Cassisi G, Sarzi-Puttini P, Casale R, Cazzola M, Boccassini L, Atzeni F, Stisi S
Rheumatology Branch, Specialist Outpatients Department, Belluno.
Reumatismo. 2014 Jun 6;66(1):72-86. doi: 10.4081/reumatismo.2014.767.
Pain is the hallmark symptom of fibromyalgia (FM) and other related syndromes, but quite different from that of other rheumatic diseases, which depends on the degree of damage or inflammation in peripheral tissues. Sufferers are often defined as patients with chronic pain without an underlying mechanistic cause, and these syndromes and their symptoms are most appropriately described as "central pain", "neuropathic pain", "nonnociceptive pain" or "central sensitivity syndromes". The pain is particular, regional or widespread, and mainly relates to the musculoskeletal system; hyperalgesia or allodynia are typical. Its origin is currently considered to be distorted pain or sensory processing, rather than a local or regional abnormality. FM is probably the most important and extensively described central pain syndrome, but the characteristics and features of FM-related pain are similar in other disorders of particular interest for rheumatologists, such as myofascial pain syndromes and temporo-mandibular joint disorders, and there is also an intriguing overlap between FM and benign joint hypermobility syndrome. This suggests that the distinctive aspects of pain in these idiopathic or functional conditions is caused by central nervous system hypersensitivity and abnormalities. Pharmacological and non-pharmacological therapies have been suggested for the treatment of these conditions, but a multidisciplinary approach is required in order to reduce the abnormal cycle of pain amplification and the related maladaptive and self-limiting behaviours.
疼痛是纤维肌痛（FM）及其他相关综合征的标志性症状，但与其他风湿性疾病的疼痛截然不同，后者取决于外周组织的损伤或炎症程度。患者通常被定义为患有慢性疼痛但无潜在机制性病因的患者，这些综合征及其症状最恰当地描述为“中枢性疼痛”“神经性疼痛”“非伤害性疼痛”或“中枢性敏感综合征”。疼痛具有特定性、区域性或广泛性，主要与肌肉骨骼系统有关；痛觉过敏或感觉异常是其典型表现。目前认为其起源是疼痛或感觉处理的扭曲，而非局部或区域性异常。FM可能是最重要且被广泛描述的中枢性疼痛综合征，但在对风湿病学家特别感兴趣的其他疾病中，如肌筋膜疼痛综合征和颞下颌关节紊乱症，与FM相关的疼痛特征相似，而且FM与良性关节过度活动综合征之间也存在有趣的重叠。这表明这些特发性或功能性疾病中疼痛的独特方面是由中枢神经系统超敏反应和异常引起的。已提出药物和非药物疗法来治疗这些疾病，但需要采用多学科方法以减少疼痛放大的异常循环以及相关的适应不良和自我限制行为。
