Fibromyalgia Classification and external resources
ICD-10	M79.7
ICD-9	729.1
MedlinePlus	000427
eMedicine	med/790  med/2934 ped/777 pmr/47
MeSH	D005356

Fibromyalgia (FM) is a disorder classified by the presence of chronic widespread pain and tactile allodynia. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings M00-M99 - Diseases of the Musculoskeletal system and Connective tissue (M00-M25 Arthropathies (M00-M03 Infectious arthropathies The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm Allodynia, meaning "other pain" is a Painful response to a usually non-painful stimulus and can be either static or mechanical ^[1] While the criteria for such an entity have not yet been thoroughly developed, the recognition that fibromyalgia involves more than just pain has led to the frequent use of the term "fibromyalgia syndrome". In Medicine and Psychology, the term syndrome refers to the association of several clinically recognizable features signs (observed by a physician It is not contagious, and recent studies suggest that people with fibromyalgia may be genetically predisposed. An infectious disease is a clinically evident Disease resulting from the presence of Pathogenic microbial agents including Pathogenic viruses Pathogenic Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is ^[2] The disorder is not directly life-threatening. The degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission; however, the disorder is generally perceived as non-progressive. A progressive illness is an illness that gradually progresses and changes mode generally to the worse ^[3]

Fibromyalgia may actually be composed of several clinical entities, ranging from a mild, idiopathic inflammatory process in some individuals, to a somatoform disorder resulting from clinical depression in others, with probable overlaps in between. Somatoform disorder (also known as Briquet's syndrome) is characterized by physical symptoms that mimic disease or injury for which there is no identifiable physical cause or Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression ^[4] Current diagnostic criteria are insufficient to differentiate these entities.

Contents 1 Signs and symptoms 1.1 Variability of symptoms 2 Causes 2.1 Genetics 2.2 Stress 2.3 Sleep disturbance 2.4 Other hypotheses 2.5 Comorbidity 2.6 Dopamine abnormality 2.7 Serotonin 2.8 Human growth hormone 2.9 Deposition disease 3 Pathophysiology 4 Diagnosis 5 Prevention 6 Treatment 6.1 Pharmaceutical 6.1.1 Analgesics 6.1.2 Muscle relaxants 6.1.3 Tricyclic antidepressants 6.1.4 Selective serotonin reuptake inhibitors 6.1.5 Anti-seizure medication 6.1.6 Dopamine agonists 6.1.7 Combination therapy 6.1.8 Central nervous system stimulants 6.1.9 Cannabis and cannabinoids 6.2 Non-drug treatment 6.2.1 Physical treatments 6.2.2 Psychological/behavioral therapies 6.2.3 Dietary treatment 6.3 Investigational treatments 7 Prognosis 8 Epidemiology 9 History 9.1 Controversies 10 References 11 Further reading 12 External links

Signs and symptoms

The defining symptoms of fibromyalgia are chronic, widespread pain and tenderness to light touch. Other symptoms can include moderate to severe fatigue, a heightened and painful response to gentle touch (allodynia), needle-like tingling of the skin, muscle aches, prolonged muscle spasms, weakness in the limbs, nerve pain, functional bowel disturbances,^[5] and chronic sleep disturbances. Allodynia, meaning "other pain" is a Painful response to a usually non-painful stimulus and can be either static or mechanical Myalgia means " Muscle Pain " and is a symptom of many diseases and disorders A spasm is a sudden involuntary contraction of a Muscle, a group of muscles or a hollow organ, or a similarly sudden Contraction of an Orifice Muscle weakness (or "lack of strength" is a direct term for the inability to exert force with one's Muscles to the degree that would be expected given the individual's Neuropathy is a medical term usually short for Peripheral neuropathy. A sleep disorder (somnipathy is a medical disorder of the Sleep patterns of a person or animal ^[6] Sleep disturbances may be related to a phenomenon called alpha-delta sleep, a condition in which deep sleep (associated with delta waves) is frequently interrupted by bursts of alpha waves, which normally occur during wakefulness. A delta wave is a high Amplitude Brain wave with a frequency of 1-4 Hertz which can be recorded with an electroencephalogram (EEG and Alpha waves are Electromagnetic oscillations in the frequency range of 8–12 Hz arising from synchronous and coherent ( in phase Slow-wave sleep is often dramatically reduced. Slow-wave sleep (SWS is stages three and four of Non-rapid eye movement sleep.

Many patients experience cognitive dysfunction^[7] (known as "brain fog" or "fibrofog"), which may be characterized by impaired concentration,^[8] problems with short^[9][8] and long-term memory, short-term memory consolidation,^[9] genitourinary symptoms and interstitial cystitis, dermatological disorders, headaches, myoclonic twitches, and symptomatic hypoglycemia. Short-term memory, sometimes referred to as "primary" "working" or "active" Memory, is said to hold a small amount of information for about 20 Long-term memory ( LTM) is Memory that can last as little as a few days or as long as decades The urinary system (also called Excretory system or the genitourinary system (GUS is the Organ system that produces stores and eliminates Urine. Interstitial cystitis (commonly abbreviated to "IC" is a Urinary bladder Disease of unknown cause characterised by urinary frequency (as often as every Dermatology (from Greek grc δέρμα derma, "skin" and grc -λογία -logia) is a branch of Medicine dealing with A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Myoclonus (maɪˈɒklənəs is brief involuntary twitching of a Muscle or a group of muscles Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood Although fibromyalgia is classified based on the presence of chronic widespread pain, pain may also be localized in areas such as the shoulders, neck, low back, hips, or other areas. In Human anatomy, the shoulder joint comprises the part of the body where the Humerus attaches to the Scapula. The neck is the part of the Body on many limbed Vertebrates that distinguishes the head from the Torso or trunk "Back" redirects here For other uses please see Back (disambiguation. Many sufferers also experience varying degrees of facial pain and have high rates of comorbid temporomandibular joint disorder. Temporomandibular joint disorder ( TMJD, TMJ or TMD) or TMJ syndrome, is an umbrella term covering acute or chronic Not all patients have all symptoms.

