Zeitschrift für Rheumatologie
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Integration of nociceptive signaling comprises peripheral, spinal, and supraspinal sites of the nervous system. Various excitatory or inhibitory neurotransmitter and--modulator systems participate in pain processing and modulation. Chronic pain states are associated with functional and structural alterations of nociceptive pathways. The numerous dynamic changes in the pharmacologically distinct systems offer novel targets for selective pharmacotherapy.
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Fibromyalgia patients hardly suffer from major psychiatric illnesses. Most often, persistent somatoform pain disorder (ICD-10) and dysthymia are identified by psychiatric assessment. ⋯ Repeated traumatic experiences during childhood and as adults can be discovered in many cases, which helps to understand some of the difficulties met in psychotherapy with FMS patients. Modified psychotherapy techniques are recommended using pain-centered behavioral methods initially, and progressing only later to an insight orientated approach.
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Psychosocial distress and psychological abnormality occurs frequently in fibromyalgia patients. Patterns of decreased levels of education, and increased rates of divorce, obesity, and smoking have been noted in clinical and epidemiological studies. Links to physical and sexual abuse have been noted as well. Major depression as well as increased rates of depression, anxiety, and somatization are also commonly found in fibromyalgia.