Title:Fibromyalgia: The Prototypical Central Sensitivity Syndrome
Volume: 11
Issue: 2
Author(s): Chad S. Boomershine
Affiliation:
Keywords:
Anticonvulsant, antidepressant, diagnosis, epidemiology, fibromyalgia, muscle relaxer, pathophysiology, treatment.
Abstract: Fibromyalgia syndrome (FM), the most common central sensitivity syndrome (CSS) affecting
over 5% of the population, is a disorder of chronic widespread pain accompanied by numerous
other symptoms that causes significant functional impairment. The core FM symptom domains can be
recalled using the FIBRO mnemonic and include Fatigue and Fog (cognitive dysfunction), Insomnia
(difficulties with all aspects of sleep including initiation, maintenance and restorative), Blues (depression
and anxiety), Rigidity (stiffness in muscles and joints) and Ow! (widespread pain and tenderness).
While typically presenting in middle-aged women, FM can affect both sexes at any age. FM is a syndrome
of abnormal central pain processing and increased central sensitivity caused by neurobiological changes that cause
dysregulation of mechanisms that normally regulate pain sensation. There are currently three different methods for diagnosing
FM; the 1990, 2010 and modified 2010 American College of Rheumatology (ACR) criteria. While disabling, FM
symptoms can be managed with a regimen of pharmacologic and nonpharmacologic treatments. Medication types with
benefit in treating FM include anticonvulsants, antidepressants, anti-inflammatories, muscle relaxers, tramadol, and stimulants.
Beneficial nonpharmacologic therapies include aerobic and resistance exercise, stretching, cognitive behavioral
therapy, and education. Effective management requires formulation of an individualized regimen since patients differ
widely in symptoms and treatments they find beneficial. Such an individualized regimen should be based on a systematic
assessment of problematic symptoms conducted at baseline and each follow-up with treatments modified over time. While
challenging, FM symptoms can be effectively managed and patients can lead full, productive lives.
