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Query: UMLS:C0016053 (fibromyalgia)
 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The history of "nondisease" dates back, at least 4000 years, to early descriptions of hysteria. More recently somatization became a part of the official diagnostic nomenclature by creation of the DSM III category, "somatoform disorders." Somatization can serve as a rationalization for psychosocial problems or as a coping mechanism, and for some illness, becomes a way of life. One variation of somatization can be the "fashionable diagnosis", for example, fibromyalgia, multiple chemical sensitivities, dysautonomia, and, in the past, "reactive hypoglycemia". These disorders are phenomenologically related to environmental or occupational syndromes and mass psychogenic illness. Fashionable illnesses are characterized by (i) vague, subjective multisystem complaints, (ii) a lack of objective laboratory findings, (iii) quasi-scientific explanations, (iv) overlap from one fashionable diagnosis to another, (v) symptoms consistent with depression or anxiety or both, (vi) denial of psychosocial distress or attribution of it to the illness. Fashionable diagnoses represent a heterogeneous collection of physical diseases, somatization, and anxiety or depression. They are final common symptomatic pathways for a variety of influences including environmental factors, intrapersonal distress and solutions to social problems. A fashionable diagnosis allows psychosocial distress to be comfortably hidden from both the patient and the physician, but premature labeling can also mask significant physical disease. Hysteria remains alive and well and one contemporary hiding place is fashionable illness.
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PMID:Somatization and fashionable diagnoses: illness as a way of life. 945 62

Abnormal activity of the sympathetic nervous system may be involved in the pathogenesis of chronic pain syndromes. This article reviews the animal studies of sympathetically induced pain behavior, the controversy of sympathetically maintained pain in clinical practice, and the dysautonomic nature of fibromyalgia (FM). FM has neuropathic pain features (stimuli-independent pain state accompanied by allodynia and paresthesias). The proposal of FM as a sympathetically maintained pain syndrome is based on the controlled studies showing that patients with FM display signs of relentless sympathetic hyperactivity and that the pain is submissive to sympathetic blockade and is rekindled by norepinephrine injections. Dysautonomia also may explain the multisystem features of FM.
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PMID:Fibromyalgia as a sympathetically maintained pain syndrome. 1536 23

Autonomic nervous system dysfunction observed in fibromyalgia, characterized without exception by a sympathetic hyperactivity and hyporeactivity, has been reported. However, several studies demonstrated reduced levels of norepinephrine and neuropeptide Y at rest and after tilt table in some patients, which was improved by beta-stimulating agents. These findings support heterogeneity in fibromyalgia-associated dysautonomia. Fibromyalgia could be a generalized sympathetic dystrophy since both conditions are activated by trauma and partly linked to sympathetic mechanisms. Yet they differ on several points: hormonal and neurochemical abnormalities are observed in fibromyalgia whereas activation by peripheral trauma and hyperosteolysis are observed in reflex sympathetic dystrophy.
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PMID:Dysautonomia, fibromyalgia and reflex dystrophy. 1909 Sep 66

Some overlap between features of fibromyalgia and systemic lupus erythematous (SLE) is well-recognized. Our objective is to describe eight patients with an original diagnosis of SLE, in whom, after re-evaluation, the multi-system symptoms could be explained on the basis of the dysautonomia that occurs in fibromyalgia.Seven of the eight patients were females. Their mean age was 31 years. All of them fulfilled the American College of Rheumatology criteria for fibromyalgia. Their lupus-like features that could later be explained by dysautonomia were the following: diffuse arthralgias with subjective feeling of swelling, malar erythema, syncopal episodes, profound fatigue, and distal vasospastic changes. Six patients had low titer ANA. None of the patients had signs of organic damage. Autonomic dysfunction was demonstrated by means of circadian studies of heart rate variability (6 patients) and/or tilt table testing (3 patients). We conclude that autonomic dysfunction may be an explanation for the lupus-like symptoms present in some patients with FM.
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PMID:The dysautonomia of fibromyalgia may simulate lupus. 1907 25

Fibromyalgia (FM) is a common, complex, and difficult to treat chronic widespread pain disorder, which usually requires a multidisciplinary approach using both pharmacological and non-pharmacological (education and exercise) interventions. It is a condition of heightened generalized sensitization to sensory input presenting as a complex of symptoms including pain, sleep dysfunction, and fatigue, where the pathophysiology could include dysfunction of the central nervous system pain modulatory systems, dysfunction of the neuroendocrine system, and dysautonomia. A cyclic model of the pathophysiological processes is compatible with the interrelationship of primary symptoms and the array of postulated triggers associated with FM. Many of the molecular targets of current and emerging drugs used to treat FM have been focused to the management of discrete symptoms rather than the condition. Recently, drugs (eg, pregabalin, duloxetine, milnacipran, sodium oxybate) have been identified that demonstrate a multidimensional efficacy in this condition. Although the complexity of FM suggests that monotherapy, non-pharmacological or pharmacological, will not adequately address the condition, the outcomes from recent clinical trials are providing important clues for treatment guidelines, improved diagnosis, and condition-focused therapies.
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PMID:Treatment options and patient perspectives in the management of fibromyalgia: future trends. 1933 51

