Fibromyalgia:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
2009
|
| Series: | Rheumatic disease clinics of North America
35,2 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XIV S., S.[215]-446 graph. Darst. |
| ISBN: | 9781437705393 1437705391 |
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| adam_text | Titel: Fibromyalgia
Autor: Mease, Philip J.
Jahr: 2009
Fibromyalgia
Contents
Preface xiii
Philip J. Mease
Clinical Manifestations and Diagnosis of Fibromyalgia 215
Robert M. Bennett
Since the publication of the American College of Rheumatology Classifica¬
tion 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. The major clinical manifestations of fibromyalgia have not
changed, but their prevalence, associations, relative importance to the pa¬
tient, and scientific underpinnings are increasingly better understood. This
article provides an update on fibromyalgia symptomatology and looks at
issues that need to be considered in the development of updated diagnos¬
tic 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.
From Fibrositis to Functional Somatic Syndromes to a Bell-Shaped Curve of Pain
and Sensory Sensitivity: Evolution of a Clinical Construct 233
Kobby Ablin and Daniel J. Clauw
This article attempts to demonstrate insight into understanding the evolv¬
ing spectrum of functional somatic syndromes. It will become evident that
in understanding these highly complex disorders, neither the Cartesian
dichotomy regarding body-mind distinction nor the pure reductionist
approach to disease (which attempts to explain clinical phenomena on
the basis of underlying structural derangement) can be strictly adhered
to. Only use of a truly integrative framework of thinking can allow us to
both recognize and accept the overlapping basic similarity between these
conditions and, in turn, teach us about nearly any medical condition char¬
acterized by pain or sensory symptoms.
Pediatric Fibromyalgia 253
Dan Buskila
Fibromyalgia is an idiopathic chronic pain syndrome defined by wide¬
spread nonarticular musculoskeletal pain and generalized tender points.
The syndrome is associated with a constellation of symptoms, including
fatigue, nonrefreshing sleep, irritable bowel, and more. Central nervous
system sensitization is a major pathophysiologic aspect of fibromyalgia;
in addition, various external stimuli such as trauma and stress may
j
Contents ;
i
j
contribute to development of the syndrome. Fibromyalgia is most common j
in midlife, but may be seen at any age. This article reviews the epidemiol¬
ogy, clinical characteristics, etiology, management, and outcome of pedi-
atric fibromyalgia. j
Abnormal Pain Modulation in Patients with Spatially Distributed Chronic Pain:
Fibromyalgia 263
Roland Staud
Many chronic pain syndromes are associated with hypersensitivity to pain¬
ful stimuli and with reduced endogenous pain inhibition. These findings
suggest that modulation of pain-related information may be linked to the
onset or maintenance of chronic pain. The combination of heightened
pain sensitivity and reduced pain inhibition seems to predispose individ¬
uals to greater risk for increased acute clinical pain. It is unknown whether
such pain processing abnormalities may also place individuals at in¬
creased risk for chronic pain. Psychophysical methods can be used for
the evaluation of pain sensitivity and pain inhibition. Long-term prospec¬
tive studies that could yield insight into the role of heightened pain sensi¬
tivity and pain disinhibition for the development of chronic pain disorders
like fibromyalgia in the general population are lacking, however.
The Significance of Dysfunctions of the Sleeping/Waking Brain to the Pathogenesis
and Treatment of Fibromyalgia Syndrome 275
Harvey Moldofsky
This article reviews how functional disturbances of the sleeping-waking
brain are involved in pathogenesis of the widespread pain, unrefreshing
sleep, fatigue, and impaired quality of life of patients who have fibromyal¬
gia syndrome. Recent studies of the effects on EEG sleep by some specific
pharmacologic and physical therapeutic agents demonstrate not only ben¬
efit for the widespread pain and fatigue, but also improved sleep physiol¬
ogy and restorative sleep of patients who suffer from fibromyalgia.
Complex Adaptive Systems Allostasis in Fibromyalgia 285
Manuel Martinez-Lavin and Angelica Vargas
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 prevail¬
ing linear-reductionist medical model. Conversely, FM can be explained
using the new complexity theory paradigms. Relentless sympathetic hy-
peractivity in FM may be a sign of allostasis. Similarly sympathetic hypo-
reactivity to stress may indicate allostatic load. Dorsal root ganglia have
been suggested as important sympathetic-nociceptive short-circuit sites.
Autonomic dysfunction also explains non-pain-related FM features. Pre¬
liminary 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.
I
! Contents
; Review of Cognitive Dysfunction in Fibromyalgia: A Convergence on Working
1 Memory and Attentional Control Impairments 299
i
: Jennifer M. Glass
Clinical and laboratory evidence confirm that dyscognition is a real and
troubling symptom in fibromyalgia (FM), and that the cognitive mecha¬
nisms most affected in FM are working memory, episodic memory, and
semantic memory. Recent evidence provides further convergence on
specific difficulty with attentional control. Dyscognition in FM cannot be at¬
tributed solely to concomitant psychiatric conditions such as depression
and poor sleep, but does seem to be related to the level of pain. This article
presents recent contributions regarding the etiology of the cognitive
dysfunction, its impact on patients, and highlights the need for further
research on this facet of FM.
