Fibromyalgia Comorbid with Anxiety Disorders and Depression: Combined Medical and Psychological Treatment
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Fibromyalgia is associated with high level of pain and suffering. Lack of diagnosis leads to onerous indirect economic costs. Recent data indicate that fibromyalgia; anxiety disorders, and depression tend to occur as comorbid conditions. They also share some common neurochemical dysfunctions and central nervous system alterations such as hypofunctional serotonergic system and altered reactivity of the hypothalamic-pituitary-adrenal axis. Conversely, functional neuroimaging findings point to different patterns of altered pain processing mechanisms between fibromyalgia and depression. There is no cure for fibromyalgia, and treatment response effect size is usually small to moderate. Treatment should be based on drugs that also target the comorbid psychiatric condition. Combined pharmacotherapy and cognitive-behavior therapy should ideally be offered to all patients. Lifestyle changes, such as physical exercise should be encouraged. The message to patients should be that all forms of pain are true medical conditions and deserve proper care.
KeywordsFibromyalgia Chronic pain Mental disorders Anxiety disorders Depressive disorders Drug therapy Cognitive behavioral therapy Duloxetine Milnacipran Pregabalin Antidepressive agents Tricyclic
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Conflict of Interest
Marcio Bernik is a board member for Eurofarma-Brazil. Bernik reported receiving a grant from FAPESP and serves as a Cientfic Director for EDIMedica. Bernik had expenses reimbursed for the APA Congress from Roche-Brazil.
Thiago P. A. Sampaio declared that he has no conflict of interest.
Lucas Gandarela declared that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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