Anxiety Disorders Program, Institute of Psychiatry FMUSP, R. Dr. Ovidio Pires de Campos, 785, Caixa Postal 3671, CEP 01060-970, Sao Paulo, SP, Brazil.
Curr Pain Headache Rep. 2013 Sep;17(9):358. doi: 10.1007/s11916-013-0358-3.
Fibromyalgia is associated with high level of pain and suffering. Lack of diagnosis leads to onerous indirect economic costs. Recent data indicate that fibromyalgia; anxiety disorders, and depression tend to occur as comorbid conditions. They also share some common neurochemical dysfunctions and central nervous system alterations such as hypofunctional serotonergic system and altered reactivity of the hypothalamic-pituitary-adrenal axis. Conversely, functional neuroimaging findings point to different patterns of altered pain processing mechanisms between fibromyalgia and depression. There is no cure for fibromyalgia, and treatment response effect size is usually small to moderate. Treatment should be based on drugs that also target the comorbid psychiatric condition. Combined pharmacotherapy and cognitive-behavior therapy should ideally be offered to all patients. Lifestyle changes, such as physical exercise should be encouraged. The message to patients should be that all forms of pain are true medical conditions and deserve proper care.
纤维肌痛与高水平的疼痛和痛苦有关。缺乏诊断会导致繁重的间接经济成本。最近的数据表明，纤维肌痛、焦虑障碍和抑郁往往是共病状态。它们还具有一些共同的神经化学功能障碍和中枢神经系统改变，如血清素能系统功能低下和下丘脑-垂体-肾上腺轴反应性改变。相反，功能神经影像学研究结果表明，纤维肌痛和抑郁症之间的疼痛处理机制改变存在不同模式。纤维肌痛没有治愈方法，治疗反应的效果大小通常较小到中等。治疗应该基于针对共病精神状况的药物。理想情况下，应向所有患者提供联合药物治疗和认知行为疗法。应鼓励改变生活方式，如体育锻炼。给患者的信息是，所有形式的疼痛都是真正的医疗状况，都需要得到适当的护理。
