Article information
Resumen
El síndrome fibromiálgico es un síndrome clínico caracterizado por dolor crónico generalizado y reducción de los umbrales del dolor a la palpación. La fisiopatología sigue siendo desconocida, pero cada vez hay más evidencia de que la sensibilización periférica y central provocan una amplificación de los impulsos sensoriales que puede alterar la percepción del dolor en los pacientes.
En su tratamiento resulta fundamental el abordaje multidisciplinario en contraposición a un abordaje biomédico tradicional, dada la enorme complejidad que suelen presentar estos pacientes. El tratamiento debe ser dirigido por el médico, quien hace el diagnóstico y coordina el equipo interdisciplinario, en el que el fisioterapeuta hace la evaluación inicial y realiza el tratamiento de rehabilitación integral y el psicólogo lleva a cabo la evaluación inicial y el tratamiento cognitivo conductual.
En esta revisión, encontraremos las tres áreas más importantes del tratamiento del síndrome fibromiálgico, profundizando en el tratamiento farmacológico y fisioterapéutico, según análisis bibliográfico de la evidencia científica más actual.
Palabras clave:
síndrome fibromiálgico
farmacoterapia
fisioterapia
Summary
The Fibromyalgia Syndrome is a clinical syndrome of chronic widespread pain and reduced pain thresholds to palpation. The pathophysiology remains unknown, but there is increasing evidence that peripheral and central sensitization cause an amplification of sensory impulses that may alter pain perception in Fibromyalgia Syndrome patients. The multidisciplinary approach for its treatment is very important, against the traditional biomedical approach, because of the high complexity of the patients.
Treatment should be directed by the physician, who makes the diagnosis and coordinates the interdisciplinary team, in which the psychologist conducting the initial assessment and cognitive behavioral therapy and the therapist makes the initial assessment and performs comprehensive rehabilitation treatment.
In this review, we find the three most important areas of treatment of fibromyalgia syndrome, furthering the pharmacological treatment and physiotherapy, as literature review the most current scientific evidence.
Key words:
fibromyalgia syndrome
pharmacotherapy
physiotherapy
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Referencias
[1.]
D.L. Goldenberg.
Fibromyalgia syndrome: an emerging but controversial condition.
JAMA, 257 (1997), pp. 2782-2787
[2.]
V.L. Villanueva, J.C. Valía, G. Cerdá, V. Monsalve, M.J. Bayona, J. de Andrés.
Fibromyalgia: diagnosis and treatment. Current knowledge.
Rev Soc Esp Dolor, 11 (2004), pp. 430-443
[3.]
F. Wolfe, H.A. Smythe, M.B. Yunus, R.M. Bennett, C. Bombardier, D.L. Goldenberg, P. Tugwell, et al.
Criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee.
Arthritis Rheum, 33 (1990), pp. 160-172
[4.]
F. Inanici, O. Özdemir, T. Aydo, A. Sendil, Y. Kutsal, Z. Hasçelik.
The frequency of fibromyalgia in sport professionals.
Rheumatol Intern, (2010), pp. 1567-1572
[5.]
J. Ferran.
Revista informativa Institut Ferran de Reumatologia.
Texto elaborado por la asociación británica Action for M.E, (2008), pp. 2-16
[6.]
N. Tastekin, K. Uzunca, N. Sut, M. Birtane.
Discriminative Value of Tender Points in Fibromyalgia Syndrome.
Pain medicine, 11 (2010), pp. 466-471
[7.]
A. Vargas, A. Vargas, R. Hernandez-Paz, J.M. Sanchez-Huerta, R. Romero-Ramirez, L. mezcua-Guerra, et al.
Sphygmomanometry-evoked allodynia-a simple bedside test indicative of fibromyalgia: a multicenter developmental study.
J Clin Rheumatol, 12 (2006), pp. 272-274
[8.]
D.L. Goldenberg.
Fibromyalgia.
pp. 1-16
[9.]
R.W. Simms.
Is there muscle pathology in fibromyalgia syndrome?.
Rheum Dis Clin North Am, 22 (1996), pp. 245-266
[10.]
