Fibromyalgia: A Critical and Comprehensive Review

Abstract

Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.

Symptoms and the body: Taking the inferential leap

“…A review by Powell et al (2013) could not establish hypocortisolism in chronic fatigue patients, but found evidence for an attenuation of the diurnal variability of the cortisol response. A similar picture arises from review studies on the role of inflammatory, infectious, or autoimmune dysfunction in functional somatic syndromes: few differences are found, and if so, they mostly pertain to different parameters (see Borchers and Gershwin, 2015;Üç eyler et al, 2011;Blundell et al, 2015;Ishihara et al, 2013;Schwille-Kiuntke et al, 2015). Importantly, whenever a dysfunction is observed, few studies test whether the abnormalities actually cause or mediate the symptoms in question.…”

Visión desde la rehabilitación del paciente con fibromialgia

“…4,6 Adicionalmente, entre el 50 al 70% de los pacientes con FM presentan depresión mayor, trastornos del sueño en un 70 a 90% y trastornos cognitivos en el 76% de los casos. 9,10 Se ha documentado que aproximadamente 200.000 de las hospitalizaciones en EE. UU.…”

“…2,5,17 Otros factores que agravan la sintomatología son ejercicio de alta intensidad, situaciones estresantes y cambios climáticos, especialmente el frío. 10 Todo lo anterior conlleva a una baja efectividad en el tratamiento instaurado (mala adherencia, resultados a largo plazo con mejoría no significativa) y al deterioro progresivo de la funcionalidad, la participación y la calidad de vida de los pacientes. 16 …”

“…4,13,17 Otros factores que mejoran los síntomas son el ejercicio aeróbico de leve a moderada intensidad, la relajación, el descanso y el calor 10 .…”

Endocannabinoids and Related Lipids in Chronic Pain: Analytical and Clinical Aspects

“…After correction for age in paper IV, significant group differences remained for OEA and SEA. However, since age also increases the risk of developing FM [197], such corrections could be disputed. BMI and circulating 2-AG seems to be positively correlated [187], which was found in paper IV as well.…”