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=== Stress === === Stress ===
<!-- Stress hypothesis is very big in FMS and this section should have better source, there is alot of MEDRS better then two studies w correlation --> <!-- Stress hypothesis is very big in FMS and this section should have better source, there is alot of MEDRS better then two studies w correlation -->
] may be an important precipitating factor in the development of fibromyalgia.<ref>{{cite journal |author = Anderberg UM, Marteinsdottir I, Theorell T, von Knorring L |title=The impact of life events in female patients with fibromyalgia and in female healthy controls |journal=Eur Psychiatry |month=August |year=2000 |pages=33–41 |volume=15 |issue=5 |pmid=10954873 |doi=10.1016/S0924-9338(00)00397-7}}</ref> Two studies that employed single-voxel ] (1H-MRS) reported metabolic abnormalities within the hippocampal complex in patients with fibromyalgia, with significant correlations between hippocampal metabolic abnormalities and severity of clinical symptoms.<ref name=p18484688 >{{cite journal |author=Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ.|title=Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic -adrenal stress axis function and the relationship with chronic widespread pain and its antecedents|journal=Arthritis Res Ther. |year=2005| volume=7|issue=5|pages=R992–R1000|pmid=16207340}}</ref> This proposition is supported in part by a prospective epidemiology study which found that variations in HPA function characterized by high levels of circulating ] following ]ing, low levels of morning salivary cortisol and high levels of evening salivary cortisol are all associated with the development of chronic widespread pain.<ref> {{cite journal|author=McBeth J, Silman AJ, Gupta A, Chiu YH, Ray D, Morriss R, Dickens C, King Y, Macfarlane GJ. | title=Moderation of catecholamine]] ]with roles in pain perception and natural analgesia. There is also strong evidence for a role of dopamine in ],<ref name=pmid16816393>{{cite journal |author=Cervenka S, Pålhagen SE, Comley RA, ''et al.'' |title=Support for dopaminergic hypoactivity in restless legs syndrome: a PET study on D2-receptor binding |journal=Brain |volume=129 |issue=Pt 8 |pages=2017–28 |year=2006 |month=August |pmid=16816393 |doi=10.1093/brain/awl163 |url=http://brain.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16816393 |accessdate=2008-05-21}}</ref> which is a condition found |journal=Arthritis Rheum. |volume=52 |issue=8 |pages=2495–505 |year=2005 |month=August |pmid=16052595 |doi=10.1002/art.21191 |accessdate=2008-05-21}}</ref> ] may be an important precipitating factor in the development of fibromyalgia.<ref>{{cite journal |author a=August |year=2000 |pages=33–41 |volume=15 |issue=5 |pmid=10954873 |doi=10.1016/S0924-9338(00)00397-7}}</ref> Two studies that employed single-voxel ] (1H-MRS) reported metabolic abnormalities within the hippocampal complex in patients with fibromyalgia, with significant correlations between hippocampal metabolic abnormalities and severity of clinical symptoms.<ref name=p18484688 >{{cite journal |author=Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ.|title=Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic -adrenal stress axis function and the relationship with chronic widespread pain and its antecedents|journal=Arthritis Res Ther. |year=2005| volume=7|issue=5|pages=R992–R1000|pmid=16207340}}</ref> This proposition is supported in part by a prospective epidemiology study which found that variations in HPA function characterized by high levels of circulating ] following ]ing, low levels of morning salivary cortisol and high levels of evening salivary cortisol are all associated with the development of chronic widespread pain.<ref> {{cite journal|author=McBeth J, Silman AJ, Gupta A, Chiu YH, Ray D, Morriss R, Dickens C, King Y, Macfarlane GJ. | title=Moderation of catecholamine]] ]with roles in pain perception and natural analgesia. There is also strong evidence for a role of dopamine in ],<ref name=pmid16816393>{{cite journal |author=Cervenka S, Pålhagen SE, Comley RA, ''et al.'' |title=Support for dopaminergic hypoactivity in restless legs syndrome: a PET study on D2-receptor binding |journal=Brain |volume=129 |issue=Pt 8 |pages=2017–28 |year=2006 |month=August |pmid=16816393 |doi=10.1093/fin fibromyalgia/fibrositis syndrome and rheumatoid arthritis |journal=in fibromyalgia |journal=Arthritis Res Ther. |volume=8 |issue=4 |pages=212 |year=2006 |pmid=16762044 |pmc=1779399 |doi=10.1186/ar1971 }}</ref> ] (]), a SNRI originally used to treat depression and painful ], has been demonstrated by controlled trials{{Citation needed|date=July 2009}} to relieve symptoms of some patients. However, the relevance of dysregulated serotonin metabolism to pathophysiology is a matter of debate.<ref>{{cite journal |author=Jaschko G, Hepp U, Berkhoff M, ''et al.'' |title=Serum serotonin levels are not useful in diagnosing fibromyalgia |journal=Ann Rheum Dis. |volume=66 |issue=9 |pages=1267–8 |year=2007 |month=September |pmid=17693607 |doi=10.1136/ard.2006.058842 }}</ref> Complicating the analysis, one of the more effective types of medication for the treatment of the disorder (i.e. serotonin ]s) actually blocks some of the effects of serotonin.<ref>{{cite journal |author=Späth M |title=Current experience with 5-HT3 receptor antagonists in fibromyalgia |journal=Rheum Dis Clin in patients does not have large effects, and a 2007 literature review reported a need for "further study before any solid recommendations can be made."<ref> {{ cite journal |author=Jones KD, Deodhar P, f/ENDO:22:1:67 |year=2003}}</ref><ref>{{cite journal |last=Yuen |first=KC |coauthors=Bennett RM, Hryciw CA, Cook MB, Rhoads SA, Cook DM |journal=Growth hormone & IGF research |title=Is further evaluation for growth hormone (GH) deficiency necessary in fibromyalgia patients with low serum insulin-like growth factor (IGF)-I levels? |volume=17 |issue=1 |year=2007 |pages=82–8 |pmid=17289417 |doi=10.1016/j.ghir.2006.12.006 }}</ref><ref>{{cite journal | last = Bennett | first = RM | coauthors = Cook DM, Clark SR, Burckhardt CS, Campbell SM. | pmid = 9228141 | title = Hypothalamic-pituitary-insulin-like growth factor-I axis dysfunction in patients with fibromyalgia | volume = 24 | issue = 7 | pages = 1384–9 | journal =J Rheumatology }}</ref><ref>{{cite journal | last = McCall-a comprehensive review. |journal=Curr Med Res Opin |volume=24 |issue=8 |pages=2359–71 |month=August |year=2008 |pmid=18606054 |author=Pae CU, Luyten P, Marks DM, Han C, Park SH, Patkar AA, Masand PS, Van Houdenhove B |doi=10.1185/03007990802288338}}</ref> Indeed, the sensation of pain has at least two dimensions: a sensory dimension which processes the magnitude of the brain that participate in affective pain processing, but not in areas involved in sensory processing which indicate that the amplification of the sensory dimension of pain in fibromyalgia occurs independently of mood or emotional processes.<ref name=Giesecke>{{cite journal |title=The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. |journal=Arthritis Rheum. |volume=52 |issue=5 |pages=1577–84 |month=May |year=2005 |pmid=15880832 |author=Giesecke T, Gracely RH, Williams DA, Geisser ME, Petzke FW, Clauw DJ |doi=10.1002/art.21008 }}</ref>