Symptoms can have a slow onset, and many patients have mild symptoms beginning in childhood, that are often misdiagnosed as growing pains. Growing Pains is an American Television sitcom that ran on the ABC network from 1985 to 1992 Symptoms are often aggravated by unrelated illness or changes in the weather. They can become more tolerable or less tolerable throughout daily or yearly cycles; however, many people with fibromyalgia find that, at least some of the time, the condition prevents them from performing normal activities such as driving a car or walking up stairs. The disorder does not cause inflammation as is characteristic of rheumatoid arthritis, although some non-steroidal anti-inflammatory drugs may temporarily reduce pain symptoms in some patients. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Rheumatoid arthritis ( RA) is a chronic systemic autoimmune disorder that causes the Immune system to attack the Joints, where Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Their use, however, is limited, and often of little to no value in pain management. ^[10]

Variability of symptoms

The following factors have been proposed to exacerbate symptoms of pain in patients:

• Increased psychosocial stress^[11]
• Excessive physical exertion (exercise seems to decrease the pain threshold of people with fibromyalgia but increase it in healthy individuals)^[12]
• Lack of slow-wave sleep
• Changes in humidity and barometric pressure

Causes

The cause of fibromyalgia is unknown. The term psychosocial refers to one in Psychological development in and interaction with a Social environment. Slow-wave sleep (SWS is stages three and four of Non-rapid eye movement sleep. Fibromyalgia can, but does not always, start as a result of some trauma such as a traffic accident, major surgery, or disease. Treatment of physical trauma is described here and in First aid. Some evidence shows that Lyme Disease may be a trigger of fibromyalgia symptoms. Lyme disease, or borreliosis, is an Emerging infectious disease caused by at least three Species of Bacteria belonging to the Genus ^[13] Another study suggests that more than one clinical entity may be involved, ranging from a mild, idiopathic inflammatory process to clinical depression. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression ^[14]

Genetics

Fibromyalgia may exhibit a modest genetic component; if one pair of an identical twin has chronic widespread pain, there is a a 15% chance their twin will as well; the risk is only 7% for fraternal twins. Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. ^[15][16]

Stress

Studies have shown that stress is a significant precipitating factor in the development of fibromyalgia,^[17] and that PTSD is linked with fibromyalgia. Post traumatic stress disorder It is a severe and ongoing emotional reaction to ^[18][19] The Amital study found that 49% of PTSD patients fulfilled the criteria for FMS, compared with none of the controls. Stress can alter the function of the HPA axis and change cortisol levels in the body, leading to widespread pain . The hypothalamic-pituitary-adrenal axis ( HPA or HTPA axis) also known as the Limbic -hypothalamic-pituitary-adrenal axis (LHPA axis is a complex set of direct influences Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex) ^[20]

A non-mainstream hypothesis that fibromyalgia may be a psychosomatic illness has been described by John E. Sarno's "tension myositis syndrome", which hypothesizes that chronic pain is caused by the mind's subconscious strategy of distracting painful or dangerous emotions. Psychosomatic medicine is an interdisciplinary medical field studying psychosomatic illness, now more commonly referred to as psychophysiologic illness or disorder John E Sarno (1923- is Professor of Clinical Rehabilitation Medicine New York University School of Medicine, and attending physician at the Howard A Tension myositis syndrome ( TMS) is a name Chronic pain is defined as Pain that persists longer than the temporal course of natural healing associated with a particular type of injury or disease process The term subconscious is defined as existing or operating in the Mind beneath or beyond Conscious Awareness. Education, attitude change, and in some cases, psychotherapy are proposed as treatments. ^[21]

Sleep disturbance

Electroencephalography studies have shown that people with fibromyalgia lack slow-wave sleep and circumstances that interfere with stage four sleep (pain, depression, serotonin deficiency, certain medications or anxiety) may cause or worsen the condition. Slow-wave sleep (SWS is stages three and four of Non-rapid eye movement sleep. Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components ^[22] According to the sleep disturbance hypothesis, an event such as a trauma or illness causes sleep disturbance and possibly initial chronic pain that may initiate the disorder. The hypothesis supposes that stage 4 sleep is critical to the function of the nervous system, as it is during that stage that certain neurochemical processes in the body 'reset'. The nervous system is a Network of specialized cells that communicate information about an animal's surroundings and itself In particular, pain causes the release of the neuropeptide substance P in the spinal cord which has the effect of amplifying pain and causing nerves near the initiating ones to become more sensitive to pain. A neuropeptide is any of the variety of Peptides found in Neural tissue; e In Neuroscience, Substance P is a Neuropeptide: a short-chain Polypeptide that functions as a Neurotransmitter and as a Neuromodulator The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected Under normal circumstances, areas around a wound to become more sensitive to pain but if pain becomes chronic and body-wide this process can run out of control. The sleep disturbance hypothesis holds that deep sleep is critical to reset the substance P mechanism and prevent this out-of-control effect.

The sleep disturbance/substance P hypothesis could explain "tender points" that are characteristic of fibromyalgia but which are otherwise enigmatic, since their positions don't correspond to any particular set of nerve junctions or other obvious body structures. The hypothesis proposes that these locations are more sensitive because the sensory nerves that serve them are positioned in the spinal cord to be most strongly affected by substance P. This hypothesis could also explain some of more general neurological features of fibromyalgia, since substance P is active in many other areas of the nervous system. The sleep disturbance hypothesis could also provide a possible connection between fibromyalgia, chronic fatigue syndrome (CFS) and post-polio syndrome through damage to the ascending reticular activating system of the reticular formation. Chronic fatigue syndrome ( CFS) is the most common name given to a poorly understood variably debilitating disorder or disorders of uncertain causation Post-polio syndrome ( PPS) sometimes termed Middle age onset Post-polio syndrome is a condition that affects survivors of Poliomyelitis, a viral The reticular formation is a part of the Brain that is involved in actions such as awaking/ sleeping cycle, and lying down This area of the brain, in addition to apparently controlling the sensation of fatigue, is known to control sleep behaviors and is also believed to produce some neuropeptides, and thus injury or imbalance in this area could cause both CFS and sleep-related fibromyalgia.

