Fibromyalgia: an overview.
Fibromyalgia: an overview.
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DOI：
10.1016/j.amjmed.2009.09.006
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发表时间：
2009-12-01
期刊：
影响因子：
--
通讯作者：
Clauw, Daniel J
中科院分区：
文献类型：
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作者：
Clauw, Daniel J
纤维肌痛是对患有慢性广泛性肌肉骨骼疼痛的个体的诊断，没有其他原因，如组织炎症或损伤，可以确定。纤维肌痛现在被认为是，至少部分是，中枢疼痛处理的障碍，产生疼痛刺激（痛觉过敏）和非疼痛刺激（异常性疼痛）的疼痛反应增强。中枢疼痛处理的异常也可能是几种慢性疼痛疾病中出现的症状的部分原因，这些慢性疼痛疾病与纤维肌痛共聚合，纤维肌痛本身是遗传和环境因素的产物。因此，异常中枢疼痛处理与肠易激综合征、颞下颌关节紊乱病、慢性腰痛和某些其他慢性疼痛障碍有关。纤维肌痛和相关疾病似乎反映了中枢神经系统中肾上腺素能和去甲肾上腺素能传递的缺陷，但不是阿片类药物能传递的缺陷。疼痛传递的增强状态也可能是由于前伤害性神经递质如谷氨酸和P物质的增加。在某些情况下，心理和行为因素也在起作用。虽然纤维肌痛和相关疾病之间的重叠可能会带来诊断挑战，但适当的检查和观察可以帮助临床医生做出准确的诊断。近年来，对纤维肌痛及其相关疾病谱的机制的认识大大提高，促进了通过药物和非药物干预治疗这些慢性疼痛疾病的快速进展。
Fibromyalgia is the diagnosis given to individuals with chronic widespread musculoskeletal pain for which no alternative cause, such as tissue inflammation or damage, can be identified. Fibromyalgia is now believed to be, at least in part, a disorder of central pain processing that produces heightened responses to painful stimuli (hyperalgesia) and painful responses to nonpainful stimuli (allodynia). Aberrations in central pain processing may also be partly responsible for symptoms experienced in several chronic pain disorders that coaggregate with fibromyalgia, which is itself a product of genetic and environmental factors. Thus, aberrational central pain processing is implicated in irritable bowel syndrome, temporomandibular disorder, chronic low back pain, and certain other chronic pain disorders. Fibromyalgia and related disorders appear to reflect deficiencies in serotonergic and noradrenergic, but not opioidergic, transmission in the central nervous system. The heightened state of pain transmission may also be owing to increases in pronociceptive neurotransmitters such as glutamate and substance P. In some cases, psychological and behavioral factors are also in play. Although the overlapping symptomatology between fibromyalgia and related disorders may present diagnostic challenges, proper examination and observation can help clinicians make an accurate diagnosis. In recent years, the vastly improved understanding of the mechanism underlying fibromyalgia and the related spectrum of diseases has fostered rapid advances in the therapy of these chronic pain disorders by both pharmacologic and nonpharmacologic interventions.