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  • Review Article
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Fibromyalgia: from pathophysiology to therapy

Abstract

Individuals with fibromyalgia generally experience chronic widespread pain, which can be accompanied by further symptoms including fatigue, sleep disturbances, cognitive dysfunction, anxiety and depressive episodes. As the recognition and diagnosis of fibromyalgia has improved, the availability of therapeutic options for patients has increased. Furthermore, research into the neurobiological mechanisms that contribute to the chronic pain and concomitant symptoms experienced by patients with fibromyalgia has advanced our understanding of this debilitating disorder. In this Review, we aim to provide an overview of existing pathophysiological concepts. The roles of biological and psychological stress, genetic factors, and pain and sensory processing in the pathophysiology of fibromyalgia and related conditions are discussed. In addition, pharmacological treatments, including monoamine modulators, calcium channel modulators and γ-aminobutyric acid modulators, as well as nonpharmacological treatment options are considered.

Key Points

  • Fibromyalgia is characterized by chronic widespread pain and is often accompanied by one or more concomitant symptoms including fatigue, sleep disturbances, cognitive dysfunction, anxiety and/or depressive episodes

  • New diagnostic criteria for fibromyalgia have been put forth, both in the USA and in Europe, which do not require the presence of tender points

  • Several risk factors for the development of fibromyalgia, such as certain types of stress, genetic polymorphisms and familial predisposition, have been identified; however, the underlying etiology and pathophysiology remains to be fully elucidated

  • Emerging evidence suggests that both an early and aberrant activation of the pain system, as well as an impaired antinociceptive system, contribute to the development of clinical pain

  • Current treatment recommendations include both pharmacological and nonpharmacological therapies

  • Understanding of, treatment options for and social acceptance of fibromyalgia have improved over the past decade, but fibromyalgia remains a scientific and clinical challenge

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Figure 1: Pathways of pain processing implicated in chronic pain and fibromyalgia.
Figure 2: Dually focused therapeutic approach to fibromyalgia.

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Acknowledgements

Tobias Schmidt-Wilcke is supported by a grant from the Deutsche Forschungsgemeinschaft (DFG, GZ: SchM 2665/1-1).

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T. Schmidt-Wilcke and D. J. Clauw contributed equally to researching data for, discussing the content of and writing the article, and reviewing/editing of the manuscript before submission.

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Correspondence to Tobias Schmidt-Wilcke.

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D. J. Clauw has served as a consultant to Cypress Bioscience, Eli Lilly and Company, Forest Laboratories, Jazz Pharmaceuticals, Johnson & Johnson, Merck, Nuvo Research, Pfizer, Pierre Fabre Médicament, Procter & Gamble, and Wyeth Pharmaceuticals, and has received research/grant support from Cypress Bioscience, Forest Laboratories, and Pfizer. T. Schmidt-Wilcke declares no conflicts of interest.

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Schmidt-Wilcke, T., Clauw, D. Fibromyalgia: from pathophysiology to therapy. Nat Rev Rheumatol 7, 518–527 (2011). https://doi.org/10.1038/nrrheum.2011.98

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