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Fibromyalgia: Up to date aspects of patophysiology, diagnosis and treatment

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Author(s): Tomašević-Todorović Snežana | Pjević Miroslava | Bošković Ksenija

Journal: Medicinski Pregled
ISSN 0025-8105

Volume: 63;
Issue: 7-8;
Start page: 507;
Date: 2010;
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Keywords: Fibromyalgia + physiopathology | Fibromyalgia + diagnosis | Fibromyalgia + drug therapy | Chronic Disease | Pain | Signs and Symptoms | Pain Measurement

ABSTRACT
Introduction. Fibromyalgia (FM) is a chronic pain condition with spontaneous, chronic, widespread musculoskeletal pain and tenderness accompanied by a number of nonspecific symptoms. The low prevalence of FM is considered an underestimation and results from insufficient knowledge about FM. In order to increase the general awareness of the unique nature of pain in fibromyalgia and the right of patients to receive specific attention, EFIC (European Federation of the IASP Chapters) launched the European campaign against pain in fibromyalgia. Pathophysiological mechanisms. The pathogenesis of fibromyalgia is not yet clear. An altered processing of pain is probably the main contributor to the pathogenesis, arising from a number of neuroendocrine, neurotransmitter and neurosensory disturbances in genetically predisposed patients. According to numerous findings, FM originates in the central nervous system and indicates a state of central sensitization in fibromyalgia. There are many reasons for considering that FM and neuropathic pain share similar mechanisms. Diagnostic criteria and fibromyalgia assessment. The ACR criteria (1990) are currently a “gold standard” applied for FM diagnosing, but a number of scoring systems and scales are valid tools for fibromyalgia assessment, differential diagnosis, treatment evaluation and estimation of patient’s quality of life. Treatment. According to multiple pathophysiological mechanisms, the treatment involves multidisciplinary and multimodal approach, includding a combination of pharmacological and non-pharmacological interventions based on EULAR (European League Against Rheumatism) recommendations from 2007. Pharmacological treatment (antidepressants, anticonvulsants and conventional analgesics) is directed toward the control of pain and other symptoms, but non-pharmacological management (aerobic exercise, strength training and cognitive behavioural therapy) is directed to functional consequences of the symptoms. Although the treatment rarely relieves the symptoms completely, the active role of an educated FM patient and supportive surrounding are secondary necessary to provide beneficial clinical effects on this complex painful condition.
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