⚫ An alternative hypothesis regarding the development of fibromyalgia in relationship to psychological conflict proposes that the disorder may be a ] as described by ]'s writing related to "]," in which ] is proposed to be a psychic ] of the mind's ] strategy of distracting painful or dangerous emotions. Education, attitude change, and in some cases, psychotherapy are proposed as fcases are due to ]<ref name=McDermott>{{cite journal |author=McDermott BE, Feldman MD |title=Malingering in the medical setting |journal=Psychiatr Clin North Am |volume=30 |issue=4 |pages=645-62 |year=2007 |17938038 }}</ref>
===Abnormal serotonin metabolism===
In 1975, researchers hypothesized that ], a ] that regulates sleep patterns, mood, concentration and pain, could be involved in the ] of fibromyalgia-associated symptoms.<ref name=p169541/> In 1992, decreased serotonin metabolites in patient ]<ref>{{cite journal |author=Russell IJ, Michalek JE, Vipraio GA, Fletcher EM, Javors MA, Bowden CA |title=Platelet 3H-imipramine uptake receptor density and serum serotonin levels in patients with fibromyalgia/fibrositis syndrome |journal=J Rheumatol. |volume=19 |issue=1 |pages=104–9 |year=1992 |month=January |pmid=1313504 }}</ref> and ] were reported.<ref name="Russell IJ, Vaeroy H, Javors M, Nyberg F 1992 550–6">{{cite journal |author=Russell IJ, Vaeroy H, Javors M, Nyberg F |title=Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis |journal=in fibromyalgia |journal=Arthritis Res Ther. |volume=8 |issue=4 |pages=212 |year=2006 |pmid=16762044 |pmc=1779399 |doi=10.1186/ar1971 }}</ref> ] (]), a SNRI originally used to treat depression and painful ], has been demonstrated by controlled trials{{Citation needed|date=July 2009}} to relieve symptoms of some patients. However, the relevance of dysregulated serotonin metabolism to pathophysiology is a matter of debate.<ref>{{cite journal |author=Jaschko G, Hepp U, Berkhoff M, ''et al.'' |title=Serum serotonin levels are not useful in diagnosing fibromyalgia |journal=Ann Rheum Dis. |volume=66 |issue=9 |pages=1267–8 |year=2007 |month=September |pmid=17693607 |doi=10.1136/ard.2006.058842 }}</ref> Complicating the analysis, one of the more effective types of medication for the treatment of the disorder (i.e. serotonin ]s) actually blocks some of the effects of serotonin.<ref>{{cite journal |author=Späth M |title=Current experience with 5-HT3 receptor antagonists in fibromyalgia |journal=Rheum Dis Clin in patients does not have large effects, and a 2007 literature review reported a need for "further study before any solid recommendations can be made."<ref> {{ cite journal |author=Jones KD, Deodhar P, Lorentzen A, Bennett RM, Deodhar AA |title=Growth hormone perturbations in fibromyalgia: a review |journal=Seminars in Arthritis and Rheumatism |year=2007 |volume=36 |issue=6 |pages=357–79 |pmid=17224178 |doi=10.1016/j.semarthrit.2006.09.006 }}</ref> There is disagreement about the role of HGH in fibromyalgia.<ref>{{cite journal |last=Shuer |first=ML |title=Fibromyalgia: symptom constellation and potential therapeutic options |journal=Endocrine |volume=22 |issue=1 |pages=67–76 |pmid=14610300 |doi=10.1385/ENDO:22:1:67 |year=2003}}</ref><ref>{{cite journal |last=Yuen |first=KC |coauthors=Bennett RM, Hryciw CA, Cook MB, Rhoads SA, Cook DM |journal=Growth hormone & IGF research |title=Is further evaluation for growth hormone (GH) deficiency necessary in fibromyalgia patients with low serum insulin-like growth factor (IGF)-I levels? |volume=17 |issue=1 |year=2007 |pages=82–8 |pmid=17289417 |doi=10.1016/j.ghir.2006.12.006 }}</ref><ref>{{cite journal | last = Bennett | first = RM | coauthors = Cook DM, Clark SR, Burckhardt CS, Campbell SM. | pmid = 9228141 | title = Hypothalamic-pituitary-insulin-like growth factor-I axis dysfunction in patients with fibromyalgia | volume = 24 | issue = 7 | pages = 1384–9 | journal =J Rheumatology }}</ref><ref>{{cite journal | last = McCall-a comprehensive review. |journal=Curr Med Res Opin |volume=24 |issue=8 |pages=2359–71 |month=August |year=2008 |pmid=18606054 |author=Pae CU, Luyten P, Marks DM, Han C, Park SH, Patkar AA, Masand PS, Van Houdenhove B |doi=10.1185/03007990802288338}}</ref> Indeed, the sensation of pain has at least two dimensions: a sensory dimension which processes the magnitude of the brain that participate in affective pain processing, but not in areas involved in sensory processing which indicate that the amplification of the sensory dimension of pain in fibromyalgia occurs independently of mood or emotional processes.<ref name=Giesecke>{{cite journal |title=The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. |journal=Arthritis Rheum. |volume=52 |issue=5 |pages=1577–84 |month=May |year=2005 |pmid=15880832 |author=Giesecke T, Gracely RH, Williams DA, Geisser ME, Petzke FW, Clauw DJ |doi=10.1002/art.21008 }}</ref>

⚫ An alternative hypothesis regarding the development of fibromyalgia in relationship to psychological conflict proposes that the disorder may be a ] as described by ]'s writing related to "]," in which ] is proposed to be a psychic ] of the mind's ] strategy of distracting painful or dangerous emotions. Education, attitude change, and in some cases, psychotherapy are proposed as treatments.<ref>{{cite book |last=Sarno |first=Dr. John E. et al.|title=The Divided Mind: The Epidemic of Mindbody Disorders |year=2006 |isbn=0-06-085178-3 |pages=21–2, 235–7, 294–8 |publisher=HC |location=New York}}</ref>

=== Malingering ===

Because there is not currently an objective clinical test for Fibromyalgia, it continues to be a significant target for ], which is a type of fraud wherein a patient feigns having an illness or exaggerates symptoms for non-medical personal gain (often financial), including obtaining access to prescription drugs for recreational use or for illegal resale.
A 2007 review observes that 25-30% of supposed fibromyalgia cases are due to ]<ref name=McDermott>{{cite journal |author=McDermott BE, Feldman MD |title=Malingering in the medical setting |journal=Psychiatr Clin North Am |volume=30 |issue=4 |pages=645-62 |year=2007 |17938038 }}</ref>


See also the section on " See also the section on "
The first objective findings associated with the disorder were reported in 1975 by Moldofsky and colleagues, who reported the presence of anomalous alpha wave activity (typically associated with arousal states) on sleep ] (EEG) during non-rapid-eye-movement sleep.<ref name=p169541>{{cite journal |author=Moldofsky H, Scarisbrick P, England R, Smythe H |title=Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects |journal=Psychosom Med |volume=37 |issue=4 |pages=341–51 |month=Jul-August |year=1975 |pmid=169541 |url=http://www.psychosomaticmedicine.org/cgi/pmidlookup?view=long&pmid=169541 |day=01}}</ref> By disrupting stage IV sleep consistently in young, healthy subjects, the researchers reproduced a significant increase in muscle tenderness similar to that experienced in fibromyalgia but which resolved when the subjects were able to resume their normal sleep patterns.<ref>{{cite journal of exercise-induced analgesic response.<ref>{{cite journal |author=Staud R, Robinson ME, Price DD |title=Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls |journal=Pain |volume=118 |issue=1-2 |pages=176–84 |year=2005 |month=November |pmid=16154700 |doi=10.1016/j.pain.2005.08.007 }} The first objective findings associated with the disorder were reported in 1975 by Moldofsky and colleagues, who reported the presence of anomalous alpha wave activity (typically associated with arousal states) on sleep ] (EEG) during non-rapid-eye-movement sleep.<ref name=p169541>{{cite journal |author=Moldofsky H, Scarisbrick P, England R, Smythe H |title=Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects |journal=Psychosom Med |volume=37 |issue=4 |pages=341–51 |month=Jul-August |year=1975 |pmid=169541 |url=http://www.psychosomaticmedicine.org/cgi/pmidlookup?view=long&pmid=169541 |day=01}}</ref> By disrupting stage IV sleep consistently in young, healthy subjects, the researchers reproduced a significant f
</ref> Together these results point to dysregulation of the nociceptive system at the central level.

