Fibromyalgia syndrome: a relevant recent construction of an ancient condition?
Fibromyalgia syndrome: a relevant recent construction of an ancient condition?
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DOI：
10.1097/spc.0b013e3283005479
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发表时间：
2008-06-01
影响因子：
2.1
通讯作者：
Perrot, Serge
中科院分区：
文献类型：
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作者：
Perrot, Serge
综述目的：纤维肌痛被认为是最常见的慢性疼痛综合征。这种综合征是知之甚少，并没有被广泛接受为一个独特的临床实体，但越来越多的药物和非药物治疗正在开发其management.Recent发现：纤维肌痛的临床描述，现在已经建立，但争议的诊断标准正在增加。病理生理学研究表明，纤维肌痛是一种疼痛性风湿性疾病，其中疼痛主要源于中枢敏化和其他神经元变化，包括外周神经元系统的改变。中枢致敏也可能是相关症状的基础，包括焦虑、睡眠障碍、疲劳和其他功能障碍，如肠易激综合征和膀胱不稳定。最近在临床试验中评估了几种药物，包括阿托宁-去甲肾上腺素再摄取抑制剂（度洛沙坦和米那普仑）、弱阿片类药物（曲马多）和抗惊厥药（普瑞巴林）以及非药物方法，证明了在减轻疼痛和改善核心症状（即，尽管病理生理学和诊断标准仍不清楚，但关于这种最近描述的病症收集的科学数据的水平应使临床医生相信这种综合征的存在，从而改善对许多患有慢性疼痛的患者的管理。
PURPOSE OF REVIEW: Fibromyalgia is considered the most common chronic pain syndrome. This syndrome is poorly understood and not widely accepted as a distinct clinical entity but an increasing number of pharmacological and nonpharmacological treatments are being developed for its management.RECENT FINDINGS: The clinical description of fibromyalgia is now well established, but controversies on diagnostic criteria are increasing. Pathophysiological studies suggest that fibromyalgia is a painful rheumatic disorder in which pain primarily stems from central sensitization and from other neuronal changes, including alterations in peripheral neuronal systems. Central sensitization may also underlie associated symptoms, including anxiety, sleep disorders, fatigue, and other dysfunctions such as irritable bowel syndrome and bladder instability. Several agents, including serotonin-norepinephrine reuptake inhibitors (duloxetine and milnacipran), weak opioids (tramadol), and anticonvulsants (pregabalin), as well as nonpharmacological approaches, have been recently evaluated in clinical trials, demonstrating benefit in terms of pain reduction and improvement of core symptoms (i.e., fatigue and sleep disturbance).SUMMARY: Despite the fact that pathophysiology and diagnostic criteria remain unclear, the level of scientific data collected on this recently described condition should convince clinicians of the existence of this syndrome, allowing improved management of the many patients suffering from chronic pain.