Professor of Anesthesiology, Medicine (Rheumatology), and Psychiatry and Director, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor.
JAMA. 2014 Apr 16;311(15):1547-55. doi: 10.1001/jama.2014.3266.
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.
To review the epidemiology, pathophysiology, diagnosis, and treatment of fibromyalgia.
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.
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).
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.
纤维肌痛在人群中的发病率为 2%至 8%，其特征为广泛疼痛，并常伴有疲劳、记忆问题和睡眠障碍。
综述纤维肌痛的流行病学、病理生理学、诊断和治疗。
通过 MEDLINE 和 Cochrane 对照试验中心注册库，对 1955 年至 2014 年 3 月的纤维肌痛医学文献进行了回顾，重点关注荟萃分析和当代循证治疗指南。治疗建议基于加拿大疼痛学会的最新循证指南，并根据现有证据的级别从 1 级到 5 级进行分级。
有许多治疗纤维肌痛的方法得到了高质量证据的支持。这些方法包括非药物疗法（教育、运动、认知行为疗法）和药物疗法（三环类抗抑郁药、5-羟色胺去甲肾上腺素再摄取抑制剂和加巴喷丁类药物）。
现在对纤维肌痛和其他“中枢性”疼痛状态的了解比以往任何时候都要好。纤维肌痛可被视为一个独立的诊断，也可被视为一种以中枢神经系统疼痛放大为特征的症状组合，伴有疲劳、记忆问题以及睡眠和情绪障碍。现在已经可以对纤维肌痛进行有效的治疗。
