Fibromyalgia

Excerpt

Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, often accompanied by fatigue, cognitive dysfunction, a variety of somatic complaints, and psychiatric disturbances such as depression and anxiety. Identifying and treating fibromyalgia effectively is essential for reducing symptoms, minimizing disability, and improving quality of life. The disorder involves a dysregulation of pain and is influenced by genetic, environmental, and neurobiological factors. Central sensitization, or alterations in central nervous system (CNS) pain processing, underlies many of the defining characteristics of fibromyalgia.

Brain imaging studies that show an amplified pain response to experimental pain stimuli, along with changes in neurotransmitter structure and function and modifications in resting-state functional connectivity, provide strong evidence that these CNS alterations are key contributors to the condition's hallmark features. Clinically, patients experience diffuse pain lasting more than 3 months, often accompanied by fatigue, sleep disturbances, and cognitive or psychiatric symptoms. Diagnosis is based on clinical evaluation based on the American College of Rheumatology (ACR) criteria, while the Yunis and Masi criteria are applied to children and adolescents. In children and adolescents, fibromyalgia is more commonly referred to as juvenile primary fibromyalgia syndrome (JPFS).

Routine laboratory and imaging tests are typically normal and, while not required for diagnosis, are essential for excluding other potential underlying conditions. Given the high prevalence of conditions that may mimic or exacerbate fibromyalgia symptoms, a strategic assessment is essential to determine which patients need further diagnostic testing. Treatment involves a comprehensive approach that combines nonpharmacological methods, such as education, exercise, and psychotherapy, with pharmacological interventions. Medications such as duloxetine, milnacipran, pregabalin, and amitriptyline have shown modest benefits in managing various fibromyalgia symptoms. In contrast, drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids are generally not recommended due to their limited effectiveness and potential risks.