Women's Health Research Program, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Am J Med. 2010 Jun;123(6):S2. doi: 10.1016/j.amjmed.2010.04.001.
Recent advances in the understanding of the etiology, epidemiology, diagnosis, and treatment of fibromyalgia must be applied in clinical practice to achieve optimal patient outcomes. Current evidence indicates that fibromyalgia is a hyperalgesic state, resulting from a generalized problem with augmented pain processing that likely results from the way the spinal cord and the brain process pain and other sensory information. The descending pain pathway involving serotonin, norepinephrine, and dopamine, as opposed to the descending opioid pain pathway, appears to be selectively attenuated. Newer treatment options targeted at the pain mechanisms include the alpha(2)-delta pregabalin, which binds to the alpha(2)-delta subunit of voltage-gated calcium channels in neurons, and the serotonin-norepinephrine dual reuptake inhibitors duloxetine and milnacipran. The US Food and Drug Administration (FDA) has approved pregabalin, duloxetine, and milnacipran for the management of fibromyalgia. In addition to pharmacologic therapy, patient education, cognitive behavioral therapy, aerobic exercise, and strength and flexibility training are important components of care. An individualized treatment plan should be developed with consideration of each patient's unique combination of fibromyalgia symptoms, functional level, and the presence of the comorbid psychiatric and medical conditions that are common in patients with fibromyalgia. This educational activity provides clinicians with the tools necessary to differentiate fibromyalgia syndrome from other chronic pain conditions through a review of recent clinical data and an application of an advanced understanding of pain pathways. Strategies to manage patients with comorbid conditions are explored, with an emphasis on the importance of a multidisciplinary approach to patient care. Online Access: http://www.cmeaccess.com/cme/ajm_fibro_program/
最近在理解纤维肌痛的病因、流行病学、诊断和治疗方面的进展必须应用于临床实践，以实现最佳的患者结果。目前的证据表明，纤维肌痛是一种痛觉过敏状态，是由于疼痛处理的普遍问题导致的，可能是脊髓和大脑处理疼痛和其他感觉信息的方式造成的。与下行阿片样物质疼痛通路相反，涉及血清素、去甲肾上腺素和多巴胺的下行疼痛通路似乎被选择性地减弱。针对疼痛机制的更新治疗选择包括与神经元电压门控钙通道的α(2)-δ亚基结合的α(2)-δ普瑞巴林，以及血清素-去甲肾上腺素双重再摄取抑制剂度洛西汀和米那普仑。美国食品和药物管理局（FDA）已批准普瑞巴林、度洛西汀和米那普仑用于纤维肌痛的治疗。除了药物治疗，患者教育、认知行为疗法、有氧运动和力量及柔韧性训练也是治疗的重要组成部分。应根据每位患者纤维肌痛症状、功能水平的独特组合以及纤维肌痛患者常见的共病精神和医学疾病的存在，制定个体化的治疗计划。本教育活动通过回顾最近的临床数据和对疼痛途径的深入了解，为临床医生提供了区分纤维肌痛综合征与其他慢性疼痛疾病所需的工具。探讨了管理共病患者的策略，强调了多学科方法对患者护理的重要性。在线访问：http://www.cmeaccess.com/cme/ajm_fibro_program/
