Diagnosis and Management of Fibromyalgia

Introduction: Fibromyalgia is a syndrome characterized by widespread pain. The etiology is multifactorial, involving biological psychological and social factors. Purpose the work: to reveal the news regarding the diagnosis and management of fibromyalgia, highlighting the role of medical rehabilitation means within this condition. Results: Fibromyalgia diagnosis is a diagnosis of exclusion, being necessary to assess the presence of other diseases as well. Clinical and laboratory investigations are not specific. They help to diagnose the diseases which frequently coexist with fibromyalgia. Discussion and conclusions: Fibromyalgia is a complex heterogeneous disorder requiring individualized multidisciplinary approach. It is a suffering characterized by clinical polymorphism, resistant to traditional therapeutic means, also generating disability. Clinical trials have demonstrated the efficacy of the pharmacological and non-pharmacological combined therapy in fibromyalgia management. INTRODUCTION Fibromyalgia (FM) is a syndrome characterized by widespread pain that causes substantial disability, with a prevalence of 6.4% in the general population according to a recent study.(1) Fibromyalgia etiology is multifactorial, involving biological, psychological and social factors. Possible risk factors are: female gender, genetic predisposition, menopause, poor physical condition. The inheritance is polygenic with the involvement of genes polymorphism within the serotonin catecholaminergic and dopaminergic system.(2) Fibromyalgia classification: 1. Primary or idiopathic FM is the most common form. 2. In secondary FM, there are triggering factors: infections (parvovirus, Epstein–Barr virus (EB virus), Lyme disease); injuries and physical trauma (accidents); emotional distress; major surgery; peripheral pain syndromes; hormonal disorders (hypothyroidism); drugs (statins, inhibitors of aromatase), vaccines. 3. Juvenile FM has a better prognosis than in adults. There is no evidence to support the fact that the pathophysiological mechanism would be different in the three forms.(3) FM causes have not yet been fully elucidated. There was identified a central sensitivity and an abnormal process of central nociception, pain in FM being considered a sensorineural disorder. The biological and neuroimaging studies support this hypothesis.(4) The pathophysiological mechanisms in fibromyalgia involve some anomalies in pain processing: excess of excitatory neurotransmitters (substance P, glutamate) resulting in neuronal hyperactivity and central sensitization; decrease of inhibitory neurotransmitters (serotonin and norepinephrine) in the antinociceptive downward pathways (5); maintaining enhanced temporal summation (by repetitive stimulation of C peripheral fibers) for secondary pain; alteration of endogenous opioid analgesic activity in several brain areas; impaired secretion of dopamine.(6)