Critics of the hypothesis argue that it does not explain slow-onset fibromyalgia, fibromyalgia present without tender points, or patients without heightened pain symptoms, and a number of the non-pain symptoms present in the disorder.

Other hypotheses

Other hypotheses have been proposed related to various toxins from the patient's environment, viral causes such as the Epstein-Barr Virus, growth hormone deficiencies possibly related to an underlying (maybe autoimmune) disease affecting the hypothalamus gland, an aberrant immune response to intestinal bacteria,^[23][24] neurotransmitter disruptions in the central nervous system, and erosion of the protective chemical coating around sensory nerves. A toxin ( Greek:, toxikon, lit (poison for use on arrows is a Poisonous substance produced by living cells or organisms that is active at very low A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable The Epstein-Barr Virus ( EBV) also called Human herpesvirus 4 (HHV-4 is a Virus of the herpes family (which includes Herpes Growth hormone ( GH) is a Peptide hormone that stimulates growth and cell reproduction in humans and other animals The gut flora are the Microorganisms that normally live in the Digestive tract and can perform a number of useful functions for their hosts See Chemical synapse for an introduction to concepts and terminology used in this article In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. A 2001 study suggested an increase in fibromyalgia among women with extracapsular silicone gel leakage, compared to women whose implants were not broken or leaking outside the capsule. ^[25][26] This association has not repeated in a number of related studies,^[27] and the US-FDA concluded "the weight of the epidemiological evidence published in the literature does not support an association between fibromyalgia and breast implants. "^[28] Due to the multi-systemic nature of illnesses such as fibromyalgia and chronic fatigue syndrome (CFS/ME), an emerging branch of medical science called psychoneuroimmunology (PNI) is looking into how the various hypotheses fit together. Chronic fatigue syndrome ( CFS) is the most common name given to a poorly understood variably debilitating disorder or disorders of uncertain causation Psychoneuroimmunology (PNI is the study of the interaction between psychological processes and the nervous and immune systems of the human body

Another hypothesis on the cause of symptoms in fibromyalgia states that patients suffer from vasomotor dysregulation causing improper vascularflow and hypoperfusion (decreased blood flow to a given tissue or organ). Vasomotor refers to actions upon a blood vessel which alter its diameter The blood vessels are part of the Circulatory system and function to transport Blood throughout the body In Medicine, ischemia ( Greek ισχαιμία, isch- is restriction hema or haema is Blood) is a restriction ^[29]

Comorbidity

Cutting across several of the above hypotheses is the proposition that fibromyalgia is almost always a comorbid disorder, occurring in combination with some other disorder (or trauma) that likely served to "trigger" the fibromyalgia in the first place. In Medicine, comorbidity (literally "additional Morbidity " is either * The presence of one or more disorders (or diseases in addition to In some cases, the original disorder abates on its own or is separately treated and cured, but the fibromyalgia remains. This is especially apparent when fibromyalgia seems triggered by major surgery.

A large percentage of chronic fatigue syndrome patients are reported to develop fibromyalgia between onset and the second year of illness. ^[30] Other possible triggers are gluten sensitivity and/or irritable bowel. Gluten sensitivity (GS encompasses a collection of medical conditions in which Gluten has an adverse effect Irritable bowel is found at high frequency in fibromyalgia,^[31] and a large support group survey of adult celiacs revealed that 9% had fibromyalgia. ^[32]

Dopamine abnormality

Dopamine is a catecholamine neurotransmitter perhaps best known for its role in the pathology of schizophrenia, Parkinson's disease and addiction. Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates See Chemical synapse for an introduction to concepts and terminology used in this article Schizophrenia ( from the Greek roots schizein (σχίζειν "to split" and phrēn Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the Central nervous system that often impairs the sufferer's The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as There is also strong evidence for a role of dopamine in restless leg syndrome,^[33] which is a common co-morbid condition in patients with fibromyalgia. Restless legs syndrome (RLS Wittmaack-Ekbom's syndrome, or sometimes but inaccurately referred to as Nocturnal myoclonus) is a condition that is characterized ^[34] In addition, dopamine plays a critical role in pain perception and natural analgesia. Accordingly, musculoskeletal pain complaints are common among patients with Parkinson's disease,^[35] which is characterized by drastic reductions in dopamine owing to neurodegeneration of dopamine-producing neurons, while patients with schizophrenia, which is thought to be due (in part) to hyperactivity of dopamine-producing neurons, have been shown to be relatively insensitive to pain. ^[36][37] Patients with restless legs syndrome have also been demonstrated to have hyperalgesia to static mechanical stimulation. Hyperalgesia is an increased sensitivity to Pain, which may be caused by damage to Nociceptors or Peripheral nerves. ^[38]

Fibromyalgia has been commonly referred to as a "stress-related disorder" due to its frequent onset and worsening of symptoms in the context of stressful events. ^[39][40] It was proposed that fibromyalgia may represent a condition characterized by low levels of central dopamine that likely results from a combination of genetic factors and exposure to environmental stressors, including psychosocial distress, physical trauma, systemic viral infections or inflammatory disorders (e. g. rheumatoid arthritis, systemic lupus erythematosus). Rheumatoid arthritis ( RA) is a chronic systemic autoimmune disorder that causes the Immune system to attack the Joints, where Systemic lupus erythematosus ( SLE or lupus,) is a chronic autoimmune disease that can be fatal though with recent medical advances fatalities are becoming ^[41] This conclusion was based on three key observations; fibromyalgia is associated with stress, chronic exposure to stress results in a disruption of dopamine-related neurotransmission^[42] and dopamine plays a critical role in modulating pain perception and central analgesia in such areas as the basal ganglia^[43] including the nucleus accumbens,^[44] insular cortex,^[45] anterior cingulate cortex,^[46] thalamus,^[47] periaqueductal gray^[48] and spinal cord. The basal ganglia (or basal nuclei) are a group of nuclei in the Brain interconnected with the Cerebral cortex, Thalamus and The nucleus accumbens (NAcc also known as the accumbens nucleus or as the nucleus accumbens septi (Latin for nucleus leaning against the Septum The insular cortex (abbrev insula) is a structure of the Human brain. The Anterior cingulate cortex (ACC is the frontal part of the Cingulate cortex, which resembles a "collar" form around the Corpus callosum, the fibrous The thalamus (from Greek θάλαμος = room chamber, IPA= /ˈθæləməs/ is a pair and symmetric part of the brain Periaqueductal gray (PAG also called the "central gray" is the Midbrain Grey matter that is located around the Cerebral aqueduct within the The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected ^[49][50]

