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Fibromyalgia.
Handb Clin Neurol 2014; 119:513-27HC

Abstract

Fibromyalgia is a chronic pain condition present in 2-4% of the population. Fibromyalgia consists of widespread pain with similarities to neuropathic pain in clinical findings, pathophysiology, and neuropharmacology. Pain is the predominant symptom and allodynia and hyperalgesia are common signs. Extreme fatigue, impaired cognition and nonrestorative sleep difficulties coexist in addition to other somatic symptoms. Research including neuroimaging investigations shows abnormalities in neurotransmitters and an abnormal response to pain. Altered pain processing peripherally and centrally contribute to central sensitization and a dampened effect of the diffuse noxious inhibitory control (DNIC). Successful management incorporates education of the patient in self-management skills, cognitive behavioral therapy (CBT), exercise, and drug therapy. Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs) (duloxetine and milnacipran), α2-δ ligands (gabapentin and pregabalin) are effective in reducing pain by≥30%. Some success has been shown with dopamine agonists (pramipexole), tramadol, other opioids and cannabinoids (nabilone). Further evidence-based trials using complementary treatments are needed. Fibromyalgia is complex and requires a multidisciplinary approach to treatment. Patient self-management is key.

Authors+Show Affiliations

Department of Pharmacy, Victoria Hospital, London Health Sciences Centre, London, Ontario, Canada. Electronic address: janice.sumpton@lhsc.on.ca.Departments of Clinical Neurological Sciences and Oncology, University of Western Ontario, London, Ontario.

Pub Type(s)

Historical Article
Journal Article
Review

Language

eng

PubMed ID

24365316

Citation

Sumpton, Janice E., and Dwight E. Moulin. "Fibromyalgia." Handbook of Clinical Neurology, vol. 119, 2014, pp. 513-27.
Sumpton JE, Moulin DE. Fibromyalgia. Handb Clin Neurol. 2014;119:513-27.
Sumpton, J. E., & Moulin, D. E. (2014). Fibromyalgia. Handbook of Clinical Neurology, 119, pp. 513-27. doi:10.1016/B978-0-7020-4086-3.00033-3.
Sumpton JE, Moulin DE. Fibromyalgia. Handb Clin Neurol. 2014;119:513-27. PubMed PMID: 24365316.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fibromyalgia. AU - Sumpton,Janice E, AU - Moulin,Dwight E, PY - 2013/12/25/entrez PY - 2013/12/25/pubmed PY - 2014/4/23/medline KW - Fibromyalgia KW - duloxetine KW - imaging KW - management KW - neurotransmitter KW - pathophysiology KW - pregabalin KW - symptoms SP - 513 EP - 27 JF - Handbook of clinical neurology JO - Handb Clin Neurol VL - 119 N2 - Fibromyalgia is a chronic pain condition present in 2-4% of the population. Fibromyalgia consists of widespread pain with similarities to neuropathic pain in clinical findings, pathophysiology, and neuropharmacology. Pain is the predominant symptom and allodynia and hyperalgesia are common signs. Extreme fatigue, impaired cognition and nonrestorative sleep difficulties coexist in addition to other somatic symptoms. Research including neuroimaging investigations shows abnormalities in neurotransmitters and an abnormal response to pain. Altered pain processing peripherally and centrally contribute to central sensitization and a dampened effect of the diffuse noxious inhibitory control (DNIC). Successful management incorporates education of the patient in self-management skills, cognitive behavioral therapy (CBT), exercise, and drug therapy. Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs) (duloxetine and milnacipran), α2-δ ligands (gabapentin and pregabalin) are effective in reducing pain by≥30%. Some success has been shown with dopamine agonists (pramipexole), tramadol, other opioids and cannabinoids (nabilone). Further evidence-based trials using complementary treatments are needed. Fibromyalgia is complex and requires a multidisciplinary approach to treatment. Patient self-management is key. SN - 0072-9752 UR - https://www.unboundmedicine.com/medline/citation/24365316/Fibromyalgia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/B978-0-7020-4086-3.00033-3 DB - PRIME DP - Unbound Medicine ER -