S.R. Pillemer, L.A. Bradley, L.J. Crofford, H. Moldofsky, G.P. Chrousos.
The neuroscience and endocrinology of fibromyalgia.
Arthritis Rheum, 40 (1997), pp. 1928-1939
[11.]
R.P. Sheon, R.W. Moskowitz, V.M. Goldberg.
Fibromyalgia and other generalized soft tissue rheumatic disorders. Soft tissue rheumatic pain: recognition, management, prevention.
3a, Williams, Wilkins, (1996), pp. 275-281
[12.]
J. Sörensen, A. Bengtsson, J. Ahlner, K.G. Henriksson, L. Ekselius, M. Bengtsson.
Fibromyalgia. Are there different mechanisms in the processing of pain? A double blind crossover comparison of analgesic drugs.
J Rheumatol, 24 (1997), pp. 1615-1621
[13.]
J.M. Mountz, L.A. Bradley, J.G. Modell.
Fibromyalgia in women: abnormalities of regional cerebral blood flow in thalamus and the caudate nucleus are associated with low pain threshold levels.
Arthritis Rheum, 38 (1995), pp. 926-938
[14.]
I.J. Russell, H. Vaeroy, F. Nyberg.
Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis.
Arthritis Rheum, 35 (1992), pp. 550-556
[15.]
J.N. Ablin, A. Bar-Shira, M. Yaron, A. Orr-Urtreger.
Candidate-gene approach in fibromyalgia syndrome: association analysis of the genes encoding substance P receptor, dopamine transporter and alpha1- antitrypsin.
Clin Exp Rheumatol, 27 (2009), pp. 33-38
[16.]
T. Graven-Nielsen, S. Aspegren, K.G. Henriksson, M. Bengtsson, J. Sopensen, A. Johnson, et al.
Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients.
Pain, 39 (1989), pp. 171-180
[17.]
E. Yasser, R. Yasser, Z. Fatma.
Hippocampus Dysfunction May Explain Symptoms of Fibromyalgia Syndrome. A Study with Single-Voxel Magnetic Resonance Spectroscopy.
J Rheumatol, 35 (2008), pp. 1371-1377
[18.]
R. Staud, C. Vierck, M. Robinson, D. Price.
Effects of the N-methyl D-aspartate receptor antagonist dextromethorphan on temporal summation of pain are similar in fibromyalgia patients and normal control subjects.
Pain, 6 (2005), pp. 323-332
[19.]
A. Mhalla, D. Ciampi de Andrade.
Alteration of cortical excitability in patients with fibromyalgia.
International Association for the Study of Pain, 149 (2010), pp. 495-500
[20.]
C.J. Vierck Jr..
Mechanisms underlying development of spatially distributed chronic pain (fibromyalgia).
Pain, 124 (2006), pp. 242-263
[21.]
T. Graven-Nielsen, Y. Jansson, M. Segerdahl, J.D. Kristensen, S. Mense, L. Arendt-Nielsen, A. Sollevi.
Experimen tal pain by ischaemic contractions compared with pain by intramuscular infusions of adenosine and hypertonic saline.
European Journal of Pain, 7 (2003), pp. 93-102
[22.]
A. Jones.
The role of the cerebral cortex in pain perception. In Justins Douglas M. Refresher Course Syllabus.
An updated review Pain, (2005), pp. 59-68
[23.]
R. Suzuki, W. Rahman, S. Hunt, A. Dickenson.
Descending facilitatory control of mechanically evoked responses is enhanced in deep dorsal horn neurones following peripheral nerve injury.
Brain Research, 1019 (2004), pp. 68-76
[24.]
Plasticity and pain;role of the dorsal horn.
Text book of pain, pp. 91-105
[25.]
L. Bendtsen, J. Norregaard, R. Jensen, J. Olesen.
Evidence of qualitatively altered nociception in patients with fibromyalgia.
Arthritis and Rheumatism, 40 (1997), pp. 98-102
[26.]
K.G. Henriksson.
Fibromyalgia - from syndrome to disease. Overview of pathogenetic mechanisms.
Journal of Rehabilitation Medicine, 41 (2003), pp. 89-94
[27.]
