desconhecida, mas alguns mecanismos fisiopatológicos podem estar presentes, tais como: somação medular de vias ascendentes da dor, hipoativação do sistema modulador da dor, sensibilização de nociceptores periféricos e centrais, desregulação do sistema neuroendócrino e desbalanço autonômico 3,[6][7][8] .…”

Low-intensity resistance training promotes a reduction of mechanical hyperalgesia and increase of muscle strength in rats submitted to the diffused chronic muscle pain model

“…Fibromyalgia syndrome (FMS) is characterized as a syndrome involving various symptoms associated with chronic musculoskeletal pain, such as anxiety, depression, sleep disturbances, intestinal dysfunction, muscle stiffness and increased fatigue [1][2][3][4] . This pathological state promotes disorders in the central nervous system by increasing nociceptive stimuli over the long term, resulting in sensitization [3][4][5][6] .…”

“…Fibromyalgia syndrome (FMS) is characterized as a syndrome involving various symptoms associated with chronic musculoskeletal pain, such as anxiety, depression, sleep disturbances, intestinal dysfunction, muscle stiffness and increased fatigue [1][2][3][4] . This pathological state promotes disorders in the central nervous system by increasing nociceptive stimuli over the long term, resulting in sensitization [3][4][5][6] . The etiology of FMS remains unknown, but some pathophysiological mechanisms may be present, such as: medullary summation of ascending pain pathways, hypoactivation of the pain modulator system, sensitization of peripheral and central nociceptors, dysregulation of the neuroendocrine system and autonomic imbalance 3,[6][7][8] .…”