الفهرس 
Epidemiology & Etiopathology of FibromyalgiaOnly 14 pages are availabe for public view
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Abstract
F
MS is a very common condition, estimated to affect 2% to 4% of the population although local epidemiologic study is lacking. It has a prevalence of 3.4% in women versus only 0.5% in men with a female-to-male ratio of approximately 9:1.
The etiology of FM remains unknown, and the findings of studies of its potential pathophysiological mechanisms are conflicting. FM patients lack consistent tissue abnormalities and show features of hyperalgesia (increased sensitivity to painful stimuli) and allodynia (a lowered pain threshold). Emerging evidence points toward augmented pain processing within the central nervous system (CNS) as having a primary role in the pathophysiology of this disorder.
The primary pathophysiology in FM engages interactions between genetic and environmental factors. A surge of physiological, psychological, behavioral, and cognitive factors in FM interact to manifest in various symptoms and comorbidities.
Diagnosis of FM involves assessment of pain and other symptoms. In 1990 the American College of Rheumatology (ACR) established diagnostic criteria for FM including chronic widespread pain (CWP) for at least 3 months and pain on at least 11 of 18 specified muscle tendon sites of focal tenderness (tender points) on digital palpation using a force of approximately 4 kg/cm2 .
Recently, a simple clinical case definition of fibromyalgia was developed. It correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.
Optimal management of fibromyalgia involves both pharmacological and nonpharmacological interventions. The American Pain Society Fibromyalgia Panel recommends a multidisciplinary clinical approach, including education, cognitive behavioral strategies, physical training and medications for treatment of fibromyalgia.
Duloxetine and milnacipran, two selective serotonin and norepinephrin inhibitors and pregabalin, an alpha2-delta agonist, have been approved by Food and Drug Administration for the treatment of FM symptoms. On the contrary, The European Medicines Agency did not approve any specific treatment for the symptoms of FM up to now. These drugs and a variety of other compounds are used for the management of FM based on their clinically meaningful and durable effect on pain in monotherapy trials and their beneficial effect on other symptom domains, such as fatigue, sleep alterations, cognition, and function. Adjunctive therapy with medicines targeted to specific symptom domains, such as mood and sleep as well as treatments aimed toward common comorbid conditions, such as chronic fatigue or headache or disease states, such as rheumatoid arthritis should be considered for the purpose of reducing the patient’s overall symptom burden