T. Graven-Nielsen, S. Aspegren, K. Henriksson, M. Bengtsson, J. Sörensen, A. Johnson, B. Gerdle, L. Arendt-Nielsen.
Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients.
Pain, 85 (2000), pp. 483-491
[28.]
S. Mense.
Referral of muscle pain.
New aspects ASP Journal, 3 (1994), pp. 1-9
[29.]
K. Ren, R. Dubner.
Descending modulation in persistent pain. An update.
Pain, (2002), pp. 1-6
[30.]
K. Kosek, J. Ekholm, P. Hansson.
Modulation of pressure pain thresholds during and following isometeric contraction in patients with fibromyalgia and in healthy controls.
Pain, 64 (1996), pp. 415-423
[31.]
R. Staud, M.E. Robinson, D.D. Price.
Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls.
Pain, 118 (2005), pp. 176-184
[32.]
R. Suzuki, L.J. Rygh, A.H. Dickenson.
Bad news from the brain. Descending 5-HT pathways that control spinal pain processing.
Trends in Pharmacological Sciences, 25 (2004), pp. 613-617
[33.]
R. Bennett.
Fibromyalgia: Present to future.
Current Pain and Headache Reports, 8 (2004), pp. 379-384
[34.]
D.J. Clauw, L.J. Crofford.
Chronic widespread pain and fibromyalgia: what we know, and what we need to know.
Best Practice & Research Clinical Rheumatology, 17 (2003), pp. 685-701
[35.]
S.M. Gelman, S. Lera, F. Caballero, M.J. López.
Tratamiento multidisciplinario de la Fibromialgia. Estudio piloto prospectivo controlado.
Rev Esp Reumat, 29 (2002), pp. 323-329
[36.]
M. López, J. Mingote.
Fibromialgia.
Clínica y Salud, 19 (2008), pp. 343-358
[37.]
A. Collado, J. Alijotas, P. Benito, C. Alegre, M. Romera, I. Sanudo, et al.
Documento de consenso sobre el diagnóstico y tratamiento de la fibromialgia en Cataluña.
Med Clin, 118 (2002), pp. 745-749
[38.]
J. Rivera, C. Alegre-De Miguel, J. Ballina, J. Carbonell, L. Carmona, B. Castel, et al.
Documento de consenso de la Sociedad Española de Reumatología sobre la fibromialgia.
Reumatol Clin, 2 (2006), pp. 38-49
[39.]
S.F. Carville, S. 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, 67 (2008), pp. 536-541
[40.]
D.L. Goldenberg, C. Burckhardt, L. Crofford.
Management of fibromyalgia syndrome.
JAMA, 292 (2004), pp. 2388-2395
[41.]
L. Collins, A. Moore, McQuay, P. Wiffen.
Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review.
J Pain Symptom Manage, 20 (2000), pp. 449-458
[42.]
L.J. Crofford, P.J. Mease, S.L. Simpson, J.P. Young Jr., S.A. Martin, G.M. Haig, U. Sharma.
Fibromyalgia relapse evaluation and efficacy for durability of mean- ingful relief (FREEDOM): a 6-months, doubleblind, placebo-controlled trial with pregabalin.
Pain, 136 (2008), pp. 419-431
[43.]
W. Häuser, K. Bernardy, N. Uçeyler, C. Sommer.
Treatment of fibromyalgia syndrome with gabapentin and pregabalin: a meta-analysis of randomized controlled trials.
Pain, 145 (2009), pp. 69-81
[44.]
L.M. Arnold, D.L. Goldenberg, S.B. Stanford, et al.
Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial.
Arthritis Rheum, 56 (2007), pp. 1336-1344
[45.]
K. Kosek, J. Ekholm, P. Hansson.
Modulation of pressure pain thresholds during and following isometeric contraction in patients with fibromyalgia and in healthy controls.
Pain, 64 (1996), pp. 415-423
[46.]
R. Staud, M.E. Robinson, D.D. Price.
Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls.
Pain, 118 (2005), pp. 176-184
[47.]
T.R. Zijlstra, P.J. Barendregt, M.A. van de Laar.
