Rheumatic diseases clinics of North America
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Fibromyalgia (FM) can be conceptualized as a failed attempt of our main complex adaptive system (the autonomic nervous system) to adjust to a hostile environment. FM cannot be fully understood through the prevailing linear-reductionist medical model. Conversely, FM can be explained using the new complexity theory paradigms. ⋯ Autonomic dysfunction also explains non-pain-related FM features. Preliminary genetic evidence supports FM's dysautonomic nature. A scientific holistic therapy is proposed to harmonize rigid complex systems and, in doing so, to help to improve FM symptoms.
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Rheum. Dis. Clin. North Am. · May 2009
ReviewClinical manifestations and diagnosis of fibromyalgia.
Since the publication of the American College of Rheumatology Classification Criteria for Fibromyalgia 18 years ago, there have been an ever-increasing number of research articles and reviews. From the National Library of Medicine alone there are more than 10,000 articles related to fibromyalgia. ⋯ This article provides an update on fibromyalgia symptomatology and looks at issues that need to be considered in the development of updated diagnostic guidelines. There is still no gold standard for making a diagnosis of fibromyalgia, but there is an increasing consensus for the development of new guidelines for diagnosis that modifies the currently proscribed tender point evaluation.
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Advances have occurred in the pharmacotherapy of fibromyalgia (FM) and the methodology of clinical trial design in FM in parallel with improved understanding of the underlying pathophysiologic mechanisms. Several medications have been approved for the management of FM based on their clinically meaningful and durable effect on pain in monotherapy trials and their beneficial effect on patients'global impression of change, function, and other key symptom domains such as fatigue, sleep disturbance, and cognition. Adjunctive therapy with medicines targeted to specific symptom domains such as sleep as well as treatments aimed toward common comorbid conditions such as irritable bowel syndrome or disease states such as rheumatoid arthritis should be considered for the purpose of reducing the patient's overall symptom burden.