Fibromyalgia and Related Conditions
Fibromyalgia and Related Conditions
复制标题
DOI：
10.1016/j.mayocp.2015.03.014
复制
发表时间：
2015-05-01
影响因子：
8.9
通讯作者：
Clauw, Daniel J.
中科院分区：
文献类型：
--
作者：
Clauw, Daniel J.
纤维肌痛是目前广泛的肌肉骨骼疼痛的首选术语，通常伴有其他症状，如疲劳，记忆问题，睡眠和情绪障碍，无法确定其他原因。早些时候，人们对这些相关疾病是否存在“有机基础”存在一些疑问，但今天，来自脑成像和其他技术的无可辩驳的证据表明，这种疾病具有强大的生物学基础，尽管心理，社会和行为因素在一些患者中显然起着重要作用。病理生理学标志是中枢神经系统敏感或过度活跃，导致对疼痛和感觉处理的音量控制或增益增加。这种疾病可以单独发生，但更常见的是与其他疾病共同发生，这些疾病目前已被证明具有相似的基础病理生理学（例如，肠易激综合征、间质性膀胱炎和紧张性头痛），或在患有以持续性外周损伤或炎症为特征的疾病（例如，自身免疫性疾病和骨关节炎）的个体中作为合并症发生。在后一种情况下，术语集中性疼痛意味着这样一个事实，即除了可能由外周因素引起的疼痛外，中枢神经系统中还发生了叠加的疼痛增强。重要的是要认识到这一现象（无论用什么术语来描述它），因为集中性疼痛的个体对外周疼痛（手术和阿片类药物）有效的治疗反应不佳，并且优先对中枢作用镇痛药和非药物治疗反应。(C)2015年马约医学教育和研究基金会
Fibromyalgia is the currently preferred term for widespread musculoskeletal pain, typically accompanied by other symptoms such as fatigue, memory problems, and sleep and mood disturbances, for which no alternative cause can be identified. Earlier there was some doubt about whether there was an "organic basis" for these related conditions, but today there is irrefutable evidence from brain imaging and other techniques that this condition has strong biological underpinnings, even though psychological, social, and behavioral factors clearly play prominent roles in some patients. The pathophysiological hallmark is a sensitized or hyperactive central nervous system that leads to an increased volume control or gain on pain and sensory processing. This condition can occur in isolation, but more often it co-occurs with other conditions now being shown to have a similar underlying pathophysiology (eg, irritable bowel syndrome, interstitial cystitis, and tension headache) or as a comorbidity in individuals with diseases characterized by ongoing peripheral damage or inflammation (eg, autoimmune disorders and osteoarthritis). In the latter instance, the term centralized pain connotes the fact that in addition to the pain that might be caused by peripheral factors, there is superimposed pain augmentation occurring in the central nervous system. It is important to recognize this phenomenon (regardless of what term is used to describe it) because individuals with centralized pain do not respond nearly as well to treatments that work well for peripheral pain (surgery and opioids) and preferentially respond to centrally acting analgesics and nonpharmacological therapies. (C) 2015 Mayo Foundation for Medical Education and Research