Developments in the Scientific and Clinical Understanding of Fibromyalgia

Dan Buskila

Disclosures

Arthritis Res Ther. 2009;11(5):242 

In This Article

Abstract and Introduction

Abstract

Our understanding of fibromyalgia (FM) has made significant advances over the past decade. The current concept views FM as the result of central nervous system malfunction resulting in amplification of pain transmission and interpretation. Research done over the past years has demonstrated a role for polymorphisms of genes in the serotoninergic, dopaminergic and catecholaminergic systems in the etiopathogenesis of FM. Various external stimuli such as infection, trauma and stress may contribute to the development of the syndrome. The management of FM requires an integrated approach combining pharmacological and nonpharmacological modalities. The recent Food and Drugs Administration approval of pregabalin, duloxetine and milnacipran as medications for FM may herald a new era for the development of medications with higher specificity and efficacy for the condition. As our understanding of the biological basis and the genetic underpinning of FM increases, we hope to gain a better understanding of the true nature of the disorder, to better classify patients and to attain more rational therapeutic modalities.

Introduction

Fibromyalgia (FM) is a chronic condition characterized by widespread pain and diffuse tenderness, along with symptoms of fatigue, nonrestorative sleep and cognitive difficulties. Although coined as a nosological entity only some two and a half decades ago, and adorned official American College of Rheumatology (ACR) criteria only in 1990,[1] patients suffering from syndromes such as fibrositis and soft tissue rheumatism have been described in the medical literature for over a century.[2] The 1990 ACR criteria for classification of FM formed a framework for a plethora of research and publications focused on FM over this period. Indeed, entering the term 'fibromyalgia' as a Medline search for the years 1990 to 2008 currently yields 4,271 results.

Significant progress has occurred over recent years regarding our understanding of the mechanisms underlying altered pain processing characteristic of FM, and this evolution of knowledge is leading towards novel strategies for management of FM pain.[3] Increasing evidence supports a genetic predisposition to FM and supports the fact that environmental factors may trigger the development of FM, in genetically predisposed individuals.[4–6] There is also a continued effort to search for biomarkers to be used to identify individuals susceptible to FM, for the diagnosis of FM and for objective measures of disease activity.[7]

An effort has also been made to better classify FM patients, to identify subgroups with unique clinical characteristics and to pinpoint therapeutic interventions. The recent Food and Drugs Administration approval of pregabalin, duloxetine and milnacipran as specific medications for FM may herald a new era for the development of medications with higher specificity and efficacy for this condition. The aim of the present article is to review the current developments in the scientific and clinical understanding of FM and progress in the management of FM.

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