الفهرس 
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Abstract
The ACR 1990 classification criteria for FM have been the gold-standard criteria for diagnosing this disorder for the last 20 years. However, there are numerous shortcomings with the previous criteria, which did not take into account the importance of common symptoms including significant fatigue, forgetfulness, sleep problems and an impaired ability to function doing normal activities. The brain will not reveal its secrets easily, particularly when subjective perceptual phenomena are being studied. The FM symptoms have not been explained by peripheral mechanisms alone or by specific CNS mechanisms. The recent imaging of the brain using minimally invasive techniques such as fMRI, DTI,VBM and 1H-MRS have been impressive, but the results are still of modest clinical significance. Although various pharmacological treatments have been studied for treating FM, no single drug has proved to be useful in treating FM patients. However, FDA has approved three drugs for the treatment of FM; pregabalin, duloxetine and milnacipran. All three drugs have shown similar efficacy in pain management, but their abilities to manage other FM symptoms are not the same. Their different pharmaco-dynamic and safety profiles, often make one a better initial choice than the others for an individual patient. Non-pharmaceutical treatment including patient’s education, exercise, physical therapy, massage, acupuncture and CBT can be helpful. Few of these approaches have been demonstrated to have clear-cut benefits for FM patients in RCT. The multifaceted nature of FM suggests that multimodal individualized treatment programs may be necessary to achieve optimal outcomes in patients with this puzzling syndrome. Conclusion: The pathophysiology of FM remains uncertain but it is believed to be partly the result of CNS dysfunction. The advanced neuroimaging techniques such as fMRI, DTI, VBM and 1H-MRS have recently provided clinicians with interesting informations about ongoing pathological changes in FM. Therefore, these techniques may be used as diagnostic tools in the future. The revised or new ACR criteria for FM may help developing better diagnostic method of this disease as it does not rely on TPs examination. It is important to note that the new criteria is not to replace the ACR 1990 classification criteria, but to represent an alternative method of diagnosis. However, the new criteria should still be viewed as preliminary criteria with 82.9% sensitivity and 96.0% specificity and further modification of this criteria may emerge soon. FM has received a lot more attention over the last couple of years promoting three drugs approved by FDA, pregabalin (Lyrica, 150 mg/day in two or three divided doses), duloxetine (Cymbalta, 60 mg once daily) and milnacipran (Savella, 50 mg twice daily). However, FM patients experienced significantly reduced pain and greater overall improvement when taking milnacipran or duloxetine in addition to the pregabalin.