Venlafaxine in fibromyalgia: results of a randomized, placebocontrolled, double-blind trial.
Arthritis Rheum, 46 (2002), pp. S105
[48.]
L.M. Arnold, A. Rosen, Y.L. Pritchett, D.N. D'Souza, D.J. Goldstein, S. Iyengar, et al.
A randomized, doubleblind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder.
Pain, 119 (2005), pp. 5-15
[49.]
L. Arnold, Y. Pritchett, D. D'Souza, D. Kajdasz, S. Iyengar, J. Wernicke.
Duloxetine for the treatment of fibromyalgia in women: pooled results from two randomized, placebo-controlled clinical trials.
J Womens Health (Larchmt), 16 (2007), pp. 1145-1156
[50.]
P.J. Mease, D.J. Clauw, R.M. Gendreau, S.G. Rao, J. Kranzler, W. Chen, et al.
The efficacy and safety of milnacipran for treatment of fibromyalgia. A randomized, double-blind, placebo-controlled trial.
J Rheumatol, 36 (2009), pp. 398-399
[51.]
A. Patkar, S. Masand, S. Krulewicz, P. Mannelli, K. Peindl, L. Beebe, et al.
A randomized controlled, trial of controlled release paroxetine in fibromyalgia.
Am J Med, 120 (2007), pp. 448-454
[52.]
I.J. Russell, A.T. Perkins, J.E. Michalek.
Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebocontrolled, multicenter clinical trial.
Arthritis Rheum, 60 (2009), pp. 299-309
[53.]
D.L. Goldenberg, C. Burckhardt, L. Crofford.
Management of fibromyalgia syndrome.
JAMA, 292 (2004), pp. 2388-2395
[54.]
L.M. Arnold, P.E. Keck.
Antidepressant treatment of fibromyalgia: A meta-analysis and review.
Psychosomatics, 41 (2000), pp. 104-113
[55.]
D.L. Goldenberg.
Update on the treatment of fibromyalgia.
Bull Rheum Dis, 53 (2004), pp. 1-7
[56.]
L.M. Arnold, P.E. Keck Jr., J.A. Welge.
Antidepressant treatment of fibromyalgia: a meta analysis and review.
Psychosomatics, 41 (2000), pp. 104-113
[57.]
P. O’Malley, E. Balden, G. Tomkins, J. Santoro, K. Kroenke, J.L. Jackson.
Treatment of fibromyalgia with antidepressants A meta-analysis.
J Gen Intern Med, 15 (2000), pp. 659-666
[58.]
U.M. Anderberg, I. Marteinsdottir, L. Von-Knorring.
Citalopram in patients with fibromyalgia: a randomized, double-blind, placebo-controlled study.
Eur J Pain, 4 (2000), pp. 27-35
[59.]
Önder Özerbil, Nilsel Okudan, Hakký Gökbe.
Comparison of the effects of two antidepressants on exercise performance of the female patients with fibromyalgia.
Clin Rheumatol, 25 (2006), pp. 495-497
[60.]
W. Häuser, K. Bernardy, N. Uçeyler, C. Sommer.
Treatment of fibromyalgia syndrome with antidepressants: a meta-analysis.
JAMA, 301 (2009), pp. 198-199
[61.]
J.K. Tofferi, J.L. Jackson, P.G. O’Malley.
Treatment of fibromyalgia with cyclobenzaprine: a meta-analysis.
Arthritis Rheum, 51 (2004), pp. 9-13
[62.]
Y. Xaio, J.E. Michalek, I.J. Russell.
Effects of tizanidine on cerebrospinal fluid substance P in patients with fibromyalgia.
The Royal Society of Medicine Press, The Trinity Press, (2002), pp. 23-28
[63.]
L.A. Rossy, S.P. Buckelew, N. Dorr, K.J. Hagglund, J.F. Thayer, M.J. McIntosh, et al.
A meta-analysis of fibromyalgia treatment interventions.
Ann Behav Med, 21 (1999), pp. 180-191
[64.]
R.M. Bennett, M. Kamin, R. Karim, N. Rosenthal.
Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study.
Am J Med, 114 (2003), pp. 537-545
[65.]
