Ugeskrift for laeger
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It is important to recognize the diagnosis of fibromyalgia (FM) to adequately advise patients with this chronic pain disease. FM coexists with other rheumatic diseases and may therefore serve as a confounder in connection with estimation of disease activity. The aetiology and pathogenesis of FM remain unknown, although central sensitisation seems to play a major role. Following exclusion of a number of differential diagnoses, the remaining patients have several treatment options including centrally-acting medication.
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Fibromyalgia is characterised by chronic widespread pain and mechanical hyperalgesia. It is associated with a higher pain intensity, fewer pain-free intervals and more pronounced pain-related interference in function than other musculoskeletal pain conditions. Increasing evidence supports an underlying augmented central pain processing which includes sensitization of pain-transmitting neurons and dysfunction of pain inhibitory pathways. If this permanent change in the function of the nociceptive system is shown to equal fibromyalgia, the condition may be considered a neuropathic pain condition.
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Functional somatic symptoms are prevalent in all medical settings, but their management is hampered by an obsolete theoretical framework and inadequate classification systems. Epidemiological and neurobiological studies suggest that the functional somatic syndromes, e.g. fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome and somatoform disorders belong to the same family of disorders. An empirically based diagnosis including different subtypes and severities is proposed as a unifying diagnostic construct: bodily distress syndrome. This construct provides a common language for functional disorders across medical specialties.