===Neuroendocrine disruption===

Patients with fibromyalgia have been demonstrated to have a disruption of normal neuroendocrine function, characterized by mild hypocortisolemia,<ref>{{cite journal |author=Gur A, Cevik R, Sarac AJ, Colpan L, Em S |title=Hypothalamic-pituitary-gonadal axis and cortisol in young women with primary fibromyalgia: the potential roles of depression, fatigue, and sleep disturbance in the occurrence of hypocortisolism |journal=Ann. Rheum. Dis. |volume=63 |issue=11 |pages=1504–6 |year=2004 |month=November |pmid=15479904 |pmc=1754816 |doi=10.1136/ard.2003.014969 }} Patients with fibromyalgia have been demonstrated to have a disruption of normal neuroendocrine function, characterized by mild hypocortisolemia,<ref>{{cite journal |author=Gur A, Cevik R, Sarac AJ, Colpan L, Em S |title=Hypothalamic-pituitary-gonadal axis and cortisol in young women with primary fibromyalgia: the potential roles of depression, fatigue, and sleep disturbance in the occurrence of hypocortisolism |journal=Ann. Rheum. Dis. |volume=63 |issue=11 |pages=1504–6 |year=2004 |month=November |pmid=15479904 |pmc=1754816 |doi=10.1136/ard.2003.014969 }}
</ref> hyperreactivity of pituitary adrenocorticotropin hormone release in response to challenge, and glucocorticoid feedback resistance.<ref>{{cite journal |author=Griep EN, Boersma JW, Lentjes EG, Prins AP, van der Korst JK, de Kloet ER |title=Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain |journal=J. Rheumatol. |volume=25 |issue=7 |pages=1374–81 |year=1998 |month=July |pmid=9676772 }}</ref> A progressive reduction of serum growth hormone levels has also been documented—at baseline in a minority of patients, while most demonstrate reduced secretion in response to exercise or pharmacological challenge.<ref>{{cite journal |author=Bennett RM |title=Adult growth hormone deficiency in patients with fibromyalgia |journal=Curr Rheumatol Rep |volume=4 |issue=4 |pages=306–12 |year=2002 |month=August |pmid=12126582 |doi=10.1007/s11926-002-0039-4 }} </ref> hyperreactivity of pituitary adrenocorticotropin hormone release in response to challenge, and glucocorticoid feedback resistance.<ref>{{cite journal |author=Griep EN, Boersma JW, Lentjes EG, Prins AP, van der Korst JK, de Kloet ER |title=Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain |journal=J. Rheumatol. |volume=25 |issue=7 |pages=1374–81 |year=1998 |month=July |pmid=9676772 }}</ref> A progressive reduction of serum growth hormone levels has also been documented—at baseline in a minority of patients, while most demonstrate reduced secretion in response to exercise or pharmacological challenge.<ref>{{cite journal |author=Bennett RM |title=Adult growth hormone deficiency in patients with fibromyalgia |journal=Curr Rheumatol Rep |volume=4 |issue=4 |pages=306–12 |year=2002 |month=August |pmid=12126582 |doi=10.1007/s11926-002-0039-4 }}
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Functional analysis of the autonomic system in patients with fibromyalgia has demonstrated disturbed activity characterized by hyperactivity of the sympathetic nervous system at baseline<ref> Martinez-Lavin M. Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther. 2007;9(4):216.</ref> with reduced sympathoadrenal reactivity in response to a variety of stressors including physical exertion and mental stress.<ref>{{cite , especially at night.<ref> {{cite journal |author=Martínez-Lavín M, Hermosillo AG, Mendoza C, ''et al.'' |title=Orthostatic sympathetic derangement in subjects with fibromyalgia |journal=J. Rheumatol. |volume=24 |issue=4 |pages=714–8 |year=1997 |month=April |pmid=9101507 }} Functional analysis of the autonomic system in patients with fibromyalgia has demonstrated disturbed activity characterized by hyperactivity of the sympathetic nervous system at baseline<ref> Martinez-Lavin M. Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther. 2007;9(4):216.</ref> with reduced sympathoadrenal reactivity in response to a variety of stressors including physical exertion and mental stress.<ref>{{cite , especially at night.<ref> {{cite journal |author=Martínez-Lavín M, Hermosillo AG, Mendoza C, ''et al.'' |title=Orthostatic sympathetic derangement in subjects with fibromyalgia |journal=J. Rheumatol. |volume=24 |issue=4 |pages=714–8 |year=1997 |month=April |pmid=9101507 }}
⚫ </ref> In addition, plasma fthe fibromyalgia syndrome |journal=Arthritis Rheum. |volume=37 |issue=11 |pages=1593–601 |year=1994 |month=November |pmid=7526868 |doi=10.1002/art.1780371106 }}</ref><ref> {{cite journal |author=Vaerøy H, Helle R, Førre O, Kåss E, Terenius L |title=Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis |journal=Pain |volume=32 |issue=1 |pages=21–6 |year=1988 |month=January3959(91)90068-9 |doi=10.1016/0304-3959(91)90068-9}}</ref> The mean concentration of nerve growth factor, a substance known to participate in structural and functional plasticity of nociceptive pathways within the dorsal root ganglia and spinal cord, is elevated.<ref>{{cite journal |author=Giovengo SL, Russell IJ, Larson AA |title=Increased concentrations of nerve growth factor in cerebrospinal fluid of patients with fibromyalgia |journal=J Rheumatol. |volume=26 |issue=7 |pages=1564–9 |year=1999 |month=July |pmid=10405946 }}</ref> There is also evidence for increased excitatory amino acid release within cerebrospinal fluid, with a correlation demonstrated between levels for metabolites of glutamate and nitric oxide and clinical indices of pain.<ref>{{cite journal |author=Larson AA, Giovengo SL, Russell IJ, Michalek JE |title=Changes in the concentrations of amino acids in the cerebrospinal fluid that correlate with pain in patients with fibromyalgia: implications for nitric oxide pathways |journal=Pain |volume=87 |issue=2 |pages=201–11 |year=2000 |month=August |pmid=10924813 |url=http://linkinghub.elsevier.com/retrieve/pii/S0304-3959(00)00284-0 |doi=10.1016/S0304-3959(00)00284-0}}</ref>
</ref> In addition, plasma levels of neuropeptide Y, which is co-localized with norepinephrine in the sympathetic nervous system, have been reported as low in patients with fibromyalgia,<ref>{{cite journal |author=Anderberg UM, Liu Z, Berglund L, Nyberg F |title=Elevated plasma levels of neuropeptide Y in female fibromyalgia patients |journal=Eur J Pain |volume=3 |issue=1 |pages=19–30 |year=1999 |month=March |pmid=10700334 |doi=10.1016/S1090-3801(99)90185-4 }}</ref> while circulating levels of epinephrine and norepinephrine have been variously reported as low, normal and high.<ref>{{cite journal |author=van Denderen JC, Boersma JW, Zeinstra P, Hollander AP, van Neerbos BR |title=

⚫ The most reproduced laboratory finding in patients with fibromyalgia is an elevation in cerebrospinal fluid levels of substance P, a putative nociceptive neurotransmitter.<ref>{{cite journal |author=Russell IJ, Orr MD, Littman B, ''et al.'' |title=Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome |journal=Arthritis Rheum. |volume=37 |issue=11 |pages=1593–601 |year=1994 |month=November |pmid=7526868 |doi=10.1002/art.1780371106 }}</ref><ref> {{cite journal |author=Vaerøy H, Helle R, Førre O, Kåss E, Terenius L |title=Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis |journal=Pain |volume=32 |issue=1 |pages=21–6 |year=1988 |month=January3959(91)90068-9 |doi=10.1016/0304-3959(91)90068-9}}</ref> The mean concentration of nerve growth factor, a substance known to participate in structural and functional plasticity of nociceptive pathways within the dorsal root ganglia and spinal cord, is elevated.<ref>{{cite journal |author=Giovengo SL, Russell IJ, Larson AA |title=Increased concentrations of nerve growth factor in cerebrospinal fluid of patients with fibromyalgia |journal=J Rheumatol. |volume=26 |issue=7 |pages=1564–9 |year=1999 |month=July |pmid=10405946 }}</ref> There is also evidence for increased excitatory amino acid release within cerebrospinal fluid, with a correlation demonstrated between levels for metabolites of glutamate and nitric oxide and clinical indices of pain.<ref>{{cite journal |author=Larson AA, Giovengo SL, Russell IJ, Michalek JE |title=Changes in the concentrations of amino acids in the cerebrospinal fluid that correlate with pain in patients with fibromyalgia: implications for nitric oxide pathways |journal=Pain |volume=87 |issue=2 |pages=201–11 |year=2000 |month=August |pmid=10924813 |url=http://linkinghub.elsevier.com/retrieve/pii/S0304-3959(00)00284-0 |doi=10.1016/S0304-3959(00)00284-0}}</ref>