I. Russell, E. Fletcher, J. Michalek, P. McBroom, G. Hester.
Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam: a doubleblind, placebo-controlled study.
Arthritis Rheum, 34 (1991), pp. 552-560
[66.]
D. Fishbain, R. Cutler, H. Rosomoff, R. Rosomoff.
Clonazepam open clinical treatment trial for myofascial syndrome associated chronic pain.
Pain Med, 1 (2000), pp. 332-339
[67.]
V. Viola, H.H. Newnham, R.W. Simpson.
Treatment of intractable painful diabetic neuropathy with intravenous lignocaine.
J Diabetes Complications, 20 (2006), pp. 34-39
[68.]
J.A. Micó, D. Ardid, E. Berrocoso, A. Eschalier.
Antidepressants and pain.
Trends Pharmacol Sci, 27 (2006), pp. 348-354
[69.]
J. Russell, T. Perkins, E. Michalek.
Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: A randomized, double-blind, placebo-controlled, multicenter clinical trial.
Arthritis Rheum, 60 (2009), pp. 299-309
[70.]
H. Moldofsky, F.A. Lue, C. Mously, B. Roth-Schechter, W.J. Reynolds.
The effect of zolpidem in patients with fibromyalgia: A dose ranging, double blind, placebo controlled, modified crossover study.
J Rheumatol, 23 (1996), pp. 529-533
[71.]
P. Morillas-Arques, C.M. Rodriguez.
Trazodone for the treatment of fibromyalgia: an open-label, 12-week study.
BMC Musculoskeletal Disorders, 11 (2010), pp. 204-210
[72.]
C.B. Pert, S.H. Snyder.
Opiate receptor demonstration in nervous tissue.
Science, 179 (1973), pp. 1011-1014
[73.]
B.H. Siolund, L. Terenius, M. Eriksson.
Increased cerebrospinal fluid levels of endorphins after electroacupunture.
Acta Physiol Scand, 100 (1977), pp. 382-384
[74.]
J. Mannheimer, G. Lampe.
Clinical Transcutaneous Electrical Nerve Stimulation, Philadelphia.
Davis, (1984), pp. 331-345
[75.]
A. Kalra, M.O. Urban, K.A. Sluka.
Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS).
J Pharmacol Exp Ther, 298 (2001), pp. 257-263
[76.]
I. Russell, M. Orr, B. Littman, G. Vipraio, D. Alboukrek, J. Michalek, Y. Lopez, F. MacKillip.
Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome.
Anhritis Rheum, 37 (1994), pp. 1593-1601
[77.]
H. Vaerøy, R. Helle, O. Førre, E. Kåss, L. Terenius.
Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis.
Pain, 32 (1988), pp. 21-26
[78.]
M. Cameron.
Physical Agents in Rehabilitation: From Research to Practice.
2nd, Saunders, (2003),
[79.]
U. Johannesson, C.N. de Boussard, G. Brodda, N. Bohm- Starke.
Evidence of diffuse noxious inhibitory controls (DNIC) elicited by cold noxious stimulation in patients with provoked vestibulodynia.
Pain, 130 (2007), pp. 31-39
[80.]
K. Matsushita, A. Masuda, C. Tei.
Efficacy of Waon therapy for fibromyalgia.
Intern Med, 47 (2008), pp. 1473-1476
[81.]
S. Matsumoto, M. Shimodozono, S. Etoh, R. Miyata, K. Kawahira.
Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia.
Complementary Therapies in Clinical Practice, 10 (2010), pp. 1-5
[82.]
Busch AJ, Barber KAR, Overend TJ, Peloso PMJ, Schachter CL. Ejercicio para el tratamiento del síndrome de fibromialgia (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2008 Número 2. Oxford: Update Software Ltd. Disponible en: http://www.update-software.com. (Traducida de The Cochrane Library, 2008 Issue 2. Chichester, UK: John Wiley & Sons, Ltd.).
[83.]
M. Comeche, A. Martín.
Tratamiento cognitivoconductual, protocolizado y en grupo, de la fibromialgia.
Clínica y salud, 21 (2010), pp. 107-110
Copyright © 2010. Asociación Colombiana de Reumatología
