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JAMA. 2014 Apr 16;311(15):1547-55. doi: 10.1001/jama.2014.3266.

Fibromyalgia: a clinical review.

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1
Professor of Anesthesiology, Medicine (Rheumatology), and Psychiatry and Director, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor.

Abstract

IMPORTANCE:

Fibromyalgia is present in as much as 2% to 8% of the population, is characterized by widespread pain, and is often accompanied by fatigue, memory problems, and sleep disturbances.

OBJECTIVE:

To review the epidemiology, pathophysiology, diagnosis, and treatment of fibromyalgia.

EVIDENCE REVIEW:

The medical literature on fibromyalgia was reviewed from 1955 to March 2014 via MEDLINE and the Cochrane Central Registry of Controlled Trials, with an emphasis on meta-analyses and contemporary evidence-based treatment guidelines. Treatment recommendations are based on the most recent evidence-based guidelines from the Canadian Pain Society and graded from 1 to 5 based on the level of available evidence.

FINDINGS:

Numerous treatments are available for managing fibromyalgia that are supported by high-quality evidence. These include nonpharmacological therapies (education, exercise, cognitive behavioral therapy) and pharmacological therapies (tricyclics, serotonin norepinephrine reuptake inhibitors, and gabapentinoids).

CONCLUSIONS AND RELEVANCE:

Fibromyalgia and other "centralized" pain states are much better understood now than ever before. Fibromyalgia may be considered as a discrete diagnosis or as a constellation of symptoms characterized by central nervous system pain amplification with concomitant fatigue, memory problems, and sleep and mood disturbances. Effective treatment for fibromyalgia is now possible.

Comment in

PMID:
24737367
DOI:
10.1001/jama.2014.3266
[Indexed for MEDLINE]
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