===Brain imaging studies=== ===Brain imaging studies===


Evidence of abnormal brain involvement in fibromyalgia has been provided via functional neuroimaging. The first findings reported were decreased blood flow within the ] and elements of the ] and mid-brain (i.e., ]).<ref>{{cite journal |author=Mountz JM, Bradley LA, Modell JG, ''et al.'' |title=Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels |journal=Arthritis Rheum. |volume=38 |issue=7 |pages=926–38 |year=1995 |month=July |pmid=7612042 |doi=10.1002/art.1780380708 }}</ref><ref>{{cite journal |author=Kwiatek R, Barnden L, Tedman R, ''et al.'' |title=Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami |journal=Arthritis Rheum. |volume=43 |issue=12 |pages=2823–33 |year=2000 |month=December |pmid=11145042 |doi=10.1002/1529-0131(200012)43:12<2823::AID-ANR24>3.0.CO;2-E }}</ref> Differential activation in response to painful stimulation has also been demonstrated.<ref name=>{{cite journal |author=Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ |title=Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic resonance spectroscopy |journal=J Rheumatol. |volume=35 |issue=7 |pages=1371–7 |year=2008 |month=July |pmid=18484688 |url=http://www.jrheum.com/subscribers/08/07/1371.html}}</ref><ref name=p18771960 /> A significant negative correlation was demonstrated between abnormal metabolite ratios and a validated index of the clinical severity (i.e. the Fibromyalgia Impact Questionnaire).<ref name=p1865419 >{{cite journal |author=Burckhardt CS, Clark SR, Bennett RM.|title=The fibromyalgia impact questionnaire: development and validation. |journal=J Rheumatol. |volume=18 |issue=5 |pages=728–33 |year=1991 |month=May |pmid=1865419}}</ref> Correlations between clinical pain severity and concentrations of the excitatory amino acid neurotransmitter ] within the insular cortex have also been demonstrated using 1H-MRS.<ref name=p18311814 >{{cite journal |author=Harris RE, Sundgren PC, Pang Y, Hsu M, Petrou M, Kim SH, McLean SA, Gracely RH, Clauw DJ.|title=Dynamic levels of glutamate within the insula are associated with improvements in multiple pain domains in fibromyalgia. |journal=Arthritis Rheum.|volume=58|issue=3 |pages=903–7 |year=2008|month=March|pmid=18311814 }}</ref> An acceleration of normal age-related brain atrophy has been demonstrated using ] (VBM) with areas of reduced gray matter located in the cingulate cortex, insula and parahippocampal gyrus.<ref>{{cite journal |author=Kuchinad A, Schweinhardt P, Seminowicz DA, Wood PB, Chizh BA, Bushnell MC |title=Accelerated brain gray matter loss in fibromyalgia patients: premature aging of the brain? |journal=J Neurosci. |volume=27 |issue=15 |pages=4004–7 |year=2007 |month=April |pmid=17428976 |doi=10.1523/JNEUROSCI.0098-07.2007 }}</ref> Studies utilizing ] have demonstrated reduced dopamine synthesis in the brainstem and elements of the limbic cortex.<ref name=p17023218 >{{cite journal |author=Wood PB, Patterson JC, Sunderland JJ, Tainter KH, Glabus MF, Lilien DL |title=Reduced presynaptic dopamine activity in fibromyalgia syndrome demonstrated with positron emission tomography: a pilot study |journal=J Pain |volume=8 |issue=1 |pages=51–8 |year=2007 |month=January |pmid=17023218 |doi=10.1016/j.jpain.2006.05.014 }}</ref> A significant negative correlation between pain severity and dopamine synthesis was demonstrated within the insular cortex. A subsequent study demonstrated gross disruption of dopaminergic reactivity in response to a tonic pain stimulus within the ] with a significant positive correlation between the defining feature of the waist. Evidence of abnormal brain involvement in fibromyalgia has been provided via functional neuroimaging. The first findings f|journal=Arthritis Rheum. |volume=38 |issue=7 |pages=926–38 |year=1995 |month=July |pmid=7612042 |doi=10.1002/art.1780380708 }}</ref><ref>{{cite journal |author=Kwiatek R, Barnden L, Tedman R, ''et al.'' |title=Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami |journal=Arthritis Rheum. |volume=43 |issue=12 |pages=2823–33 |year=2000 |month=December |pmid=11145042 |doi=10.1002/1529-0131(200012)43:12<2823::AID-ANR24>3.0.CO;2-E }}</ref> Differential activation in response to painful stimulation has also been demonstrated.<ref name=>{{cite journal |author=Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ |title=Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic resonance spectroscopy |journal=J Rheumatol. |volume=35 |issue=7 |pages=1371–7 |year=2008 |month=July |pmid=18484688 |url=http://www.jrheum.com/subscribers/08/07/1371.html}}</ref><ref name=p18771960 /> A significant negative correlation was demonstrated between abnormal metabolite ratios and a validated index of the clinical severity (i.e. the Fibromyalgia Impact Questionnaire).<ref name=p1865419 >{{cite journal |author=Burckhardt CS, Clark SR, Bennett RM.|title=The fibromyalgia impact questionnaire: development and validation. |journal=J Rheumatol. |volume=18 |issue=5 |pages=728–33 |year=1991 |month=May |pmid=1865419}}</ref> Correlations between clinical pain severity and freduced gray matter located in the cingulate cortex, insula and parahippocampal gyrus.<ref>{{cite journal |author=Kuchinad A, Schweinhardt P, Seminowicz DA, Wood PB, Chizh BA, Bushnell MC |title=Accelerated brain gray matter loss in fibromyalgia patients: premature aging of the brain? |journal=J Neurosci. |volume=27 |issue=15 |pages=4004–7 |year=2007 |month=April |pmid=17428976 |doi=10.1523/JNEUROSCI.0098-07.2007 }}</ref> Studies utilizing ] have demonstrated reduced dopamine synthesis in the brainstem and elements of the limbic cortex.<ref name=p17023218 >{{cite journal |author=Wood PB, Patterson JC, Sunderland JJ, Tainter KH, Glabus MF, Lilien DL |title=Reduced presynaptic dopamine activity in fibromyalgia syndrome demonstrated with positron emission tomography: a pilot study |journal=J Pain |volume=8 |issue=1 |pages=51–8 |year=2007 |month=January |pmid=17023218 |doi=10.1016/j.jpain.2006.05.014 }}</ref> A significant negative correlation between pain severity and dopamine synthesis was demonstrated within the insular cortex. A subsequent study demonstrated gross disruption of dopaminergic reactivity in response to a tonic pain stimulus within the ] with a significant positive correlation between the defining feature of the waist.
*Tender points—there are 18 designated possible tender or trigger points (although a person with the disorder may feel pain in other areas as well). During diagnosis, four ] (39 ]s) of ] is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered.<ref>{{cite web |author=National Institute of Arthritis and Musculoskeletal and Skin Diseases |title=Questions and Answers About Fibromyalgia &ndash; How Is Fibromyalgia Diagnosed? |url=http://www.niams.nih.gov/hi/topics/fibromyalgia/fibrofs.htm#fib_d |month=June | year=2004 |publisher=National Institutes for Health}}</ref> Four kilograms of force is about the amount of pressure required to blanch the thumbnail when applying pressure. *Tender points—there are 18 designated possible tender or trigger points (although a person with the disorder may feel pain in other areas as well). During diagnosis, four ] (39 ]s) of ] is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered.<ref>{{cite web |author=National Institute of Arthritis and Musculoskeletal and Skin Diseases |title=Questions and Answers About Fibromyalgia &ndash; How Is Fibromyalgia Diagnosed? |url=http://www.niams.nih.gov/hi/topics/fibromyalgia/fibrofs.htm#fib_d |month=June | year=2004 |publisher=National Institutes for Health}}</ref> Four kilograms of force is about the amount of pressure required to blanch the thumbnail when applying pressure.