In support of the dopamine hypothesis of fibromyalgia, a reduction in dopamine synthesis has been reported by a study that used positron emission tomography (PET) and demonstrated a reduction in dopamine synthesis among fibromyalgia patients in several brain regions in which dopamine plays a role in inhibiting pain perception, including the mesencephalon, thalamus, insular cortex and anterior cingulate cortex. A hypothesis (from Greek) consists either of a suggested explanation for a phenomenon (an event that is observable or of a reasoned proposal suggesting a possible Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the In biological anatomy the mesencephalon (or midbrain) comprises the Tectum (or corpora quadrigemini Tegmentum, the ventricular mesocoelia (or "iter" ^[51] A subsequent PET study demonstrated that, whereas healthy individuals release dopamine into the caudate nucleus and putamen during a tonic experimental pain stimulus (i. The caudate nucleus is a nucleus located within the Basal ganglia of the Brains of many animal species "Putamen" is also a botanical term for the stone in a Fruit, such as a Peach. e. hypertonic saline infusion into a muscle bed),^[52] fibromyalgia patients fail to release dopamine in response to pain and, in some cases, actually have a reduction in dopamine levels during painful stimulation. ^[53] Moreover, a substantial subset of fibromyalgia patients respond well in controlled trials to pramipexole, a dopamine agonist that selectively stimulates dopamine D2/D3 receptors and is used to treat both Parkinson's disease and restless legs syndrome. Pramipexole ( INN, trade names Mirapex and Sifrol) is a Medication indicated for treating Parkinson's disease and Restless legs A dopamine agonist is a compound that activates Dopamine receptors mimicking the effect of the neurotransmitter Dopamine. ^[54]

Serotonin

Serotonin is a neurotransmitter that is known to play a role in regulating sleep patterns, mood, feelings of well-being, concentration and descending inhibition of pain. Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons See Chemical synapse for an introduction to concepts and terminology used in this article Accordingly, it has been hypothesized that the pathophysiology underlying the symptoms of fibromyalgia may be a dysregulation of serotonin metabolism, which may explain (in part) many of the symptoms associated with the disorder. Pathophysiology is the study of the disturbance of normal Mechanical, Physical, and Biochemical functions either caused by a Disease, or resulting This hypothesis is derived in part by the observation of decreased serotonin metabolites in patient plasma ^[55] and cerebrospinal fluid. A hypothesis (from Greek) consists either of a suggested explanation for a phenomenon (an event that is observable or of a reasoned proposal suggesting a possible Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system ^[56] However, selective serotonin reuptake inhibitors (SSRIs) have met with limited success in alleviating the symptoms of the disorder, while drugs with activity as mixed serotonin-norepinephrine reuptake inhibitors (SNRIs) have been more successful^[57]. Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders Serotonin-norepinephrine reuptake inhibitors (SNRIs are a class of Antidepressant used in the treatment of major depression and other mood disorders Accordingly, duloxetine (Cymbalta), a SNRI originally used to treat depression and painful diabetic neuropathy, has been demonstrated by controlled trials to relieve symptoms of some patients. Duloxetine (brand names Cymbalta, Yentreve) is a Serotonin-norepinephrine reuptake inhibitor (SNRI used for Major depressive disorder (MDD Duloxetine (brand names Cymbalta, Yentreve) is a Serotonin-norepinephrine reuptake inhibitor (SNRI used for Major depressive disorder (MDD Diabetic neuropathies are neuropathic disorders that are associated with Diabetes mellitus. Eli Lilly and Company, the manufacturer of duloxetine has submitted a supplementary new drug application (sNDA) to the FDA for approval of it use in the treatment of FM. The relevance of dysregulated serotonin metabolism to the pathophysiology is a matter of debate. ^[58] Ironically, one of the more effective types of medication for the treatment of the disorder (i. e. serotonin 5-HT3 antagonists) actually block some of the effects of serotonin. The 5-HT3 antagonists are a class of Medications which act as Receptor antagonists at the 5-hydroxytryptamine-3 receptor (5-HT3 receptor ^[59]

Human growth hormone

An alternate hypothesis suggests that stress-induced problems in the hypothalamus may lead to reduced sleep and reduced production of human growth hormone (HGH) during slow-wave sleep. The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis Growth hormone ( GH) is a Peptide hormone that stimulates growth and cell reproduction in humans and other animals Slow-wave sleep (SWS is stages three and four of Non-rapid eye movement sleep. People with fibromyalgia tend to produce inadequate levels of HGH. Most patients with FM with low IGF-I levels failed to secrete HGH after stimulation with clonidine and l-dopa.

