Fibromyalgia

Abstract

Fibromyalgia is a common illness characterized by chronic widespread pain, sleep problems (including unrefreshing sleep), physical exhaustion and cognitive difficulties. The definition, pathogenesis and treatment are controversial, and some even contest the existence of this disorder. In 1990, the American College of Rheumatology (ACR) defined classification criteria that required multiple tender points (areas of tenderness occurring in muscles and muscle-tendon junctions) and chronic widespread pain. In 2010, the ACR preliminary diagnostic criteria excluded tender points, allowed less extensive pain and placed reliance on patient-reported somatic symptoms and cognitive difficulties. Fibromyalgia occurs in all populations worldwide, and symptom prevalence ranges between 2% and 4% in the general population. The prevalence of people who are actually diagnosed with fibromyalgia ('administrative prevalence') is much lower. A model of fibromyalgia pathogenesis has been suggested in which biological and psychosocial variables interact to influence the predisposition, triggering and aggravation of a chronic disease, but the details are unclear. Diagnosis requires the history of a typical cluster of symptoms and the exclusion of a somatic disease that sufficiently explains the symptoms by medical examination. Current evidence-based guidelines emphasize the value of multimodal treatments, which encompass both non-pharmacological and selected pharmacological treatments tailored to individual symptoms, including pain, fatigue, sleep problems and mood problems. For an illustrated summary of this Primer, visit: http://go.nature.com/LIBdDX.

Definition, Klassifikation, klinische Diagnose und Prognose des Fibromyalgiesyndroms

“…Beim Fibromyalgiesyndrom (FMS) handelt es sich um ein Beschwerdebild, dessen Definition, Klassifikation und Diagnose zwischen den einzelnen medizinischen Fachgesellschaften sowie zwischen Ärzten, Psychologen und Betroffenen weiter umstritten ist [17]. Die Diskussion um die Definition, Klassifikation und Diagnose wird teilweise durch berufspolitische Ansprüche der medizinischen Fachgesellschaften und Versorgungsansprüche von Betroffenen mitbestimmt.…”

“…In klinischen Einrichtungen sind bis zu 80 % der Patientinnen Frauen im Alter von 40 bis 60 Jahren [17]. In der repräsentativen Stichprobe der deutschen Bevölkerung war das Geschlechtsverhältnis ausgeglichen [33].…”

A paradigm change to inform fibromyalgia research priorities by engaging patients and health care professionals

“…2016 9,10 The exact cause and pathogenesis of FM are mostly unknown. 2,9 Effective treatments for FM are elusive, with no current "gold standard" of care and an expectation that symptoms will likely persist throughout life. Symptoms of FM have immediate effects on HRQoL and personal and social functioning.…”

“…This novel concept is particularly relevant for directing research in fibromyalgia (FM), a condition with many unanswered questions but specifically those surrounding ideal management that may ultimately improve patient outcomes. [1][2][3] An innovator in this area of patient engagement has been the James Lind Alliance (JLA), a United Kingdombased iniative that has developed a standardized methodology to involve various key stakeholders in identifying unanswered questions or "uncertainties" in clinical care that can help direct a research agenda. [4][5][6] Partnering with JLA in a research priority-setting partnership (PSP) provides the opportunity to recognize real-life gaps in clinical care and thereby propel research that will improve symptoms and health related quality of life (HRQoL) for various medical conditions.…”

“…It is characterized by widespread body pain with associated core symptoms of fatigue, sleep disturbance, and cognitive problems as well as other somatic and mood complaints. 2,7,8 Clinical criteria and severity scales for FM were defined by the American College of Rheumatology (ACR) in 2011, with further revision in. 2016 9,10 The exact cause and pathogenesis of FM are mostly unknown.…”