There is an urgent need to increase the awareness on the Joint Hyper mobility Syndrome QHS). This is a congenital and prevalent emergent condition that is frequently undiagnosed and that causes significant health problems. Besides recurrent muscular-skeletal problems and signs and symptoms derived from tissue fragility, adolescents and young adults may develop osteoporosis, early osteoarthritis or dysautonomia, that are common in the disease, and deteriorate quality of life. Many JHS patients have signs and symptoms suggestive of fibromyalgia and are usually misdiagnosed. Physicians should be able to differentiate the less severe form of JHS from the Vascular Ehlers-Danlos Syndrome, to diagnose it before the appearance of serious complications and even death. The study of these diseases is a promising area for genomic and rheumatologic research.
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PMID:[Ehlers-Danlos syndrome, with special emphasis in the joint hypermobility syndrome]. 2009 10

Science is an ever-changing discipline. Modern medical knowledge is based on science. Current medical paradigm is both linear and reductionist. There is a new general theory validated by computer's calculations named chaos and complexity theory. This new paradigm will probably have an impact on medical practice. Cardiovascular physiology may display fractal and/ or chaotic behavior. Computerized heart rhythm analyses enhanced our understanding of complex diseases otherwise not explainable by current linear-reductionist paradigms. Cases in point are diverse dysautonomia including orthostatic intolerance, cardiac X syndrome and fibromyalgia. Derived from this, new knowledge is a different diagnostic and therapeutic stance: scientific holism.
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PMID:[Chaos, complexity and cardiology]. 2245 67

Joint hypermobility syndrome (JHS), or Ehlers-Danlos syndrome (EDS) hypermobility type (EDS-HT), is a underdiagnosed heritable connective tissue disorder characterized by generalized joint hypermobility and a wide range of visceral, pelvic, neurologic, and cognitive dysfunctions. Deterioration of quality of life is mainly associated with pain and fatigue. Except for the recognized effectiveness of physiotherapy for some musculoskeletal features, there are no standardized guidelines for the assessment and treatment of pain and fatigue. In this work, a practical classification of pain presentations and factors contributing in generating painful sensations in JHS/EDS-HT is proposed. Pain can be topographically classified in articular limb (acute/subacute and chronic), muscular limb (myofascial and fibromyalgia), neuropathic limb, back/neck, abdominal and pelvic pain, and headache. For selected forms of pain, specific predisposing characteristics are outlined. Fatigue appears as the result of multiple factors, including muscle weakness, respiratory insufficiency, unrefreshing sleep, dysautonomia, intestinal malabsorption, reactive depression/anxiety, and excessive use of analgesics. A set of lifestyle recommendations to instruct patients as well as specific investigations aimed at characterizing pain and fatigue are identified. Available treatment options are discussed in the set of a structured multidisciplinary approach based on reliable outcome tools.
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PMID:Management of pain and fatigue in the joint hypermobility syndrome (a.k.a. Ehlers-Danlos syndrome, hypermobility type): principles and proposal for a multidisciplinary approach. 2278 15

This review imparts an impressionistic tone to our current understanding of autonomic nervous system abnormalities in fibromyalgia. In the wake of symptoms present in patients with fibromyalgia (FM), autonomic dysfunction seems plausible in fibromyalgia. A popular notion is that of a relentless sympathetic hyperactivity and hyporeactivity based on heart rate variability (HRV) analyses and responses to various physiological stimuli. However, some exactly opposite findings suggesting normal/hypersympathetic reactivity in patients with fibromyalgia do exist. This heterogeneous picture along with multiple comorbidities accounts for the quantitative and qualitative differences in the degree of dysautonomia present in patients with FM. We contend that HRV changes in fibromyalgia may not actually represent increased cardiac sympathetic tone. Normal muscle sympathetic nerve activity (MSNA) and normal autonomic reactivity tests in patients with fibromyalgia suggest defective vascular end organ in fibromyalgia. Previously, we proposed a model linking deconditioning with physical inactivity resulting from widespread pain in patients with fibromyalgia. Deconditioning also modulates the autonomic nervous system (high sympathetic tone and a low parasympathetic tone). A high peripheral sympathetic tone causes regional ischaemia, which in turn results in widespread pain. Thus, vascular dysregulation and hypoperfusion in patients with FM give rise to ischaemic pain leading to physical inactivity. Microvascular abnormalities are also found in patients with FM. Therapeutic interventions (e.g. exercise) that result in vasodilatation and favourable autonomic alterations have proven to be effective. In this review, we focus on the vascular end organ in patients with fibromyalgia in particular and its modulation by exercise in general.
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PMID:Autonomic nervous system profile in fibromyalgia patients and its modulation by exercise: a mini review. 2338 85

Juvenile-onset fibromyalgia (JFM) is a poorly understood chronic pain condition most commonly affecting adolescent girls. The condition is characterized by widespread musculoskeletal pain and other associated symptoms, including fatigue, nonrestorative sleep, headaches, irritable bowel symptoms, dysautonomia and mood disorders such as anxiety and/or depression. In the past few years, there has been a greater focus on understanding JFM in adolescents. Research studies have provided insight into the clinical characteristics of this condition and its effect on both short-term and long-term psychosocial and physical functioning. The importance of early and effective intervention is being recognized, as research has shown that symptoms of JFM tend to persist and do not resolve over time as was previously believed. Efforts to improve treatments for JFM are underway, and new evidence strongly points to the potential benefits of cognitive-behavioural therapy on improving mood and daily functioning. Research into pharmacotherapy and other nonpharmacological options is in progress. Advancements in the understanding of adult fibromyalgia have paved the way for future studies on diagnosis, assessment and management of JFM. This Review focuses on our current knowledge of the condition, provides an update of the latest research advances, and highlights areas for further study.
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PMID:Juvenile fibromyalgia: current status of research and future developments. 2427 66


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