Vol. 12. Núm. 27.
Páginas 1586-1595 (Marzo 2017)

Actualización
Fibromialgia

Fibromyalgia

W.A. Sifuentes-GiraldoJ.L. Morell-Hita
Doi : https://10.1016/j.med.2017.02.004
Opciones
Resumen
Introducción

La fibromialgia es un trastorno caracterizado por dolor musculoesquelético crónico generalizado que se asocia a otros síntomas somáticos y alteraciones cognitivas, que tiene un impacto significativo en la calidad de vida de los pacientes afectados y es una causa potencial de discapacidad.

 Etiopatogenia

Estudios recientes sugieren que el mecanismo patogénico predominante en la fibromialgia es la alteración de la regulación del dolor a nivel cerebral, por lo que se considera un síndrome de sensibilización central, pero existen otros factores periféricos implicados cuyo papel no está claramente establecido.

 Diagnóstico

No existen pruebas diagnósticas específicas para la fibromialgia, por lo que la historia clínica y la exploración física continúan siendo esenciales para una adecuada diferenciación de otros procesos que cursan con dolor musculoesquelético generalizado.

 Tratamiento

La fibromialgia representa un desafío terapéutico y requiere un abordaje multidisciplinar, incluyendo medidas farmacológicas y no farmacológicas.

Palabras clave
Fibromialgia
Dolor generalizado
Dolor neuropático
Sensibilización central
Abstract
Introduction

Fibromyalgia is a disorder characterized by chronic widespread musculoskeletal pain that is associated with other somatic symptoms and cognitive impairment, which has a significant impact on the quality of life of affected patients and is a potential cause of disability.

 Etiopathogenesis

Recent studies suggest that the predominant pathogenic mechanism in fibromyalgia is the dysregulation of pain tranmission in the brain, so currently it is considered a syndrome of central sensitization, but other peripheral factors are involved whose role is not clearly established.

 Diagnosis

There are no specific diagnostic tests for fibromyalgia, so the medical history and physical examination remain essential for proper differentiation of other processes that may present with widespread musculoskeletal pain.

 Treatment

Fibromyalgia represents a therapeutic challenge and requires a multidisciplinary approach, including pharmacological and non-pharmacological measures.

Keywords
Fibromyalgia
Generalized pain
Neuropathic pain
Central sensitization

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Bibliografía
[1]
201702270030133348
201702270030133349
D.J. Clauw.
Fibromyalgia: a clinical review.
JAMA., (2014), 311 pp. 1547-1555
http://dx.doi.org/10.1001/jama.2014.3266 | Medline
[2]
2017022700301333410
J.C. Deare, Z. Zheng, C.C. Xue, J.P. Liu, J. Shang, S.W. Scott, G. Littlejohn, et al.
Acupuncture for treating fibromyalgia.
Cochrane Database Syst Rev., (2013), 5 pp. CD007070
[3]
2017022700301333411
P. Juuso, L. Skar, M. Olsson, S. Soderberg.
Living with a double burden: Meanings of pain for women with fibromyalgia.
Int J Qual Stud Health Well-being., (2011), 6
[4]
2017022700301333412
T. Schmidt-Wilcke, A. Kairys, E. Ichesco, M.L. Fernández-Sánchez, P. Barjola, M. Heitzeg, et al.
Changes in clinical pain in fibromyalgia patients correlate with changes in brain activation in the cingulate cortex in a response inhibition task.
Pain Med., (2014), 15 pp. 1346-1358
http://dx.doi.org/10.1111/pme.12460 | Medline
[5]
2017022700301333413
S. Campos Sánchez.
Fibromialgia.
Rev Esp Reumatol, (2000), 27 pp. 417-420
[6]
2017022700301333414
S.H. Ralston, I.B. McInnes.
Rheumatology and Bone Disease.
Davidson's principles and practice of medicine., 22nd ed., Churchill Livingstone Elsevier, pp. 1057-1135
[7]
2017022700301333415
B. Walitt, R.L. Nahin, R.S. Katz, M.J. Bergman, F. Wolfe.
The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey.
PLoS One., (2015), 10 pp. e0138024
http://dx.doi.org/10.1371/journal.pone.0138024 | Medline
[8]
2017022700301333416
A. Vincent, B.D. Lahr, F. Wolfe, D.J. Clauw, M.O. Whipple, T.H. Oh, et al.
Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project. ahr BD.
Arthritis Care Res (Hoboken)., (2013), 65 pp. 786-792
http://dx.doi.org/10.1002/acr.21896 | Medline
[9]
2017022700301333417
F. Wolfe, K. Ross, J. Anderson, I.J. Russell, L. Hebert.
The prevalence and characteristics of fibromyalgia in the general population.
Arthritis Rheum., (1995), 38 pp. 19-28
Medline
[10]
2017022700301333418
G.T. Jones, F. Atzeni, M. Beasley, E. Fluss, P. Sarzi-Puttini, G.J. Macfarlane.
The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria.
Arthritis Rheumatol., (2015), 67 pp. 568-575
http://dx.doi.org/10.1002/art.38905 | Medline
[11]
2017022700301333419
2017022700301333420
J.A. Verbunt, D.H. Pernot, R.J. Smeets.
Disability and quality of life in patients with fibromyalgia.
Health Qual Life Outcomes., (2008), 6 pp. 8
http://dx.doi.org/10.1186/1477-7525-6-8 | Medline
[12]
2017022700301333421
2017022700301333422
Goldenberg DL. Initial treatment of fibromyalgia in adults. UpToDate 2016. Disponible en: http://www.UpToDate.com
[13]
2017022700301333423
International Statistical Classification of Diseases and Related Health Problems 10th Revision.
World Health Organization, (2014),
Disponible en: http://www.who.int/classifications/icd/en/
[14]
2017022700301333424
2017022700301333425
F. Wolfe, D.J. Clauw, M.A. Fitzcharles, D.L. Goldenberg, R.S. Katz, P. Mease, et al.
The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.
Arthritis Care Res (Hoboken)., (2010), 62 pp. 600-610
http://dx.doi.org/10.1002/acr.20140 | Medline
[15]
2017022700301333426
2017022700301333427
P. Glennon, G.P. Stafford.
Fibromyalgia syndrome: management in primary care.
Arthritis Research UK, (2010),
Disponible en: http://www.arthritisresearchuk.org/health-professionals-and-students/reports/hands-on/hands-on-autumn-2010.aspx
[16]
2017022700301333428
2017022700301333429
F. Wolfe, H.A. Smythe, M.B. Yunus, R.M. Bennett, C. Bombardier, D.L. Goldenberg, et al.
The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee.
Arthritis Rheum., (1990), 33 pp. 160-172
Medline
[17]
2017022700301333430
2017022700301333431
Goldenberg DL. Clinical manifestations and diagnosis of fibromyalgia in adults. UpToDate 2016. Disponible en: http://www.UpToDate.com
[18]
2017022700301333432
F. Wolfe, D.J. Clauw, M.A. Fitzcharles, D.L. Goldenberg, W. Häuser, R.S. Katz, et al.
Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.
J Rheumatol., (2011), 38 pp. 1113-1122
http://dx.doi.org/10.3899/jrheum.100594 | Medline
[19]
2017022700301333433
2017022700301333434
J. Walker.
Fibromyalgia: clinical features, diagnosis and management.
Nurs Stand., (2016), 31 pp. 51-63
http://dx.doi.org/10.7748/ns.2017.e10588 | Medline
[20]
2017022700301333435
2017022700301333436
Goldenberg DL. Pathogenesis of fibromyalgia. UpToDate 2016. Disponible en: http://www.UpToDate.com
[21]
2017022700301333437
2017022700301333438
A.T. Borchers, M.E. Gershwin.
Fibromyalgia: a critical and comprehensive review.
Clin Rev Allergy Immunol., (2015), 49 pp. 100-151
http://dx.doi.org/10.1007/s12016-015-8509-4 | Medline
[22]
2017022700301333439
J.N. Ablin, D. Buskila.
Update on the genetics of the fibromyalgia syndrome.
Best Pract Res Clin Rheumatol., (2015), 29 pp. 20-28
http://dx.doi.org/10.1016/j.berh.2015.04.018 | Medline
[23]
2017022700301333440
X.J. Caro, E.F. Winter.
The role and importance of small fiber neuropathy in fibromyalgia pain.
Curr Pain Headache Rep., (2015), 19 pp. 55
