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Feature Article

Fibromyalgia: towards mechanism-targeted therapy

Emma Guymer, Geoffrey O Littlejohn

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Abstract

Fibromyalgia is a common syndrome, with significantly diminished personal health and wide ranging downstream societal costs. Better understanding of the intertwined genetic, personality, neurobiological and psychological aspects involved in the condition is allowing the development of mechanism-targeted therapy.

Key Points

  • The syndrome fibromyalgia is characterised by persistent widespread pain and abnormal tenderness, usually with sleep disturbance, fatigue, stiffness and high levels of emotional distress.
  • A complex mix of influences, including genetic, neurobiological, psychological and behavioural factors, contributes to fibromyalgia.
  • The musculoskeletal pain sensitisation process of the syndrome is complex and varies from patient to patient.
  • Management of fibromyalgia is based on the individual patient’s key symptoms and should begin with patient education.
  • Nondrug treatments of proven efficacy include aerobic exercise, relaxation programs, psychological therapies, physical therapies such as massage and mobilisation, and acupuncture.
  • Pharmacotherapy aims to target specific mechanisms involved in fibromyalgia. Drugs affecting neurochemicals, such as tricyclic antidepressants and the serotonin and noradrenaline reuptake inhibitors, generally seem to be the most effective. Some of the medications used overseas are not yet available in Australia.

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