Line 64: Line 49:


==Treatment== ==Treatment==
As with many other ], there is no known cure or universally accepted treatment for fibromyalgia, and treatment is typically aimed at symptom management. f==== Antidepressants ====
As with many other ], there is no known cure or universally accepted treatment for fibromyalgia, and treatment is typically aimed at symptom management. Developments in the understanding of the pathophysiology of the disorder have led to improvements in treatment, which include prescription medication, behavioral intervention, exercise, and ] and ]. Indeed, integrated treatment plans that incorporate medication, patient education, aerobic exercise and cognitive-behavioral therapy have been shown to be effective in alleviating pain and other fibromyalgia-related symptoms.<ref name=Goldenberg2008>{{cite journal |author=Goldenberg DL |title=Multidisciplinary modalities in the treatment of fibromyalgia |journal=J Clin Psychiatry |volume=69 |suppl=2 |pages=30–4 |year=2008 |pmid=18537461 }}</ref> In 2005, the ] produced the first comprehensive guidelines for patient evaluation and management.<ref name=APS_2005>{{cite journal |author=Burkhardt C, Goldenberg DL, Crofford LJ, et al. |title=Guideline for the Management of Fibromyalgia Syndrome , or fat, neither their goals nor those of society are satisfactorily met.”<ref name=SmytheMUS>Smythe HA, Explaining medically unexplained symptoms: widespread pain. J Rheumatol. 2009 Apr;36(4):679-83.</ref>

==== Antidepressants ====
A 2009 meta analysis in the ] reported that some antidepressants were effective, for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial |journal=Arthritis Rheum. |volume=52 |issue=4 |pages=1264–73 |year=2005 |pmid=15818684 |doi=10.1002/art.20983}}</ref> A Cochrane Database analysis of pregabalin use in chronic pain concluded that “A minority of patients will have substantial benefit with pregabalin, and more will have moderate benefit. Many will have no or trivial benefit, or will discontinue because of adverse events.”<ref> Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007076. DOI: 10.1002/14651858.CD007076.pub2</ref> A 2009 meta analysis in the ] reported that some antidepressants were effective, for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial |journal=Arthritis Rheum. |volume=52 |issue=4 |pages=1264–73 |year=2005 |pmid=15818684 |doi=10.1002/art.20983}}</ref> A Cochrane Database analysis of pregabalin use in chronic pain concluded that “A minority of patients will have substantial benefit with pregabalin, and more will have moderate benefit. Many will have no or trivial benefit, or will discontinue because of adverse events.”<ref> Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007076. DOI: 10.1002/14651858.CD007076.pub2</ref>


Line 75: Line 58:


===Physical treatments=== ===Physical treatments===
Studies have found exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia.<ref name=pmid12137713>{{cite journal |author=Busch A, Schachter CL, Peloso PM, Bombardier C |title=Exercise for treating fibromyalgia syndrome |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD003786 |year=2002 |pmid=12137713|doi=10.1002/14651858.CD003786}}</ref> Many patients find temporary relief by applying heat to painful areas. Those with access to ], ], or acupuncture may find them beneficial.<ref name=pmid10086765>{{cite journal |author=Berman BM, Ezzo J, Hadhazy V, Swyers JP |title=Is acupuncture effective in the treatment of fibromyalgia? |journal=The Journal of family practice |volume=48 |issue=3 |pages=213–8 |year=1999 |pmid=10086765 |doi=}}</ref> Most patients find exercise, even low intensity exercise to be extremely helpful.<ref techniques such as pacing and stress management may also be helpful for some patients. {{Citation needed|date=June 2008}} Because the nature of fibromyalgia is not well understood, some physicians believe that it may be ] or ].<ref>{{cite book |last=Sarno|first=Dr. John E, et al.|authorlink=John E. Sarno| title=The Divided Mind: The Epidemic of Mindbody Disorders|publisher=ReganBooks|year=2006 |isbn=0-06-085178-3 |pages=21–2, 235–7, 264–5, 294–8, 315, 319–20, 363}}</ref> Accordingly, some doctors have claimed to have successfully treated fibromyalgia when a psychological cause is accepted.<ref>{{cite book |last=Leonard-Segal|first=Dr. Andrea| title=The Divided Mind: The Epidemic of Mindbody Disorders|chapter=A Rheumatologist's Experience With Psychosomatic Disorders|publisher=ReganBooks|year=2006 |isbn=0-06-085178-3 |pages=264–5 }}</ref> Studies have found exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia.<ref name=pmid12137713>{{cite journal |author=Busch A, Schachter CL, Peloso PM, Bombardier C |title=Exercise for treating fibromyalgia syndrome |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD003786 |year=2002 |pmid=12137713|doi=10.1002/14651858.CD003786}}</ref> Many patients find temporary relief by applying heat to painful areas. Those with access to ], ], or acupuncture may find them beneficial.<ref name=pmid10086765>{{cite journal |author=Berman BM, Ezzo J, Hadhazy V, Swyers JP |title=Is ffcite book |last=Sarno|first=Dr. John E, et al.|authorlink=John E. Sarno| title=The Divided Mind: The Epidemic of Mindbody Disorders|publisher=ReganBooks|year=2006 |isbn=0-06-085178-3 |pages=21–2, 235–7, 264–5, 294–8, 315, 319–20, 363}}</ref> Accordingly, some doctors have claimed to have successfully treated fibromyalgia when a psychological cause is accepted.<ref>{{cite book |last=Leonard-Segal|first=Dr. Andrea| title=The Divided Mind: The Epidemic of Mindbody Disorders|chapter=A Rheumatologist's Experience With Psychosomatic Disorders|publisher=ReganBooks|year=2006 |isbn=0-06-085178-3 |pages=264–5 }}</ref>


==Prognosis== ==Prognosis==
Although neither degenerative nor fatal, the chronic pain of fibromyalgia is pervasive and persistent. Most fibromyalgia patients report that their symptoms do not change over time. An evaluation of 332 consecutive new fibromyalgia patients found that, out of 15 factors, pain levels, self-assessed inability to work, psychological distress, pending litigation, helplessness, level of education, and coping ability had a significant and independent association with symptom severity and function.<ref>{{cite journal | title=A model to assess severity and impact of fibromyalgia | journal=J Rheumatol. | volume=22| issue=12 | pages=2313–8 |month=December| year=1995 | pmid=8835568 | author=Goldenberg DL, Mossey CJ, Schmid CH. }}</ref> Although neither degenerative nor fatal, the chronic pain of fibromyalgia is pervasive and persistent. Most fibromyalgia patients report that their symptoms do not change over time. An evaluation of 332 consecutive new fibromyalgia patients found that, out of 15 factors, pain levels, self-assessed inability to work, psychological distress, pending litigation, helplessness, level of education, and coping ability had a significant and independent association with symptom severity and function.<ref>{{cite journal | title=A model to assess severity and impact of fibromyalgia | journal=J Rheumatol. | volume=22| issue=12 | pages=2313–8 |month=December| year=1995 | pmid=8835568 f=247–254 |month=July | year=2007 | url=http://www.aafp.org/afp/20070715/247.html | pmid=17695569 | accessdate=2008-01-06 }}</ref> and affects more females than males, with a ratio of 9:1 by ACR criteria.<ref>{{eMedicine|med|790|Fibromyalgia}}</ref> It is most commonly diagnosed in individuals between the ages of 20 and 50, though onset can occur in childhood.

==Epidemiology==
Fibromyalgia is seen in about 2% of the general population<ref name=Chakrabarty>{{cite journal | last=Chakrabarty | first=S | coauthors=Zoorob R | title=Fibromyalgia | journal=American Family Physician | volume=76 | issue=2 | pages=247–254 |month=July | year=2007 | url=http://www.aafp.org/afp/20070715/247.html | pmid=17695569 | accessdate=2008-01-06 }}</ref> and affects more females than males, with a ratio of 9:1 by ACR criteria.<ref>{{eMedicine|med|790|Fibromyalgia}}</ref> It is most commonly diagnosed in individuals between the ages of 20 and 50, though onset can occur in childhood.


