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Fibromyalgia: A Critical and Comprehensive Review

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Abstract

Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.

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Abbreviations

ACC:

Anterior cingulate cortex

ACR:

American College of rheumatology

ACTH:

Adrenocorticotropic hormone

AGE:

Advanced glycation end product

AUC:

Area under the curve

AVS:

Arteriole-venule shunts

BAI:

Beck anxiety inventory

BDI:

Beck depression inventory

BMI:

Body mass index

BOLD:

Blood oxygen level dependent

CAP:

Cyclic alternating pattern

CES:

D Center for Epidemiologic Studies Depression Scale

CFS:

Chronic fatigue syndrome

CML:

Carboxymethyllysine

CoQ10:

Coenzyme Q10

CRH:

Corticotropin-releasing hormone

CSF:

Cerebrospinal fluid

CWP:

Chronic widespread pain

DLPFC:

Dorsolateral prefrontal cortex

DMN:

Default mode network

DNIC:

Diffuse noxious inhibitory control

DRG:

Dorsal root ganglion

DST:

Dexamethasone suppression test

ENFD:

Epidermal nerve fiber density

FIQ:

Fibromyalgia impact questionnaire

FMS:

Fibromyalgia syndrome

GABA:

γ-aminobutyric acid

GHRH:

Growth hormone releasing hormone

HADS:

Hospital Anxiety and Depression Scale

HPA:

Hypothalamic pituitary adrenal

HRV:

Heart rate variability

IGF-I:

Insulin-like growth factor-I

IBS:

Inflammatory bowel syndrome

ICPM:

Inhibitory conditioned pain modulation

IL:

Interleukin

ITT:

Insulin tolerance test

LEP:

Laser-evoked potential

MOR:

μ opioid receptor

MPQ:

McGill Pain Questionnaire

MRS:

Magnetic resonance spectroscopy

NAA:

N-acetylaspartate

NFR:

Nociceptive flexion reflex

NMDA:

N-methyl-d-aspartate

NREM:

Non-rapid eye movement

PrelimACR 2010 criteria:

Preliminary ACR 2010 diagnostic criteria

PAG:

Periaqueductal gray

PBMC:

Peripheral blood mononuclear cells

PPT:

Pressure point threshold

QoL:

Quality of life

RA:

Rheumatoid arthritis

RAGE:

Receptor for AGE (= advanced glycation end product)

REM:

Rapid eye movement

ROS:

Reactive oxygen species

SI:

Primary somatosensory cortex

SII:

Secondary somatosensory cortex

SSS:

Symptom severity scale

TSD:

Total sleep deprivation

WPI:

Widespread pain index

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    Andrea T. Borchers & M. Eric Gershwin

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Borchers, A.T., Gershwin, M.E. Fibromyalgia: A Critical and Comprehensive Review. Clinic Rev Allerg Immunol 49, 100–151 (2015). https://doi.org/10.1007/s12016-015-8509-4

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