Moldofsky Harvey
Faculty of Medicine, University of Toronto, Sleep Disorders Clinic of the Centre for Sleep and Chronobiology, 340 College Street, Suite 580, Toronto, ON MST 3A9, Canada.
Joint Bone Spine. 2008 Jul;75(4):397-402. doi: 10.1016/j.jbspin.2008.01.021. Epub 2008 May 5.
The clinical focus of rheumatologists on the widespread pain and numerous tender points in specific anatomic regions in their patients who show no evidence for disease pathology has lead to the characterization of such peripheral symptoms as a specific disorder of the musculoskeletal system, now commonly known as fibromyalgia. This rheumatologic diagnostic entity has resulted in relative inattention to an understanding of their patients' common complaints of unrefreshing sleep, chronic fatigue and psychological distress. Experimental evidence from humans and animal studies indicate that there is an inter-relationship of disturbances in the physiology of the sleeping-waking brain with the widespread musculoskeletal pain, chronic fatigue, and psychological distress in patients with hitherto unexplained pain/fatigue illnesses, e.g., fibromyalgia and chronic fatigue syndromes. The emerging knowledge of the dysfunction of the nervous system in such patients has lead to the study of novel medications that affect neurotransmitter functions, e.g., pregabalin, serotonin/noradrenaline compounds and sodium oxybate that are shown to improve many of the symptoms of such patients.
对于那些没有疾病病理学证据的患者，风湿病学家临床关注的是其广泛的疼痛以及特定解剖区域的众多压痛点，这导致了将此类外周症状描述为肌肉骨骼系统的一种特定疾病，即现在通常所知的纤维肌痛。这种风湿病学诊断实体导致相对忽视了对患者关于睡眠不佳、慢性疲劳和心理困扰等常见主诉的理解。来自人类和动物研究的实验证据表明，在迄今无法解释的疼痛/疲劳疾病（如纤维肌痛和慢性疲劳综合征）患者中，睡眠-觉醒大脑生理学的紊乱与广泛的肌肉骨骼疼痛、慢性疲劳和心理困扰之间存在相互关系。此类患者神经系统功能障碍的新知识促使人们研究影响神经递质功能的新型药物，例如普瑞巴林、5-羟色胺/去甲肾上腺素化合物和γ-羟基丁酸钠，这些药物已被证明可改善此类患者的许多症状。