==History== ==History==
Many names, including “muscular rheumatism,” “fibrositis,” “psychogenic rheumatism,” and “neurasthenia” were applied historically to symptoms resembling those of fibromyalgia.<ref>{{cite web |author=Health Information Team |title=Fibromyalgia |url=http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/fibromyalgia.html |month=February | year=2004 |publisher=BUPA insurance}}</ref> The term ''fibromyalgia'' was coined in 1976 from the ] ''fibra'' (fiber)<ref>{{cite web | url = http://dictionary.reference.com/browse/fibro- | title = Fibro- | publisher = Dictionary.com | accessdate = 2008-05-21 }}</ref> and the ] words ''myo'' (muscle)<ref></ref> and ''algos'' (pain).<ref></ref> Many names, including “muscular rheumatism,” “fibrositis,” “psychogenic rheumatism,” and “neurasthenia” were applied historically to symptoms resembling those of fibromyalgia.<ref>{{cite web |author=Health Information Team |title=Fibromyalgia |url=http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/fibromyalgia.html |month=February | year=2004 |publisher=BUPA insurance}}</ref> The term ''fibromyalgia'' was coined in 1976 from the ] ''fibra'' (fiber)<ref>{{cite web | url = http://dictionary.reference.com/browse/fibro- | title = Fibro- | publisher = Dictionary.com | accessdate = 2008-05-21 }}</ref> and the ] words ''myo'' (muscle)<ref></ref> and ''algos'' (pain).<ref></ref>
-6|url= |accessdate=2008-05-21}}</ref> and in 1986, trials of the first proposed medications for fibromyalgia were published.<ref name=Inanici/> -6|url= |accessdate=2008-05-21}}</ref> and in 1986, trials of the first proposed medications for fibromyalgia were published.<ref name=Inanici/>
f.1001/jama.257.20.2782}}</ref> The ] (ACR) published its first classification criteria for fibromyalgia in 1990,<ref name=Wolfe/> although these are not strictly diagnostic criteria.<ref name=p17653720/>

A 1987 article in the ] used the term "fibromyalgia syndrome" while saying it was a "controversial condition."<ref name=Goldenberg1987>{{cite journal |author=Goldenberg DL |title=Fibromyalgia syndrome. An emerging but controversial condition |journal=JAMA |volume=257 |issue=20 |pages=2782–7 |year=1987|month=May|pmid=3553636 |doi=10.1001/jama.257.20.2782}}</ref> The ] (ACR) published its first classification criteria for fibromyalgia in 1990,<ref name=Wolfe/> although these are not strictly diagnostic criteria.<ref name=p17653720/>


==Controversies== ==Controversies==

Revision as of 17:26, 10 July 2009

Medical condition
Fibromyalgia

Fibromyalgia (new lat., fibro-, fibrous tissue, Gk. myo-, muscle, Gk. algos-, pain), meaning muscle and connective tissue pain (also referred to as FM or FMS), is a [[medically Some health care providers continue to dispute the validity or efficacy of the diagnosis. See the "Controversies" section.

Signs and symptoms

The defining symptoms of fibromyalgia are chronic, widespread pain, fatigue, and heightened pain in response to pressure (allodynia). Other symptoms may include tingling of the skin, prolonged muscle spasms, weakness in the limbs, nerve pain, functional bowel disturbances, and chronic sleep disturbances.

Many patients experience cognitive dysfunction (known as "brain fog" or "fibrofog"), which may be characterized by impaired concentration, problems with shortCite error: A <ref> tag is missing the closing </ref> (see the help page). reported that the most frequently cited factors perceived to worsen fibromyalgia symptoms were emotional distress (83%), weather changes (80%), sleeping problems (79%), strenuous activity (70%), =21 |issue=4 |pages=207 |year=1992 |pmid=1529291 |doi=10.3109/03009749209099225}}</ref> The mode of inheritance is currently unknown, but it is most probably polygenic. Research has demonstrated that fibromyalgia is associated with polymorphisms of genes in the serotoninergic, dopaminergic) and with depression.

Stress

Stress may be an important precipitating factor in the development of fibromyalgia. Two studies that employed single-voxel magnetic resonance spectroscopy (1H-MRS) reported metabolic abnormalities within the hippocampal complex in patients with fibromyalgia, with significant correlations between hippocampal metabolic abnormalities and severity of clinical symptoms. This proposition is supported in part by a prospective epidemiology study which found that variations in HPA function characterized by high levels of circulating cortisol following dexamethasone suppression testing, low levels of morning salivary cortisol and high levels of evening salivary cortisol are all associated with the development of chronic widespread pain.Cite error: A <ref> tag is missing the closing </ref> (see the help page). Duloxetine (Cymbalta), a SNRI originally used to treat depression and painful diabetic neuropathy, has been demonstrated by controlled trials to relieve symptoms of some patients. However, the relevance of dysregulated serotonin metabolism to pathophysiology is a matter of debate. Complicating the analysis, one of the more effective types of medication for the treatment of the disorder (i.e. serotonin 5-HT3 antagonists) actually blocks some of the effects of serotonin.Cite error: A <ref> tag is missing the closing </ref> (see the help page). Indeed, the sensation of pain has at least two dimensions: a sensory dimension which processes the magnitude of the brain that participate in affective pain processing, but not in areas involved in sensory processing which indicate that the amplification of the sensory dimension of pain in fibromyalgia occurs independently of mood or emotional processes.

An alternative hypothesis regarding the development of fibromyalgia in relationship to psychological conflict proposes that the disorder may be a psychosomatic illness as described by John E. Sarno's writing related to "tension myositis syndrome," in which chronic pain is proposed to be a psychic diathesis of the mind's subconscious strategy of distracting painful or dangerous emotions. Education, attitude change, and in some cases, psychotherapy are proposed as fcases are due to malingering

See also the section on " The first objective findings associated with the disorder were reported in 1975 by Moldofsky and colleagues, who reported the presence of anomalous alpha wave activity (typically associated with arousal states) on sleep electroencephalogram (EEG) during non-rapid-eye-movement sleep. By disrupting stage IV sleep consistently in young, healthy subjects, the researchers reproduced a significant f Patients with fibromyalgia have been demonstrated to have a disruption of normal neuroendocrine function, characterized by mild hypocortisolemia, hyperreactivity of pituitary adrenocorticotropin hormone release in response to challenge, and glucocorticoid feedback resistance. A progressive reduction of serum growth hormone levels has also been documented—at baseline in a minority of patients, while most demonstrate reduced secretion in response to exercise or pharmacological challenge. Other abnormalities hormones.

Sympathetic hyperactivity

Functional analysis of the autonomic system in patients with fibromyalgia has demonstrated disturbed activity characterized by hyperactivity of the sympathetic nervous system at baseline with reduced sympathoadrenal reactivity in response to a variety of stressors including physical exertion and mental stress.Cite error: A <ref> tag is missing the closing </ref> (see the help page). In addition, plasma fthe fibromyalgia syndrome |journal=Arthritis Rheum. |volume=37 |issue=11 |pages=1593–601 |year=1994 |month=November |pmid=7526868 |doi=10.1002/art.1780371106 }}</ref> The mean concentration of nerve growth factor, a substance known to participate in structural and functional plasticity of nociceptive pathways within the dorsal root ganglia and spinal cord, is elevated. There is also evidence for increased excitatory amino acid release within cerebrospinal fluid, with a correlation demonstrated between levels for metabolites of glutamate and nitric oxide and clinical indices of pain.

Brain imaging studies

Evidence of abnormal brain involvement in fibromyalgia has been provided via functional neuroimaging. The first findings f|journal=Arthritis Rheum. |volume=38 |issue=7 |pages=926–38 |year=1995 |month=July |pmid=7612042 |doi=10.1002/art.1780380708 }}</ref> Differential activation in response to painful stimulation has also been demonstrated. A significant negative correlation was demonstrated between abnormal metabolite ratios and a validated index of the clinical severity (i.e. the Fibromyalgia Impact Questionnaire). Correlations between clinical pain severity and freduced gray matter located in the cingulate cortex, insula and parahippocampal gyrus. Studies utilizing positron emission tomography have demonstrated reduced dopamine synthesis in the brainstem and elements of the limbic cortex. A significant negative correlation between pain severity and dopamine synthesis was demonstrated within the insular cortex. A subsequent study demonstrated gross disruption of dopaminergic reactivity in response to a tonic pain stimulus within the basal ganglia with a significant positive correlation between the defining feature of the waist.

  • Tender points—there are 18 designated possible tender or trigger points (although a person with the disorder may feel pain in other areas as well). During diagnosis, four kilograms-force (39 newtons) of force is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered. Four kilograms of force is about the amount of pressure required to blanch the thumbnail when applying pressure.

This set of criteria was developed by the American College of Rheumatology as a means of classifying an individual as having fibromyalgia for both clinical and research purposes. While these criteria for classification of patients were originally established as inclusion criteria for research purposes and were not intended for clinical diagnosis, they have become the de facto diagnostic criteria in the clinical setting. It should be noted that the number of tender points that may be active at any one time may vary with time and circumstance.