This view is supported by the fact that those hormones under the direct or indirect control of HGH, including IGF-1, cortisol, leptin and neuropeptide Y are abnormal in people with fibromyalgia,^[60] In addition, treatment with exogenous HGH or growth hormone secretagogue reduces fibromyalgia related pain and restores slow wave sleep^{[61][62][63][64]} though there is disagreement about the proposition. Insulin-like growth factor 1 (IGF-1 that was once called somatomedin C is a Polypeptide Protein Hormone similar in Molecular structure Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex) Leptin (Greek leptos meaning thin is a 16 kDa Neuropeptide Y (NPY is a 36 Amino acid peptide Neurotransmitter found in the Brain and Autonomic nervous system. ^[65]

Deposition disease

The 'deposition hypothesis of fibromyaglia' posits fibromyalgia is due to intracellular phosphate and calcium accumulations that eventually reaches levels sufficient to impede the ATP process, possibly caused by a kidney defect or missing enzyme that prevents the removal of excess phosphates from the blood stream. A phosphate, an Inorganic chemical, is a salt of Phosphoric acid. Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 Adenosine-5'-triphosphate ( ATP) is a multifunctional Nucleotide that is most important as a " molecular currency" of intracellular Energy The kidneys are complicated organs that have numerous biological roles Enzymes are Biomolecules that catalyze ( ie increase the rates of Chemical reactions Almost all enzymes are Proteins Accordingly, proponents of this hypothesis suggest that fibromyalgia may be an inherited disorder, and that phosphate build-up in cells is gradual but can be accelerated by trauma or illness. Calcium is required for the excess phosphate to enter the cells. The additional phosphate slows down the ATP process; however the excess calcium prods the cell to continue producing ATP. ^[66]

Diagnosis is made with a specialized technique called mapping, a gentle palpitation of the muscles to detect lumps and areas of spasm thought to be caused by an excess of calcium in the cytosol of the cells. Diagnosis is the identification by Process of elimination, of the nature of anything Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 The cytosol or intracellular fluid (or cytoplasmic matrix) is the liquid found inside cells. The mapping technique is notably different from the manual tenderpoint examination^[67] upon which a diagnosis of fibromyalgia depends and is purportedly different from the detection of trigger points that characterize the myofascial pain syndrome. Trigger points are described as hyperirritable spots in Skeletal muscle that are associated with palpable nodules in taut bands of Muscle fibers Myofascial Pain Syndrome (or MPS is a term used to describe one of the conditions characterized by chronic pain

While this hypothesis does not identify the causative mechanism in the kidneys, it proposes a treatment known as guaifenesin therapy. Guaifenesin protocol is an experimental alternative treatment for Fibromyalgia proposed in the 1990s by Dr R This treatment involves administering the drug guaifenesin to a patient's individual dosage, avoiding salicylic acid in medications or on the skin. Salicylic acid (from the Latin word for the willow tree Salix, from whose bark it can be obtained is a Beta hydroxy acid (BHA with the formula Often products for salicylate sensitivity are very helpful. Salicylate sensitivity, also known as salicylate intolerance, is any Adverse effect that occurs when a normal amount of salicylate ( Salicylic acid) is introduced If the patient is also hypoglycemic, a diet is designed to keep insulin levels low. Insulin is a Hormone with intensive effects on both metabolism and several other body systems (eg vascular compliance

The phosphate build-up hypothesis explains many of the symptoms present in fibromyalgia. and proposes an underlying cause. The guaifenesin treatment, based on this hypothesis, has received mixed reviews, with some practitioners claiming many near-universal successes and others reporting no success. Of note, guaifenesin is also a central acting muscle relaxant used in veterinary anaesthesia^[68] that is structurally related to methocarbamol, a property that might explain its utility in some fibromyalgia patients. This article refers to skeletal muscle relaxants For information on Smooth muscle relaxants see Antispasmodic. Methocarbamol (trade names Robaxin, Robaxacet, and Robax Platinum) is a central Muscle relaxant used to treat Skeletal muscle A controlled trial of guaifenesin for the treatment of fibromyalgia demonstrated no evidence for efficacy of this medication. ^[69] However, this study has been criticized by the chief proponent of the deposition hypothesis for not limiting salicylic acid exposure in patients, and for studying the effectiveness of only guaifenesin, not the entire treatment method. ^[70] As of 2005, further studies to test the protocol's effectiveness are in the planning stages, with funding for independent studies largely collected from groups which advocate the hypothesis. Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar. It should be noted that nothing in the scientific literature supports the proposition that fibromyalgia patients have excessive levels of phosphate in their tissues.

Pathophysiology

Diagnosis

There is still debate over what should be considered essential diagnostic criteria. The most widely accepted set of classification criteria for research purposes were elaborated in 1990 by the Multicenter Criteria Committee of the the American College of Rheumatology. These criteria, which are known informally as "the ACR 1990" define fibromyalgia according to the presence of the following criteria:

• A history of widespread pain lasting more than three months—affecting all four quadrants of the body, i. e. , both sides, and above and below the waist.
• Tender points—there are 18 designated possible tender or trigger points (although a person with the disorder may feel pain in other areas as well). During diagnosis, four kilograms-force (39 newtons) of force is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered. The unit kilogram-force ( kgf, often incorrectly just kg) or kilopond ( kp) is defined as the Force exerted by Earth's gravity The newton (symbol N) is the SI derived unit of Force, named after Isaac Newton in recognition of his work on Classical In Physics, a force is whatever can cause an object with Mass to Accelerate. ^[71] Four kilograms of force is about the amount of pressure required to blanch the thumbnail when applying pressure. This set of criteria was developed by the American College of Rheumatology as a means of classifying an individual as having fibromyalgia for both clinical and research purposes. While these criteria for classification of patients were originally established as inclusion criteria for research purposes and were not intended for clinical diagnosis, they have become the de facto diagnostic criteria in the clinical setting. It should be noted that the number of tender points that may be active at any one time may vary with time and circumstance.

Prevention

Treatment

As with many other syndromes, there is no universally accepted cure for fibromyalgia, though some physicians claim to have found cures. ^[72] However, a steady interest in the disorder on the part of academic researchers as well as pharmaceutical interests has led to improvements in its treatment, which ranges from symptomatic prescription medication to alternative and complementary medicine. The term alternative medicine, as used in the modern western world encompasses any healing practice "that does not fall within the realm of conventional Medicine.

The European League Against Rheumatism (EULAR) issued the first guidelines^[73] for the treatment of fibromyalgia syndrome (FMS) and published them in the September 17th On-line First issue of the Annals of the Rheumatic Diseases.