Neuroimaging of Fibromyalgia 313
Mary B. Nebel and Richard H. Gracely
Functional MRI blood oxygenation level dependent activation studies on
patients who have fibromyalgia have demonstrated augmented sensitivity
to painful pressure and the association of this augmentation with variables
such as depression and catastrophizing and have also been used to eval¬
uate the symptoms of cognitive dysfunction. Using a wide array of tech¬
niques, these studies have found differences in opioid receptor binding,
in the concentration of metabolites associated with neural processing in
pain-related regions, in functional brain networks, and in regional brain
volume and white matter tracks. A common theme of all of these methods
is that they provide information that may be pertinent to the otherwise
unobservable and poorly treated symptoms of persistent widespread
chronic pain.
Key Symptom Domains to Be Assessed in Fibromyalgia (Outcome Measures
in Rheumatoid Arthritis Clinical Trials) 329
Ernest H. Choy and Philip J. Mease
This article discusses the key symptom domains to be assessed in fibro¬
myalgia. Development of a consensus on a core set of outcome measures
that should be assessed and reported in all clinical trials is needed to facil¬
itate interpretation, pooling, and comparison of results. This aligns with the
key objective of the Outcome Measures in Rheumatoid Arthritis Clinical
Trials initiative to improve outcome measurement in rheumatic diseases
through a data-driven interactive consensus process.
Advances in the Assessment of Fibromyalgia 339
David A. Williams and Stephen Schilling
Fibromyalgia (FM) has historically been considered a chronic pain condi¬
tion. Recent clinical studies, however, reveal that while pain may be the
cardinal symptom of FM, there are many other symptoms and
I
Contents !
}
i
consequences of having FM that have an impact on the lives of individuals
with this condition. As such, an area of intense clinical research has
focused upon improving approaches to assessment for FM. This article
provides an overview of how the art of assessing FM has evolved over
time, current methods of assessment, the value of patients perspectives
in assessment, and emerging advancements representing the future of
for FM. ;
Pharmacotherapy of Fibromyalgia 359
Philip J. Mease and Ernest H. Choy
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, func¬
tion, 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 com¬
mon 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.
Exercise Interventions in Fibromyalgia: Clinical Applications from the Evidence 373
Kim D. Jones and Ginevra L. Liptan
This article summarizes physiologic obstacles to exercise and reviews
exercise interventions in fibromyalgia (FM). In addition, the authors de¬
scribe the top 10 principles for successfully prescribing exercise in
the comprehensive treatment of FM and provide a practical exercise re¬
source table to share with patients. A therapeutic alliance between the
provider and patient is enhanced if both understand the risks and ben¬
efits of exercise. Such an alliance increases the likelihood of the patient
successfully integrating life-long exercise into his or her comprehensive
FM treatment plan.
Nonpharmacologic Treatment for Fibromyalgia: Patient Education,
Cognitive-Behavioral Therapy, Relaxation Techniques, and Complementary
and Alternative Medicine 393
Afton L Hassett and Richard N. Gevirtz
Because of the dynamic and complex nature of chronic pain, successful
treatment usually requires addressing behavioral, cognitive, and affective
processes. Many adjunctive interventions have been implemented in fibro¬
myalgia (FM) treatment, but few are supported by controlled trials. Herein,
some of the more commonly used nonpharmacologic interventions for FM
are described and the evidence for efficacy is presented. Clinical obser¬
vations and suggestions are also offered, including using the principles
outlined in the acronym ExPRESS to organize a comprehensive nonphar¬
macologic pain management approach.
Contents
Potential Dietary Links to Central Sensitization in Fibromyalgia: Past Reports
and Future Directions 409
Kathleen F. Holton, Lindsay L. Kindler, and Kim D. Jones
This article reviews the existing literature on fibromyalgia (FM) and diet,
discusses the possible role of diet on central sensitization in FM, proposes
a novel hypothesis of possible food-related contributors to central sensiti¬
zation, and makes recommendations for future dietary research directions.
Neurophysiopathogenesis of Fibromyalgia Syndrome: A Unified Hypothesis 421
Jon Russell and Alice A. Larson
The characteristic presenting complaint of patients with fibromyalgia syn¬
drome (FMS) is chronic widespread allodynia. Research findings support
the view that FMS is an understandable and treatable neuropathophysio-
logic disorder. The pain of FMS is often accompanied by one or more other
manifestations, such as affective moods, cognitive insecurity, autonomic
dysfunction, or irritable bowel or bladder. Growing evidence suggests
that this is a familial disorder with many underlying genetic associations.
New findings from brain imaging and polysomnography imply that FMS
may be a disorder of premature neurologic aging. A conceptual model at
the molecular level is proposed to explain many of the observed features
of FMS. The model can also explain anticipated responses to FDA
approved pharmacologic therapies.
Index 437
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