Treatment

As with many other medically unexplained syndromes, there is no known cure or universally accepted treatment for fibromyalgia, and treatment is typically aimed at symptom management. f==== Antidepressants ==== A 2009 meta analysis in the Journal of the American Medical Association reported that some antidepressants were effective, for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial |journal=Arthritis Rheum. |volume=52 |issue=4 |pages=1264–73 |year=2005 |pmid=15818684 |doi=10.1002/art.20983}}</ref> A Cochrane Database analysis of pregabalin use in chronic pain concluded that “A minority of patients will have substantial benefit with pregabalin, and more will have moderate benefit. Many will have no or trivial benefit, or will discontinue because of adverse events.”

Dopamine agonists

Dopamine agonists (e.g. pramipexole (Mirapex) and ropinirole (ReQuip) resulted in some improvement in a minority of patients, but numerous side effects, including the onset of impulse control disorders like compulsive gambling and shopping, have led to concern about this approach. A trial of transdermal rotigotine is currently ongoing.Cite error: A <ref> tag is missing the closing </ref> (see the help page).

Physical treatments

Studies have found exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia. Many patients find temporary relief by applying heat to painful areas. Those with access to physical therapy, massage, or acupuncture may find them beneficial. Accordingly, some doctors have claimed to have successfully treated fibromyalgia when a psychological cause is accepted.

Prognosis

Although neither degenerative nor fatal, the chronic pain of fibromyalgia is pervasive and persistent. Most fibromyalgia patients report that their symptoms do not change over time. An evaluation of 332 consecutive new fibromyalgia patients found that, out of 15 factors, pain levels, self-assessed inability to work, psychological distress, pending litigation, helplessness, level of education, and coping ability had a significant and independent association with symptom severity and function. and affects more females than males, with a ratio of 9:1 by ACR criteria. It is most commonly diagnosed in individuals between the ages of 20 and 50, though onset can occur in childhood.

History

Many names, including “muscular rheumatism,” “fibrositis,” “psychogenic rheumatism,” and “neurasthenia” were applied historically to symptoms resembling those of fibromyalgia. The term fibromyalgia was coined in 1976 from the Latin fibra (fiber) and the Greek words myo (muscle) and algos (pain). -6|url= |accessdate=2008-05-21}}</ref> and in 1986, trials of the first proposed medications for fibromyalgia were published. f.1001/jama.257.20.2782}}</ref> The American College of Rheumatology (ACR) published its first classification criteria for fibromyalgia in 1990, although these are not strictly diagnostic criteria.

Controversies

Fibromyalgia continues to be a disputed diagnosis. Many members of the medical community consider fibromyalgia a ‘non-disease’ because of a lack of abnormalities on physical examination, the absence of objective diagnostic tests, and extensive overlap with other proposed conditions like chronic fatigue syndrome.

Several controversial issues exist with regard to fibromyalgia that range from questions regarding the validity of the disorder as a clinical entity, to issues regarding primary pathophysiology and the potential existence of fibromyalgia subtypes.

According to the article "Fibromyalgia wars", “the large majority of physicians, sociologists, and medical historians” are skeptical about the validity of fibromyalgia as a clinical entity. Some call fibromyalgia a “non-disease” and “an over-inclusive and ultimately meaningless label.” Frederick Wolfe, the most-cited fibromyalgia researcher and lead author of the 1990 paper that first defined the fibromyalgia classification criteria, questions the validity of fibromyalgia as a disease. He considers fibromyalgia a physical response to stress, depression, and economic and social anxiety, and believes the associated symptoms are a normal part say that labeling fibromyalgia as a "disease" simply legitimizes patients’ sickness behavior, slowing their recovery and harming them.

In a study of 100 individuals identified as having fibromyalgia, physical functioning decreased significantly over time, and individuals who had been diagnosed earlier had larger numbers of reported symptoms and greater severity. However, there was also a statistically significant improvement in satisfaction with health following classification. The authors of the study concluded that the ‘fibromyalgia label’ does not have a meaningful adverse affect on clinical outcome over the long term. It is however possible that these results can be accounted for by Regression toward the mean.

The validity of fibromyalgia as a unique clinical entity is also a matter of contention. There is considerable overlap between fibromyalgia and other medically unexplained syndromes, which are frequently referred to collectively as "functional somatic syndromes" (e.g. irritable bowel syndrome, chronic fatigue syndrome).

Some researchers believe that differences in psychological and autonomic nervous system profiles among affected individuals may indicate the existence of fibromyalgia subtypes. A 2007 review divides individuals with fibromyalgia into four groups as well as “mixed types”:

  1. “extreme sensitivity to pain but no associated psychiatric conditions” (may respond to medications that block the 5-HT3 receptor)
  2. “fibromyalgia and comorbid, pain-related depression” (may respond to antidepressants)
  3. “depression with concomitant fibromyalgia syndrome” (may respond to antidepressants)
  4. “fibromyalgia due to somatization” (may respond to psychotherapy).

