A history of present illness typically reveals the insidious onset of a classic constellation of symptoms that includes flu-like achiness, fatigue, muscular stiffness, and chronic early/middle insomnia. The first clue may be the difficulty that members of the clinical staff have in eliciting a single chief complaint, given that patients are commonly beset with multiple symptoms involving a variety of systems. The astute clinician should therefore maintain a relatively high index of suspicion for its presence. Patients with FM comprise a substantial subpopulation in the primary care setting. Clinical Presentation and Diagnostic Considerations Among the most important objective findings associated with FM are abnormalities on sleep electroencephalograms (EEG) abnormal cerebrospinal fluid concentrations of a variety of neurochemicals related to pain modulation abnormal brain activation in response to noxious stimulation as demonstrated by functional magnetic resonance imaging (fMRI) an acceleration of normal, age-related cortical brain atrophy and a disruption of dopaminergic neurotransmission as demonstrated by positron emission tomography (PET) under baseline conditions and in response to tonic pain. While FM has been historically considered a musculoskeletal disorder, research conducted over the last 2 decades has increasingly implicated the central nervous system as the seat of FM pathophysiology. In addition to chronic pain, patients typically experience a variety of other symptoms involving multiple body systems ( table 2). Although references to FM appear in medical literature as early as the turn of the 20th century, it was not until 1990 that the American College of Rheumatology (ACR) formalized the classification criteria for FM ( table 1). It has been estimated to affect as many as 10 million Americans and occurs disproportionately among women. Fibromyalgia (FM) is a condition characterized by the presence of chronic widespread pain and tenderness upon light manual palpation.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |