Definición de la fibromialgia / Definition of fibromyalgia

El artículo define brevemente la fibromialgia dentro de un contexto más amplio incluyendo las raíces históricas del concepto y su posible etiología, así como su interpretación dentro de los modelos biopsicosociales más actuales, con implicaciones terapéuticas de alto interés.(AU)

Dolor y calidad de vida: el proceso de recepción y construcción del diagnóstico de fibromialgia al interior del discurso médico chileno / Health and quality of life. the reception and construction process of fibromyalgia diagnosis in the chilean medical discourse

INTRODUCCIÓN: El presente artículo propone una revisión del proceso de recepción y construcción del diagnóstico de fibromialgia al interior del discurso médico chileno. Se plantea que, derivado de las discusiones que previamente se instalan en torno al fenómeno del dolor crónico, la amplia penetración de la fibromialgia entre los profesionales de la salud chilenos puede ser entendida en función de su estrecha ligazón a la noción de calidad de vida. MATERIAL Y MÉTODOS: Se revisó ochenta y un artículos editados en Chile en revistas especializadas del ámbito médico desde 1953 a 2018, tres libros y una guía clínica cuyo tema principal es el dolor crónico y la fibromialgia. Se realizó un análisis de contenidos utilizando una codificación abierta en tres etapas mediante el programa Atlas.ti RESULTADOS: La información obtenida permite desprender tres discusiones principales: factores biológicos involucrados en el dolor crónico y la fibromialgia, los aspectos subjetivos de quienes los padecen, y el ámbito interpersonal que se ve concernido en torno a dichos diagnósticos. DISCUSIÓN: Se constata que, al ser un diagnóstico que no presenta una clara etiología alojada en la biología de quien lo padece, la fibromialgia se transforma en el indicador de quienes no se adecúan a los comportamientos esperables según una adecuada calidad de vida. Aquello habilita al profesional tratante a intervenir buscando la modificación de comportamientos en diversos ámbitos de la vida del paciente, bajo el supuesto que aquello conducirá a una reducción del dolor. (AU)

INTRODUCTION: The present work offers a revision of the construction and reception process of the fibromyalgia diagnosis in the Chilean medical discourse. It argues that, derived from previous discussions about chronic pain, the wide-ranging expansion of fibromyalgia diagnosis among Chilean health professionals could be understood in the context of quality of life considerations. MATERIAL AND METHODS: Eighty-three papers edited in Chilean medical journals were reviewed, from 1953 to 2018, as well as three books and one clinical guide whose principal subjects were chronic pain and fibromyalgia.RESULTS: The information was divided into four periods from which is possible to draw conclu-sions about key points in discussions concerning the construction of chronic pain and fibromyalgia, involving biological considerations, subjective aspects of those diagnosed with it, and interpersonal elements involved in these diagnoses.DISCUSSION: The information shows that, fibromyalgia, as a diagnosis without a clear etiology located inside the patient ́s biology, becomes the designated diagnosis of those whose beha-viors do not fit with what defined as a good quality of life. This allows the health professional to suggest a range of behavioral modifications in the life of the fibromyalgia sufferer, assuming that behavioral modification will eventually lead to pain relief. (AU)

Fisiopatología de la fibromialgia / Physiopathology of fibromyalgia

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Fibromyalgia in biblical times.

Although fibromyalgia (FM) is now a recognized clinical entity, an early description of this clinical syndrome is found in the Old Testament. In this Letter, biblical passages which are mentioned to the main symptoms of FM (e.g. chronic and disabling pain, unrefreshing sleep and physical exhaustion), actually associated with chronic stress and depression, are presented indicatively.

The physician, the Emperor and the fibromyalgia: Charles-Édouard Brown-Séquard (1817-1894) and Dom Pedro II (1825-1891) of Brazil.

The physician Charles-Édouard Brown-Séquard was a neurologist of considerable importance. In 1846 his thesis 'Researches and Experiments on the Physiology of the Spinal Cord' brought out knowledge about the sensory pathways which remains until today. The Emperor, Dom Pedro II was the second and last Emperor of Brazil, reigning for 49 years and remembered for defending the nation's integrity, the end of slavery, support for education and culture, diplomacy and relations with international personalities. He married Dona Teresa Cristina of Bourbon-Two Sicilies (1822-1889) by proxy in 1843, the fourth and last Empress consort of Brazil. This paper reports the exchange of letters between these personalities of the XIX century. Although they lived far from each other and worked in areas so different, they discussed the health of the Empress in letters. Dom Pedro II made contact with Brown-Séquard hoping that ' … your knowledge shall help heal my wife of nervous disease … . ' According to Dom Pedro the Empress suffered ' … for a long time with more or less long interruptions of horrible neuralgic pains in the legs, head and the scalp. Two points on the dorsal spine feel the effects more or less with pressure applied … . ' In addition to describing and documenting the exchange of letters, this paper raises the possibility that the Empress suffered from the fibromyalgia syndrome.

A historical and clinical perspective endorsing person-centered management of fibromyalgia syndrome.

Fibromyalgia or fibromyalgia syndrome (FMS) is a complex chronic pain disorder of unknown causation frequently associated with debilitating fatigue, unrefreshing sleep, cognitive and affective symptoms. A fibromyalgia-type suffering was possibly described in the Book of Job. Analogous symptomatic conditions have been medically recognized since the early 1900s, when initially labeled as "fibrositis". Since the early 1980s, FMS has evolved and differentiated after its characterization in a controlled study. Since then, research has focused on multiple aspects of this disorder, including characterization and management of symptoms, psychophysiology, neuroendocrine-immune pathophysiology, including central sensitization mechanisms. The complex and multifaceted nature of FMS lends itself better to a holistic (integrative medicine) or biopsychosocial approach than the more specific bioscientific pathways typical for a pathologically-defined disease. A person-centered approach to evaluation and care more effectively addresses and encompasses the biopsychosocial aspects of this disorder than traditional bioscientific clinical methods. This review outlines a holistic multi-modal, patientcentered approach to evaluation and care as a framework for primary clinic settings. Future directions in research, diagnosis, and management of fibromyalgia patients should incorporate revised person-centered and other qualitative models of care for critical comparison to current conventional concepts and clinical practice. The more comprehensive personcentered services need to be compared to the current standardized practice in terms of their cost-effective outcomes, patient satisfaction, physician gratification, and practical logistics of providing long-term follow up and management.

Fibromyalgia.

Fibromyalgia is a chronic pain condition present in 2-4% of the population. Fibromyalgia consists of widespread pain with similarities to neuropathic pain in clinical findings, pathophysiology, and neuropharmacology. Pain is the predominant symptom and allodynia and hyperalgesia are common signs. Extreme fatigue, impaired cognition and nonrestorative sleep difficulties coexist in addition to other somatic symptoms. Research including neuroimaging investigations shows abnormalities in neurotransmitters and an abnormal response to pain. Altered pain processing peripherally and centrally contribute to central sensitization and a dampened effect of the diffuse noxious inhibitory control (DNIC). Successful management incorporates education of the patient in self-management skills, cognitive behavioral therapy (CBT), exercise, and drug therapy. Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs) (duloxetine and milnacipran), α2-δ ligands (gabapentin and pregabalin) are effective in reducing pain by≥30%. Some success has been shown with dopamine agonists (pramipexole), tramadol, other opioids and cannabinoids (nabilone). Further evidence-based trials using complementary treatments are needed. Fibromyalgia is complex and requires a multidisciplinary approach to treatment. Patient self-management is key.

The rise of fibromyalgia in 20th-century America.

At the beginning of the 21st century, fibromyalgia syndrome (FM) has become a diagnostic category that includes extremely large numbers of people, predominantly women. Yet only a few decades ago, FM (and its predecessor fibrositis) was of little interest or concern to either physicians or the general public. What, then, were the origins of the FM diagnosis, and why did its boundaries expand so rapidly during and after the 1980s? The answers to such questions are complex. Broad social and intellectual currents, internal developments within medicine, the appearance of a self-conscious women's movement, and the rise of an increasingly important pharmaceutical industry all converged to elevate the importance of FM. Yet the diagnosis has remained highly contested, and there are competing etiological theories and therapies.

[Historical evolution of the concept of fibromyalgia: the main stages]. / Evoluzione storica del concetto di fibromialgia: le tappe principali.

The concept of fibromyalgia is fairly recent, by evolving from previous notions such as muscular rheumatism and fibrositis. In this concise report the main stages leading to the development of the concept of fibromyalgia are sketched out, beginning from the notions of fibrositis nodules, trigger points and myofascial pain, up to the most recent knowledge including this clinical condition in the cluster of central sensitivity syndromes.

History of fibromyalgia: past to present.

Fibromyalgia syndrome (FMS) is now a recognized clinical entity causing chronic and disabling pain. For several centuries, muscle pains have been known as rheumatism and then as muscular rheumatism. The term fibrositis was coined by Gowers in 1904 and was not changed to fibromyalgia until 1976. Smythe laid the foundation of modern FMS in 1972 by describing widespread pain and tender points. The first sleep electroencephalogram study was performed in 1975. The first controlled clinical study with validation of known symptoms and tender points was published in 1981. This same study also proposed the first data-based criteria. The important concept that FMS and other similar conditions are interconnected was proposed in 1984. The first American College of Rheumatology criteria were published in 1990 and neurohormonal mechanisms with central sensitization were developed in the 1990s. Serotonergic/norepinephric drugs were first shown to be effective in 1986.