See also

References

  1. Cite error: The named reference p15361320 was invoked but never defined (see the help page).
  2. Moldofsky H, Scarisbrick P, England R, Smythe H (1975). "Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects". Psychosom Med. 37 (4): 341–51. PMID 169541. Retrieved 2008-05-21.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. Cite error: The named reference p17092441 was invoked but never defined (see the help page).
  4. ^ Leavitt F, Katz RS, Mills M, Heard AR (2002). "Cognitive and Dissociative Manifestations in Fibromyalgia". J Clin Rheumatol. 8 (2): 77–84. doi:10.1097/00124743-200204000-00003. PMID 17041327.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. Arnold LM, Hudson JI, Hess EV; et al. (2004). "Family study of fibromyalgia". Arthritis Rheum. 50 (3): 944–52. doi:10.1002/art.20042. PMID 15022338. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  6. Buskila D, Sarzi-Puttini P (2006). "Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome". Arthritis Res Ther. 8 (5): 218. doi:10.1186/ar2005. PMC 1779444. PMID 16887010.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  7. Cohen H, Buskila D, Neumann L, Ebstein RP (2002). "Confirmation of an association between fibromyalgia and serotonin transporter promoter region (5- HTTLPR) polymorphism, and relationship to anxiety-related personality traits". Arthritis Rheum. 46 (3): 845–7. doi:10.1002/art.10103. PMID 11920428. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. Buskila D, Dan B, Cohen H; et al. "An association between /pii/S0016508502001208". {{cite journal}}: Cite journal requires |journal= (help); Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  9. Hudson JI, Mangweth B, Pope HG JR, De COL C, Hausmann A, Gutweniger S, Laird NM, Biebl W, Tsuang MT. Family study of affective spectrum disorder. Arch Gene Psychiatry. 2003;60:170–177. doi: 10.1001/archpsyc.60.2.170.
  10. . 15 (5). 2000: 33–41. doi:10.1016/S0924-9338(00)00397-7. PMID 10954873. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help); Unknown parameter |author a= ignored (help)
  11. Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ. (2005). "Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic -adrenal stress axis function and the relationship with chronic widespread pain and its antecedents". Arthritis Res Ther. 7 (5): R992 – R1000. PMID 16207340.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. Jaschko G, Hepp U, Berkhoff M; et al. (2007). "Serum serotonin levels are not useful in diagnosing fibromyalgia". Ann Rheum Dis. 66 (9): 1267–8. doi:10.1136/ard.2006.058842. PMID 17693607. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  13. Yuen, KC (2007). "Is further evaluation for growth hormone (GH) deficiency necessary in fibromyalgia patients with low serum insulin-like growth factor (IGF)-I levels?". Growth hormone & IGF research. 17 (1): 82–8. doi:10.1016/j.ghir.2006.12.006. PMID 17289417. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  14. Bennett, RM. "Hypothalamic-pituitary-insulin-like growth factor-I axis dysfunction in patients with fibromyalgia". J Rheumatology. 24 (7): 1384–9. PMID 9228141. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  15. McCall-a comprehensive review. (2008). Curr Med Res Opin. 24 (8): 2359–71. doi:10.1185/03007990802288338. PMID 18606054. {{cite journal}}: Missing or empty |title= (help); More than one of |author= and |last= specified (help); Unknown parameter |month= ignored (help)
  16. Giesecke T, Gracely RH, Williams DA, Geisser ME, Petzke FW, Clauw DJ (2005). "The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort". Arthritis Rheum. 52 (5): 1577–84. doi:10.1002/art.21008. PMID 15880832. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  17. McDermott BE, Feldman MD (2007). "Malingering in the medical setting". Psychiatr Clin North Am. 30 (4): 645–62. {{cite journal}}: Text "17938038" ignored (help)
  18. Moldofsky H, Scarisbrick P, England R, Smythe H (1975). "Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects". Psychosom Med. 37 (4): 341–51. PMID 169541. {{cite journal}}: Unknown parameter |day= ignored (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  19. Gur A, Cevik R, Sarac AJ, Colpan L, Em S (2004). "Hypothalamic-pituitary-gonadal axis and cortisol in young women with primary fibromyalgia: the potential roles of depression, fatigue, and sleep disturbance in the occurrence of hypocortisolism". Ann. Rheum. Dis. 63 (11): 1504–6. doi:10.1136/ard.2003.014969. PMC 1754816. PMID 15479904. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  20. Griep EN, Boersma JW, Lentjes EG, Prins AP, van der Korst JK, de Kloet ER (1998). "Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain". J. Rheumatol. 25 (7): 1374–81. PMID 9676772. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  21. Bennett RM (2002). "Adult growth hormone deficiency in patients with fibromyalgia". Curr Rheumatol Rep. 4 (4): 306–12. doi:10.1007/s11926-002-0039-4. PMID 12126582. {{cite journal}}: Unknown parameter |month= ignored (help)
  22. Neeck G, Crofford LJ (2000). "Neuroendocrine perturbations in fibromyalgia and chronic fatigue syndrome". Rheum. Dis. Clin. North Am. 26 (4): 989–1002. doi:10.1016/S0889-857X(05)70180-0. PMID 11084955. {{cite journal}}: Unknown parameter |month= ignored (help)
  23. Martinez-Lavin M. Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther. 2007;9(4):216.
  24. Vaerøy H, Helle R, Førre O, Kåss E, Terenius L (1988). "Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis". Pain. 32 (1): 21–6. doi:10.1016/0304-3959(91)90068-9. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  25. Giovengo SL, Russell IJ, Larson AA (1999). "Increased concentrations of nerve growth factor in cerebrospinal fluid of patients with fibromyalgia". J Rheumatol. 26 (7): 1564–9. PMID 10405946. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  26. Larson AA, Giovengo SL, Russell IJ, Michalek JE (2000). "Changes in the concentrations of amino acids in the cerebrospinal fluid that correlate with pain in patients with fibromyalgia: implications for nitric oxide pathways". Pain. 87 (2): 201–11. doi:10.1016/S0304-3959(00)00284-0. PMID 10924813. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  27. Kwiatek R, Barnden L, Tedman R; et al. (2000). "Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami". Arthritis Rheum. 43 (12): 2823–33. doi:10.1002/1529-0131(200012)43:12<2823::AID-ANR24>3.0.CO;2-E. PMID 11145042. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  28. Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ (2008). "Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic resonance spectroscopy". J Rheumatol. 35 (7): 1371–7. PMID 18484688. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  29. Cite error: The named reference p18771960 was invoked but never defined (see the help page).
  30. Burckhardt CS, Clark SR, Bennett RM. (1991). "The fibromyalgia impact questionnaire: development and validation". J Rheumatol. 18 (5): 728–33. PMID 1865419. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  31. Kuchinad A, Schweinhardt P, Seminowicz DA, Wood PB, Chizh BA, Bushnell MC (2007). "Accelerated brain gray matter loss in fibromyalgia patients: premature aging of the brain?". J Neurosci. 27 (15): 4004–7. doi:10.1523/JNEUROSCI.0098-07.2007. PMID 17428976. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  32. Wood PB, Patterson JC, Sunderland JJ, Tainter KH, Glabus MF, Lilien DL (2007). "Reduced presynaptic dopamine activity in fibromyalgia syndrome demonstrated with positron emission tomography: a pilot study". J Pain. 8 (1): 51–8. doi:10.1016/j.jpain.2006.05.014. PMID 17023218. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  33. National Institute of Arthritis and Musculoskeletal and Skin Diseases (2004). "Questions and Answers About Fibromyalgia – How Is Fibromyalgia Diagnosed?". National Institutes for Health. {{cite web}}: Unknown parameter |month= ignored (help)
  34. Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007076. DOI: 10.1002/14651858.CD007076.pub2
  35. Cite error: The named reference pmid16052595 was invoked but never defined (see the help page).
  36. J Gambl Stud. 2009 Feb 25. Impulse Control Disorder Behaviors Associated with Pramipexole Used to Treat Fibromyalgia. Holman AJ
  37. Busch A, Schachter CL, Peloso PM, Bombardier C (2002). "Exercise for treating fibromyalgia syndrome". Cochrane database of systematic reviews (Online) (3): CD003786. doi:10.1002/14651858.CD003786. PMID 12137713.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  38. Sarno, Dr. John E; et al. (2006). "The Divided Mind: The Epidemic of Mindbody Disorders". ReganBooks: 21–2, 235–7, 264–5, 294–8, 315, 319–20, 363. ISBN 0-06-085178-3. {{cite journal}}: Cite journal requires |journal= (help); Explicit use of et al. in: |first= (help); More than one of |author= and |last= specified (help)
  39. Leonard-Segal, Dr. Andrea (2006). "A Rheumatologist's Experience With Psychosomatic Disorders". The Divided Mind: The Epidemic of Mindbody Disorders. ReganBooks. pp. 264–5. ISBN 0-06-085178-3.
  40. "A model to assess severity and impact of fibromyalgia". J Rheumatol. 22 (12): 2313–8. 2007. PMID 17695569. Retrieved 2008-01-06. {{cite journal}}: Unknown parameter |month= ignored (help)
  41. Fibromyalgia at eMedicine
  42. Health Information Team (2004). "Fibromyalgia". BUPA insurance. {{cite web}}: Unknown parameter |month= ignored (help)
  43. "Fibro-". Dictionary.com. Retrieved 2008-05-21.
  44. Meaning of myo
  45. Meaning of algos
  46. Cite error: The named reference Inanici was invoked but never defined (see the help page).
  47. Cite error: The named reference Wolfe was invoked but never defined (see the help page).
  48. ^ Müller W, Schneider EM, Stratz T (2007). "The classification of fibromyalgia syndrome". Rheumatol Int. 27 (11): 1005–10. doi:10.1007/s00296-007-0403-9. PMID 17653720. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  49. ^ Wolfe F (2009). "Fibromyalgia wars". J Rheumatol. 36 (4): 679–83. PMID 19342721. {{cite journal}}: Unknown parameter |month= ignored (help)
  50. ^ Goldenberg DL (1995). "Fibromyalgia: why such controversy?". Ann. Rheum. Dis. 54 (1): 3–5. PMC 1005499. PMID 7880118. {{cite journal}}: Unknown parameter |month= ignored (help)
  51. Cite error: The named reference Deary was invoked but never defined (see the help page).
  52. Buchwald D, Garrity D (1995). "Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities". Arch Intern Med. 154 (18): 2049–53. PMID 8092909. {{cite journal}}: Unknown parameter |month= ignored (help)
  53. Wolfe F, Rasker JJ “Fibromyalgia.” In: Firestein GS, Budd RC, Harris ED, Jr, McInnes IB, Ruddy S, Sergent JS, editors. Kelley’s textbook of rheumatology. 8th ed. Amsterdam: Elsevier; 2008
  54. Baillieres Best Pract Res Clin Rheumatol. 1999 Sep;13(3):421-5. “Is fibromyalgia a distinct clinical entity? The disapproving rheumatologist's evidence.” Cohen ML
  55. http://www.nytimes.com/2008/01/14/health/14pain.html
  56. White KP; et al. (2002). "Does the label "fibromyalgia" alter health status, function, and health service utilization? A prospective, within-group comparison in a community cohort of adults with chronic widespread pain". Arthritis Rheum. 47 (3): 260–5. PMID 12115155. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)
  57. Kanaan RA, Lepine JP, Wessely SC (2007). "The association or otherwise of the functional somatic syndromes". Psychosom Med. 69 (9): 855–9. doi:10.1097/PSY.0b013e31815b001a. PMC 2575798. PMID 18040094. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

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