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Fibromyalgia Resource Center
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Fibromyalgia (FM) and other chronic pain and fatigue syndromes constitute a huge societal burden that traditional Western medicine is currently failing to approach effectively. Although the hallmarks of FM (ie, chronic widespread pain, fatigue, multiple other somatic symptoms) have neurophysiologic and endocrinologic underpinnings, these biologic aspects likely derive significantly from psychologic, developmental, and sociocultural variables that lead to chronic unrelieved stress and distress. Female sex, adverse experiences during childhood, psychologic vulnerability to stress, and a stressful, often frightening, environment and culture are important antecedents of FM. To understand FM and related syndromes and to provide optimum care require a biopsychosocial, not a biomedical, viewpoint.
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Although children and adults with fibromyalgia syndrome experience similar symptoms, children seem to experience more sleep disturbances and fewer tender points than adults. Other associated symptoms include chronic headaches, soft tissue swelling, tension, and anxiety.
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Some investigators believe that a successful rehabilitation program involves a multidisciplinary team of professionals and various modalities individualized for each patient. The team includes the physician, a medical psychologist, physical and massage therapists, and an exercise physiologist. These professionals should have expertise in the treatment of soft tissue disorders.
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At a clinical level, fibromyalgia is much more than widespread pain. Substantial overlap exists in major depressive disorder, various anxiety disorders, and chronic fatigue syndrome and in multiple regional pain syndromes, such as headache, atypical chest pain (chest pain with normal cardiac evaluation findings), irritable bowel syndrome, chronic pelvic pain, temporomandibular joint pain (jaw pain with no underlying pathologic condition), and others. Indeed, the diagnostic label attached to a patient may be determined largely by the first specialist that he or she sees. For example, a rheumatologist might diagnosis fibromyalgia, whereas a gastroenterologist would diagnose irritable bowel syndrome.
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Fibromyalgia, in many cases, presents as a form of allodynia, in which usually painless stimuli are perceived as painful, and hyperalgesia, in which normally painful stimuli is amplified. Cerebrospinal fluid levels of substance P are elevated, and additional abnormalities in the serotonin system and in the regulation of cortisol exist. Fibromyalgia can also coexist with various autoimmune diseases and often presents after a severe flulike syndrome, a defined infection (eg, Lyme disease), or trauma. Sleep is often disturbed, and nonrestorative sleep is associated with increased pain. The increased prevalence in females may point to a hormonal influence. Few abnormalities occur in the peripheral musculature. Studies that show abnormalities of cerebral blood flow in the thalamus and caudate nucleus help support the likelihood that pain processing in the central nervous system behaves abnormally.
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Clinical Trial Testing the Safety and Efficacy of Fluoxetine in Juvenile Fibromyalgia |
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Eszopiclone in the Treatment of Insomnia and Fibromyalgia |
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Exercise-Based Motivational Interviewing for Fibromyalgia
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Neurotropin to Treat Fibromyalgia |
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A 14-Week, Multi-Center Study of [S,S]-Reboxetine in Patients With Fibromyalgia |
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A Trial Assessing the Effect of Nabilone on Pain and Quality of Life in Patients With Fibromyalgia |
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Lifestyle Physical Activity to Reduce Pain and Fatigue in Adults With Fibromyalgia |
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A Safety and Efficacy Study of Xyrem® (Sodium Oxybate) to Treat Fibromyalgia |
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Double-Blind Multicenter Proof of Concept Trial to Assess the Efficacy and Safety of Rotigotine in Subjects With Fibromyalgia Syndrome (SP888) |
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Pain Relief Investigation of Neuromodulation Therapy in an Adult Fibromyalgia Population |
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Armodafinil for Fibromyalgia Fatigue |
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Vagus Nerve Stimulation in Fibromyalgia
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Study Evaluating Safety and Efficacy of Desvenlafaxine Sustained Release (DVS SR) in Adult Female Outpatients With Fibromyalgia |
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Nondrug Treatment Programs for Adults With Fibromyalgia
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Harris RE, Sundgren PC, Pang Y, Hsu M, Petrou M, Kim SH, McLean SA, Gracely RH, Clauw DJ. Dynamic levels of glutamate within the insula are associated with improvements in multiple pain domains in fibromyalgia. Arthritis Rheum 2008 Mar;58(3):903-7 |
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Pregabalin (Lyrica) for fibromyalgia. Med Lett Drugs Ther 2007 Sep 24;49(1270):77-8 |
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Annemans L, Wessely S, Spaepen E, Caekelbergh K, Caubère JP, Lay KL, Taïeb C. Health economic consequences related to the diagnosis of fibromyalgia syndrome. Arthritis Rheum 2008 Mar;58(3):895-902 |
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Arnold LM, Russell IJ, Diri EW, Duan WR, Young JP Jr, Sharma U, Martin SA, Barrett JA, Haig G. A 14-week, Randomized, Double-Blinded, Placebo-Controlled Monotherapy Trial of Pregabalin in Patients With Fibromyalgia. J Pain 2008 Jun 2. [Epub ahead of print] |
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Jones KD, Burckhardt CS, Deodhar AA, Perrin NA, Hanson GC, Bennett RM. A six-month randomized controlled trial of exercise and pyridostigmine in the treatment of fibromyalgia. Arthritis Rheum 2008 Feb;58(2):612-22 |
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Caro XJ, Winter EF, Dumas AJ. A subset of fibromyalgia patients have findings suggestive of chronic inflammatory demyelinating polyneuropathy and appear to respond to IVIg. Rheumatology (Oxford) 2008 Feb;47(2):208-11 |
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Rooks DS, Gautam S, Romeling M, Cross ML, Stratigakis D, Evans B, Goldenberg DL, Iversen MD, Katz JN. Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial. Arch Intern Med 2007 Nov 12;167(20):2192-200 |
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Sadreddini S, Molaeefard M, Noshad H, Ardalan M, Asadi A. Efficacy of Raloxifen in treatment of fibromyalgia in menopausal women. Eur J Intern Med 2008 Jul;19(5):350-5. Epub 2007 Nov 28 |
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Mascitelli L, Pezzetta F, Goldstein MR. Detrimental effect of statin therapy in women with fibromyalgia. Arch Intern Med 2008 Jun 9;168(11):1228-9 |
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Staud R, Koo EB. Are cannabinoids a new treatment option for pain in patients with fibromyalgia? Nat Clin Pract Rheumatol 2008 Jun 3. [Epub ahead of print] |
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Hassett AL, Simonelli LE, Radvanski DC, Buyske S, Savage SV, Sigal LH. The relationship between affect balance style and clinical outcomes in fibromyalgia. Arthritis Rheum 2008 May 30;59(6):833-840. [Epub ahead of print] |