Pharmaceutical

Analgesics

A number of analgesics are used to treat the pain symptoms resulting from fibromyalgia. This includes NSAID medications over the counter, COX-2 inhibitors, and tramadol in prescription form for more advanced cases. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Tramadol ( INN) (ˈtræmədɒl is an atypical Opioid which is a centrally acting Analgesic, used for treating moderate to severe Pain. Recently, pregabalin (marketed as Lyrica) has been given FDA approval for the treatment of diagnosed fibromyalgia. Pregabalin ( INN) (prɨˈgæbəlɨn is an Anticonvulsant drug used for Neuropathic pain and as an adjunct therapy for Partial seizures with or ^[74]

Muscle relaxants

Muscle relaxants, such as cyclobenzaprine (Flexeril) or tizanidine (Zanaflex), may be used to treat the muscle pain associated with the disorder. Cyclobenzaprine is a long-acting skeletal muscle relaxant. It is marketed as Flexeril (5 and 10 mg tablets and also as Fexmid (7 Tizanidine (brandnames Zanaflex Sirdalud is a Drug which is used as a Muscle relaxant. ^[75][76][77]

Tricyclic antidepressants

Traditionally, low doses of sedating antidepressants (e. g. amitriptyline and trazodone) have been used to reduce the sleep disturbances that are associated with fibromyalgia and are believed by some practitioners to alleviate the symptoms of the disorder. Amitriptyline (or Amitryptyline) hydrochloride (sold as Elavil Tryptanol Endep Elatrol Tryptizol Trepiline Laroxyl Saroten is a Tricyclic antidepressant Trazodone (trade names Desyrel, Molipaxin, Trittico, Thombran, Trialodine, Trazorel) is a Psychoactive compound Because depression often accompanies chronic illness, these antidepressants may provide additional benefits to patients suffering from depression. Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain. Amitriptyline (or Amitryptyline) hydrochloride (sold as Elavil Tryptanol Endep Elatrol Tryptizol Trepiline Laroxyl Saroten is a Tricyclic antidepressant Neuropathy is a medical term usually short for Peripheral neuropathy. It is to be noted that Fibromyalgia is not considered a depressive disorder; antidepressants are used for their sedating effect to aid in sleep.

Selective serotonin reuptake inhibitors

Research data consistently contradict the utility of agents with specificity as serotonin reuptake inhibitors for the treatment of core symptoms of fibromyalgia. ^[78][79][80] Moreover, SSRIs are known to aggravate many of the comorbidities that commonly affect patients with fibromyalgia including restless legs syndrome and sleep bruxism. Bruxism (from the Greek βρυγμός (brugmós gnashing of teeth) is the grinding of the teeth and is typically accompanied by the clenching ^[81][82][83]

Anti-seizure medication

Anti-seizure drugs are also sometimes used, such as gabapentin^[84] and pregabalin (Lyrica). Gabapentin (brand name Neurontin) is a medication originally developed for the treatment of Epilepsy. Pregabalin ( INN) (prɨˈgæbəlɨn is an Anticonvulsant drug used for Neuropathic pain and as an adjunct therapy for Partial seizures with or Pregabalin, originally used for the nerve pain suffered by diabetics, has been approved by the American Food and Drug Administration for treatment of fibromyalgia. Pregabalin ( INN) (prɨˈgæbəlɨn is an Anticonvulsant drug used for Neuropathic pain and as an adjunct therapy for Partial seizures with or A randomized controlled trial of pregabalin 450 mg/day found that a number needed to treat of 6 patients for one patient to have 50% reduction in pain. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Pregabalin ( INN) (prɨˈgæbəlɨn is an Anticonvulsant drug used for Neuropathic pain and as an adjunct therapy for Partial seizures with or The number needed to treat (NNT is an epidemiological measure used in assessing the effectiveness of a health-care intervention typically a treatment with Medication ^[85]

Dopamine agonists

Dopamine agonists (e. A dopamine agonist is a compound that activates Dopamine receptors mimicking the effect of the neurotransmitter Dopamine. g. pramipexole (Mirapex) and ropinirole(ReQuip)) have been studied for use in the treatment of fibromyalgia with good results. Pramipexole ( INN, trade names Mirapex and Sifrol) is a Medication indicated for treating Parkinson's disease and Restless legs Ropinirole (marketed under the brand names Requip and Ropark, in Extended release form as Requip XL) is a non- Ergoline Dopamine ^[54] A trial of transdermal rotigotine is currently on going ^[86]. Rotigotine is a non-ergot (or non-ergotamine Dopamine agonist drug and is indicated for the treatment of Parkinson's disease.

Combination therapy

A controlled clinical trial of amitriptyline and fluoxetine demonstrated utility when used in combination. Amitriptyline (or Amitryptyline) hydrochloride (sold as Elavil Tryptanol Endep Elatrol Tryptizol Trepiline Laroxyl Saroten is a Tricyclic antidepressant ^[87]

Central nervous system stimulants

Cognitive dysfunction in fibromyalgia, often referred to as "brain fog," may be treated with low doses of central nervous system (CNS) stimulants such as modafinil, adderall or methylphenidate. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. Stimulant drugs are Drugs that temporarily increase alertness and awareness Modafinil ( Provigil) is a stimulant-like drug manufactured by Cephalon, and is approved by the FDA for the treatment of Narcolepsy Adderall is a brand-name pharmaceutical Psychostimulant composed of mixed Amphetamine salts, the actions of which are Sympathomimetic These non-amphetamine stimulants are also used to treat the chronic fatigue that is characteristic of fibromyalgia. ^{[88] [89]}

Stimulants may be habit forming and can have other serious side effects, so it is important to note that other treatments may be effective. ^[90] Care should be taken with any prescription, as people with fibromyalgia are known to be sensitive to medications. ^[91]

