de Miquel C Alegre, Campayo J García, Flórez M Tomás, Arguelles J M Gómez, Tarrio E Blanco, Montoya M Gobbo, Martin Á Pérez, Salio A Martínez, Fuentes J Vidal, Alberch E Altarriba, de la Cámara A Gómez
Jefe de Servicio de ReumatologíaHospital Universitari Val d’HebrónBarcelona, Spain.
Actas Esp Psiquiatr. 2010 Mar-Apr;38(2):108-20.
Backgrounds. The elevated prevalence and enormous clinical and social impact of fibromyalgia, together with the complexity of its treatment, require action consensuses that guide health care professionals. Although there are some similar documents in our language, most have been made from the perspective of a single discipline.Objective. To develop a consensus on the treatment of fibromyalgia made by selected representatives and supported by the principal medical associations that intervene in its treatment (rheumatology, neurology, psychiatry,rehabilitation and family medicine) and representatives of the associations of patients. On the other hand, understanding the disease not as a homogenous disorders but also as the sum of different clinical subtypes,having specific symptomatic characteristics and different therapeutic needs is stressed. This approach represented a need perceived by the clinicians and a novelty regarding previous consensuses.Methods. The different clinical classifications proposed in fibromyalgia and the scientific evidence of the treatments used in this disease were reviewed. For the selection of the classification used and performance of the therapeutic recommendations, some of the usual techniques to obtain the consensus (nominal group and brainstorming) were used.Conclusion. The classification of Giesecke of fibromyalgia into 3 subgroups seems to have the greatest scientific evidence and the most useful for the clinician. The guide offers a series of general recommendations for all the patients with fibromyalgia. However, in addition, for each subgroup, there are a series of specific pharmacological and psychological-type recommendations and those of modification of the environment, which will make it possible to have a personalized approach to the patient with fibromyalgia in accordance with their individual clinical characteristics (pain, catastrophizing levels, etc.).
背景。纤维肌痛症的高患病率及其巨大的临床和社会影响，再加上其治疗的复杂性，需要形成指导医疗保健专业人员的行动共识。尽管有一些用我们的语言撰写的类似文件，但大多数是从单一学科的角度编写的。
目的。由选定代表制定并得到干预其治疗的主要医学协会（风湿病学、神经病学、精神病学、康复医学和家庭医学）以及患者协会代表支持的关于纤维肌痛症治疗的共识。另一方面，强调不应将该疾病视为一种同质疾病，而应视为不同临床亚型的总和，这些亚型具有特定的症状特征和不同的治疗需求。这种方法体现了临床医生所察觉到的一种需求，并且相对于以往的共识而言具有新颖性。
方法。回顾了纤维肌痛症中提出的不同临床分类以及该疾病所用治疗方法的科学证据。为了选择所使用的分类并制定治疗建议，采用了一些达成共识的常用技术（名义小组法和头脑风暴法）。
结论。吉泽克将纤维肌痛症分为3个亚组的分类似乎具有最充分的科学依据，对临床医生最为有用。该指南为所有纤维肌痛症患者提供了一系列一般建议。然而，此外，对于每个亚组，都有一系列特定的药理学和心理类建议以及环境调整建议，这将有可能根据纤维肌痛症患者的个体临床特征（疼痛、灾难化程度等）对其进行个性化治疗。
