Fibromyalgia Syndrome Treatment from a Multidimensional Perspective

ABSTRACT

Objectives: Fibromyalgia syndrome [FMS] is a pain syndrome which is not due to tissue damage or inflammation, and is thus fundamentally different from rheumatic disorders and many other pain conditions. Presenting as a “prototype” of a “central pain” disease, FMS widespread pain is often associated with a wide range of other symptoms such as sleep disturbance, fatigue, cognitive disturbance, stiffness, and depressive symptoms. The underlying mechanisms involved in the development of central sensitization both explain the clinical variety of symptoms [heterogeneity] and provide targets for pharmacologic and nonpharmacologic treatment strategies.

Findings: Nonpharmacologic therapies include education, exercise, cognitive behavorial therapy, and other multidimensional therapeutic approaches. These should enable the patient to develop his or her own disease management strategies, in which drugs can be incorporated.

Today, pharmacologic treatment targets several mechanisms involved in the development of central sensitization. In particular, serotonin norepinephrine reuptake inhibitors such as duloxetine and milnacipran and α2–δ receptor ligands such as pregabalin have been shown in a variety of placebo-controlled studies to bring significant relief from pain and other symptoms.

The role of nonrestorative, unrefreshing sleep has been underestimated for many years. Recently, clinical trials have been published, emphasizing the important role of improved sleep quality. There was significant benefit on many disease domains by giving sodium oxybate.

Conclusions: The complex symptomatology of FMS will continue to require a multidisciplinary approach including education and exercise, in addition to drug therapy to achieve the most efficient management of FMS, thus indicating a strong need for further and more extended studies targeting the benefits from using combinations of pharmacologic and nonpharmacologic treatments.

KEYWORDS. :

• Fibromyalgia syndrome
• treatment
• multidimensional
• multidisciplinary