Cannabis and cannabinoids

Fibromyalgia patients frequently self-report using cannabis therapeutically to treat symptoms of the disorder. Cannabis, also known as marijuana or marihuana, or ganja (from Hindi / Sanskrit: गांजा gānjā hemp) is a ^[92] Writing in the July 2006 issue of the journal Current Medical Research and Opinion, investigators at Germany's University of Heidelberg evaluated the analgesic effects of oral THC (∆⁹-tetrahydrocannabinol) in nine patients with fibromyalgia over a 3-month period. Subjects in the trial were administered daily doses of 2. 5 to 15 mg of THC, but received no other pain medication during the trial. Among those participants who completed the trial, all reported a significant reduction in daily recorded pain and electronically induced pain. ^[93] Previous clinical and preclinical trials have shown that both naturally occurring and endogenous cannabinoids hold analgesic qualities,^[94] particularly in the treatment of cancer pain and neuropathic pain,^[95][96] both of which are poorly treated by conventional opioids. As a result, some experts have suggested that cannabinoid agonists would be applicable for the treatment of chronic pain conditions unresponsive to opioid analgesics such as fibromyalgia, and they propose that the disorder may be associated with an underlying clinical deficiency of the endocannabinoid system. The endocannabinoid system refers to a group of neuromodulators (Kreitzer and Regehr 2001 Maejima et al, 2001 and their receptors that are involved in a variety ^[97][98]

Non-drug treatment

Physical treatments

Studies have found exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia. ^[99] Many patients find temporary relief by applying heat to painful areas. Those with access to physical therapy, massage, or acupuncture may find them beneficial. ^[100] Most patients find exercise, even low intensity exercise to be extremely helpful. ^[101] Osteopathic manipulative therapy can also temporarily relieve pain due to fibromyalgia. This is the main article for the category Osteopathic manipulative medicine. ^[102]

A holistic approach—including managing diet, sleep, stress, activity, and pain—is used by many patients. Dietary supplements, massage, chiropractic care, managing blood sugar levels, and avoiding known triggers when possible means living as well as it is in the patient's power to do.

Psychological/behavioral therapies

As the nature of fibromyalgia is not well understood, some physicians believe that it may be psychosomatic or psychogenic. Psychosomatic medicine is an interdisciplinary medical field studying psychosomatic illness, now more commonly referred to as psychophysiologic illness or disorder A psychogenic disease is a set of symptoms or complaints whose origin likely lies within the complex interactions of the frontal lobes of the brain and the system in which the complaint ^[103] Although there is no universally accepted cure, some doctors have claimed to have successfully treated fibromyalgia when a psychological cause is accepted. ^[104]

Cognitive behavioral therapy has been shown to improve quality of life and coping in fibromyalgia patients and other sufferers of chronic pain. See also Cognitive Therapy Cognitive Behavioral Therapy ( CBT) is an umbrella-term for psychotherapeutic systems that deal with cognitions interpretations ^[105] Neurofeedback has also shown to provide temporary and long-term relief. Neurofeedback (NFB, also called neurotherapy, neurobiofeedback or EEG biofeedback (EEGBF is a therapy technique that presents the user with realtime

Biofeedback and self-management techniques such as pacing and stress management may be helpful for some patients. The use of medication to improve sleep helps some patients, as does supplementation with folic acid and ginkgo biloba. Folic acid (also known as Vitamin M and Folacin) and Folate (the Anionic form are forms of the water-soluble Vitamin B9 Ginkgo ( Ginkgo biloba; in Chinese 銀杏 Pinyin romanization yín xìng) frequently misspelled as "Gingko" and also known

Dietary treatment

In a 2001 review of four case studies, symptoms were alleviated by minimizing consumption of monosodium glutamate. Monosodium glutamate, also known as sodium glutamate and MSG, is a Sodium salt of the non-essential Amino acid Glutamic acid ^[106] Reviews of the research indicate that the physiological effect of monosodium glutamate is overstated. ^[107] There are few other studies linking diet and the disease.

Investigational treatments

Milnacipran, a serotonin-norepinephrine reuptake inhibitor (SNRI), is available in parts of Europe where it has been safely prescribed for other disorders. Milnacipran is an Antidepressant of the Serotonin-norepinephrine reuptake inhibitor class Serotonin-norepinephrine reuptake inhibitors (SNRIs are a class of Antidepressant used in the treatment of major depression and other mood disorders On May 22nd, 2007, a Phase III study demonstrated statistically significant therapeutic effects of Milnacipran as a treatment of fibromyalgia syndrome. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Milnacipran is an Antidepressant of the Serotonin-norepinephrine reuptake inhibitor class At this time, only initial top-line results are available and further analyses will be completed in the coming weeks. If ultimately approved by the FDA, Milnacipran could be distributed in the United States as early as summer, 2008. Milnacipran is an Antidepressant of the Serotonin-norepinephrine reuptake inhibitor class 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common ^[108]

Among the more controversial therapies involves the use of guaifenesin; called St. Guaifenesin (gwaɪˈfɛnəsɪn ( INN) or guaiphenesin (former BAN) is an Expectorant drug usually taken orally (by mouth to assist Amand's protocol or the guaifenesin protocol^[66] the efficacy of guaifenesin in treating fibromyalgia has not been proven in properly designed research studies. Guaifenesin protocol is an experimental alternative treatment for Fibromyalgia proposed in the 1990s by Dr R Indeed, a controlled study conducted by researchers at Oregon Health Science University in Portland failed to demonstrate any benefits from this treatment,^[69] and the lead researcher has suggested that the anecdotally reported benefits where due to placebo suggestion. ^[109] The results of the study have since been contested by Dr St. Amand, who was a co-author or the original research report. ^[110]

Dextromethorphan is an over-the-counter cough medicine with activity as an NMDA receptor antagonist. Dextromethorphan ( DXM or DM) is an Antitussive (cough suppressant drug found in many over-the-counter cold and Cough medicines NMDA receptor antagonists are a class of Anesthetics that work to antagonize, or inhibit the action of the N-methyl d-aspartate receptor ( NMDAR It has been used in the research setting to investigate the nature of fibromyalgia pain^[111][112]; however, there are no controlled trials of safety or efficacy in clinical use.

Prognosis

Fibromyalgia can affect every aspect of a person's life. While neither degenerative nor fatal, the chronic pain associated with fibromyalgia is pervasive and persistent. FMS can severely curtail social activity and recreation, and as many as 30% of those diagnosed with fibromyalgia are unable to maintain full-time employment. Like others with disabilities, individuals with FMS often need accommodations to fully participate in their education or remain active in their careers.