http://dx.doi.org/10.1007/s11916-015-0527-7 | Medline
[24]
2017022700301333441
J. Birnbaum.
Peripheral nervous system manifestations of Sjogren syndrome: clinical patterns, diagnostic paradigms, etiopathogenesis, and therapeutic strategies.
Neurologist., (2010), 16 pp. 287-297
http://dx.doi.org/10.1097/NRL.0b013e3181ebe59f | Medline
[25]
2017022700301333442
BMJ Best Practice: fibromyalgia.
British Medical Journal, (2015),
Disponible en: http://bestpractice.bmj.com/best-practice/monograph/187.htm
[26]
2017022700301333443
2017022700301333444
K.A. Firestone, K.F. Holton, S.D. Mist, C.L. Wright, K.D. Jones.
Optimizing fibromyalgia management.
Nurse Pract., (2012), 37 pp. 12-21
http://dx.doi.org/10.1097/01.NPR.0000422204.02853.e0 | Medline
[27]
2017022700301333445
2017022700301333446
Goldenberg DL. Differential diagnosis of fibromyalgia. UpToDate 2016. Disponible en: http://www.UpToDate.com
[28]
2017022700301333447
A. Barton, B. Pal, P.J. Whorwell, D. Marshall.
Increased prevalence of sicca complex and fibromyalgia in patients with irritable bowel syndrome.
Am J Gastroenterol., (1999), 94 pp. 1898-1901
http://dx.doi.org/10.1111/j.1572-0241.1999.01146.x | Medline
[29]
2017022700301333448
S. Haliloglu, A. Carlioglu, D. Akdeniz, Y. Karaaslan, A. Kosar.
Fibromyalgia in patients with other rheumatic diseases: prevalence and relationship with disease activity.
Rheumatol Int., (2014), 34 pp. 1275-1280
http://dx.doi.org/10.1007/s00296-014-2972-8 | Medline
[30]
2017022700301333449
A. Khan, A. Georgiou, E. Roussou.
THU0060 Application of the ASAS criteria for spondyloarthritis to patients with fibromyalgia.
Ann Rheum Dis., (2014), 73 pp. 197
[31]
2017022700301333450
C. Palazzi, E. D’Amico, S. D’Angelo, M. Gilio, I. Olivieri.
Rheumatic manifestations of hepatitis C virus chronic infection: Indications for a correct diagnosis.
World J Gastroenterol., (2016), 22 pp. 1405-1410
http://dx.doi.org/10.3748/wjg.v22.i4.1405 | Medline
[32]
2017022700301333451
L. Yazmalar, Ö. Deveci, I. Batmaz, D. Ipek, T. Çelepkolu, M. Alpaycı, et al.
Fibromyalgia incidence among patients with hepatitis B infection.
Int J Rheum Dis., (2016), 19 pp. 637-643
http://dx.doi.org/10.1111/1756-185X.12593 | Medline
[33]
2017022700301333452
C. Fox, K. Walker-Bone.
Evolving spectrum of HIV-associated rheumatic syndromes.
Best Pract Res Clin Rheumatol., (2015), 29 pp. 244-258
http://dx.doi.org/10.1016/j.berh.2015.04.019 | Medline
[34]
M. Blettery, L. Brunier, K. Polomat, F. Moinet, C. Deligny, S. Arfi.
Management of chronic post-chikungunya rheumatic disease: The Martinican Experience.
Arthritis Rheumatol, (2016),
En prensa
[35]
2017022700301333453
S. Karras, E. Rapti, S. Matsoukas, K. Kotsa.
Vitamin D in fibromyalgia: a causative or confounding biological interplay?.
Nutrients., (2016), 8
http://dx.doi.org/10.3390/nu8040194 | Medline
[36]
2017022700301333454
2017022700301333455
S.F. Carville, L. Arendt-Nielsen, H. Bliddal, F. Blotman, J.C. Branco, D. Buskila, et al.
EULAR evidence-based recommendations for the management of fibromyalgia syndrome.
Ann Rheum Dis., (2008), 67 pp. 536-541
http://dx.doi.org/10.1136/ard.2007.071522 | Medline
[37]
2017022700301333456
M.A. Fitzcharles, P.A. Ste-Marie, D.L. Goldenberg, J.X. Pereira, S. Abbey, M. Choinière, et al.
2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary.
Pain Res Manag., (2013), 18 pp. 119-126
Medline
[38]
2017022700301333457
2017022700301333458
Goldenberg DL. Treatment of fibromyalgia in adults not responsive to initial therapies. UpToDate 2016. Disponible en: http://www.UpToDate.com
[39]
2017022700301333459
2017022700301333460
P.J. Wiffen, S. Derry, R.A. Moore, D. Aldington, P. Cole, A.S. Rice, et al.
Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews.
Cochrane Database Syst Rev., (2013), 11 pp. CD010567
[40]
2017022700301333461
A. Moore, P. Wiffen, E. Kalso.
Antiepileptic drugs for neuropathic pain and fibromyalgia.
JAMA., (2014), 312 pp. 182-183
http://dx.doi.org/10.1001/jama.2014.6336 | Medline
[41]
2017022700301333462
2017022700301333463
W. Hauser, K. Bernardy, N. Uceyler, C. Sommer.
Treatment of fibromyalgia syndrome with gabapentin and pregabalin--a meta-analysis of randomized controlled trials.
Pain., (2009), 145 pp. 69-81
http://dx.doi.org/10.1016/j.pain.2009.05.014 | Medline
[42]
2017022700301333464
2017022700301333465
D. Goldenberg, M. Mayskiy, C. Mossey, R. Ruthazer, C. Schmid.
A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia.
Arthritis Rheum., (1996), 39 pp. 1852-1859
Medline
[43]
2017022700301333466
2017022700301333467
P.J. Mease, M.V. Farmer, R.H. Palmer, R.M. Gendreau, J.M. Trugman, Y. Wang.
Milnacipran combined with pregabalin in fibromyalgia: a randomized, open-label study evaluating the safety and efficacy of adding milnacipran in patients with incomplete response to pregabalin.
Ther Adv Musculoskelet Dis., (2013), 5 pp. 113-126
http://dx.doi.org/10.1177/1759720X13483894 | Medline
[44]
2017022700301333468
M. Ghini, G. Carpenito, M.T. Mascia.
Effects of a paracetamol and tramadol fixed-dose combination on pain, asthenia, cognitive disorders and sleep quality in fibromyalgia.
Clin Exp Rheumatol., (2016), 34 pp. S152
Medline