In the United States, those who are unable to maintain a full-time job due to the condition may apply for Social Security Disability benefits. The United States of America —commonly referred to as the Although fibromyalgia has been recognized as a genuine, severe medical condition by the government, applicants are often denied benefits, since there are no formal diagnostic criteria or medically provable symptoms.

In the United Kingdom, the Department for Work and Pensions recognizes fibromyalgia as a condition for the purpose of claiming benefits and assistance. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The Department for Work and Pensions (or DWP) ( Welsh: Adran Gwaith a Phensiynau) is the largest government department in the Government ^[113]

Epidemiology

Fibromyalgia is seen in about 2% of the general population^[105] and affects more females than males, with a ratio of 9:1 by ACR criteria. ^[114] It is most commonly diagnosed in individuals between the ages of 20 and 50, though onset can occur in childhood.

History

Fibromyalgia has been studied since the early 1800s and referred to by a variety of former names, including muscular rheumatism and fibrositis. ^[115] The term fibromyalgia was coined in 1976 to more accurately describe the symptoms, from the Latin fibra (fiber)^[116] and the Greek words myo (muscle)^[117] and algos (pain). Latin ( lingua Latīna, laˈtiːna is an Italic language, historically spoken in Latium and Ancient Rome. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly ^[118]

Dr. Muhammad B. Yunus, considered the father of the modern view of fibromyalgia, published the first clinical, controlled study of the characteristics of fibromyalgia syndrome in 1981. In health care clinical trials are conducted to allow safety and Efficacy data to be collected for new drugs or devices ^[119][120] Yunus' work validated the known symptoms and tender points that characterise the condition, and proposed data-based criteria for diagnosis. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from In 1984, Yunus proposed the interconnection between fibromyalgia syndrome and other similar conditions, and in 1986 demonstrated the effectiveness of serotonergic and norepinephric drugs. Serotonergic means "related to the Neurotransmitter Serotonin " Norepinephrine ( INN) (abbreviated norepi or NE) or noradrenaline ( BAN) (abbreviated NA or NAd) is a ^[121] Yunus later emphasized the "biopsychosocial perspective" of fibromyalgia, which synthesized the contributions of genes, personal and medical history, stress, posttraumatic and mood disorders, coping skills, self-efficacy of pain management and social support towards the functioning and dysfunctioning of the central nervous system in relation to pain and fatigue. The biopsychosocial model is a general model or approach Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is The medical history or Anamnesis of a Patient is information gained by a Physician or other healthcare professional by asking specific questions Post traumatic stress disorder It is a severe and ongoing emotional reaction to A mood disorder is the term given for a group of diagnoses in the DSM IV TR classification system where a disturbance in the person's emotional mood is hypothesised A coping skill is a behavioral tool which may be used by individuals to offset or overcome Adversity, Disadvantage, or Disability without correcting or Pain management (also called pain medicine is the medical discipline concerned with the relief of Pain. Social support is the physical and Emotional comfort given to us by our Family, friends co-workers and others In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm ^[119][120]

Fibromyalgia was recognized by the American Medical Association as an illness and a cause of disability in 1987. The American Medical Association (AMA founded in 1847 and incorporated 1897 is the largest association of Physicians and Medical students in the United States In an article the same year, in the Journal of the American Medical Association, a physician named Dr. JAMA The Journal of the American Medical Association is an international peer-reviewed general Medical journal, published 48 times per year by the American Don Goldenberg also called the disorder fibromyalgia. The American College of Rheumatology (ACR) published a criteria for fibromyalgia in 1990, and developed neurohormonal mechanisms with central sensitization in the 1990s. The American College of Rheumatology is an organization of and for physicians health professionals and scientists that advances Rheumatology through programs of education A neurohormone is any Hormone produced by neurosecretory cells usually in the Brain. Sensitization is an example of non-associative Learning in which the progressive amplification of a response follows repeated administrations of a stimulus (Bell ^[121]

Controversies

The validity of fibromyalgia as a unique clinical entity is a matter of some contention among researchers in the field. For example, it has been proposed that the pathophysiology responsible for the symptoms that are collectively classified as representing "fibromyalgia" is poorly understood, thereby suggesting that the fibromyalgia phenotype which is the difference between an individual’s heredity and what that heredity produces, may result from several different disease processes that have global hyperalgesia - an increased sensitivity to pain - and allodynia in common, ^{[122][123][124]} an observation that has led to the proposition that current diagnostic criteria are insufficient to differentiate patient groups from each other. A phenotype is any observable characteristic of an Organism, such as its morphology, Development, biochemical or physiological properties ^[125] Alternatively, there is evidence for the existence of differing pathophysiological processes within the greater fibromyalgia construct^[126][127], which may be interpreted to represent evidence for the existence of biologically distinct "sub-types" of the disorder akin to conditions such as epilepsy, schizophrenia and major depressive disorder. Epilepsy is a common chronic Neurological disorder that is characterized by recurrent unprovoked seizures. Schizophrenia ( from the Greek roots schizein (σχίζειν "to split" and phrēn Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression In a January 14, 2008 article in the New York Times, the controversy of the reality of the disease and its proposed cures are discussed, while citing that the American College of Rheumatology, the Food and Drug Administration and insurers recognize fibromyalgia as a diagnosable disease. The American College of Rheumatology is an organization of and for physicians health professionals and scientists that advances Rheumatology through programs of education Drug companies are aggressively pursuing fibromyalgia treatments, seeing the potential for a major new market. ^[128]

References

Further reading

• Fibromyalgia for Pharmacists, a medication guide

External links

• American College of Rheumatology Fibromyalgia factsheet
• Living with Fibromyalgia, First Drug Approved at US Food and Drug Administration
• Questions and Answers About Fibromyalgia by the National Institute of Arthritis and Musculoskeletal and Skin Diseases
• Fibromyalgia at the Open Directory Project

The Open Directory Project ( ODP) also known as dmoz (from directory

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