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Other books in the series. Miniatlas 1 - 10 of 38 books. Trivia About Anatomy Miniatlas. No trivia or quizzes yet. Welcome back. Just a moment while we sign you in to your Goodreads account. Accordingly, a study that employed functional magnetic resonance imaging to evaluate brain responses to experimental pain among people with fibromyalgia found that depressive symptoms were associated with the magnitude of clinically induced pain response specifically in areas of the brain that participate in affective pain processing, but not in areas involved in sensory processing which indicates that the amplification of the sensory dimension of pain in fibromyalgia occurs independently of mood or emotional processes.
Non-celiac gluten sensitivity NCGS may be an underlying cause of fibromyalgia symptoms but further research is needed. Abnormalities in the ascending and descending pathways involved in processing pain have been observed in fibromyalgia. Fifty percent less stimulus is needed to evoke pain in those with fibromyalgia.
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There is also some data that suggests altered dopaminergic and noradrenergic signaling in fibromyalgia. Studies on the neuroendocrine system and HPA axis in fibromyalgia have been inconsistent. One study found fibromyalgia patients exhibited higher plasma cortisol , more extreme peaks and troughs, and higher rates of dexamethasone non suppression.
However, other studies have only found correlations between a higher cortisol awakening response and pain, and not any other abnormalities in cortisol. Autonomic nervous system abnormalities have been observed in fibromyalgia, including decreased vasoconstriction response, increased drop in blood pressure and worsening of symptoms in response to tilt table test , and decreased heart rate variability.
Heart rate variabilities observed were different in males and females. Disrupted sleep, insomnia , and poor-quality sleep occur frequently in FM, and may contribute to pain by decreased release of IGF-1 and human growth hormone , leading to decreased tissue repair. Restorative sleep was correlated with improvement in pain related symptoms.
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Neuroimaging studies have observed decreased levels of N -acetylaspartic acid NAA in the hippocampus of people with fibromyalgia, indicating decreased neuron functionality in this region. Altered connectivity and decreased grey matter of the default mode network ,  the insula , and executive attention network have been found in fibromyalgia. Increased levels of glutamate and glutamine have been observed in the amygdala, parts of the prefrontal cortex , the posterior cingulate cortex , and the insula, correlating with pain levels in FM.
Decreased GABA has been observed in the anterior insular in fibromyalgia. However, neuroimaging studies, in particular neurochemical imaging studies, are limited by methodology and interpretation. Overlaps have been drawn between chronic fatigue syndrome and fibromyalgia.
One study found increased levels of pro-inflammatory cytokines in fibromyalgia, which may increase sensitivity to pain, and contribute to mood problems. There is no single test that can fully diagnose fibromyalgia and there is debate over what should be considered essential diagnostic criteria and whether an objective diagnosis is possible. In most cases, people with fibromyalgia symptoms may also have laboratory test results that appear normal and many of their symptoms may mimic those of other rheumatic conditions such as arthritis or osteoporosis.
The most widely accepted set of classification criteria for research purposes was elaborated in by the Multicenter Criteria Committee of the American College of Rheumatology. These criteria, which are known informally as "the ACR ", define fibromyalgia according to the presence of the following criteria:.
The ACR criteria for the classification of patients were originally established as inclusion criteria for research purposes and were not intended for clinical diagnosis but have now become the de facto diagnostic criteria in the clinical setting. The number of tender points that may be active at any one time may vary with time and circumstance.
A controversial study was done by a legal team looking to prove their client's disability based primarily on tender points and their widespread presence in non-litigious communities prompted the lead author of the ACR criteria to question now the useful validity of tender points in diagnosis. In , the American College of Rheumatology approved provisional revised diagnostic criteria for fibromyalgia that eliminated the criteria's reliance on tender point testing.
The WPI counts up to 19 general body areas [a] in which the person has experienced pain in the preceding two weeks. The SS rates the severity of the person's fatigue, unrefreshed waking, cognitive symptoms, and general somatic symptoms, [b] each on a scale from 0 to 3, for a composite score ranging from 0 to The revised criteria for diagnosis are:. Some research has suggested not to categorise fibromyalgia as a somatic disease or a mental disorder, but to use a multidimensional approach taking into consideration somatic symptoms, psychological factors, psychosocial stressors and subjective belief regarding fibromyalgia.
As many as two out of every three people who are told that they have fibromyalgia by a rheumatologist may have some other medical condition instead. The differential diagnosis is made during the evaluation on the basis of the person's medical history , physical examination, and laboratory investigations. As with many other medically unexplained syndromes , there is no universally accepted treatment or cure for fibromyalgia, and treatment typically consists of symptom management. Developments in the understanding of the pathophysiology of the disorder have led to improvements in treatment, which include prescription medication, behavioral intervention, and exercise.
Indeed, integrated treatment plans that incorporate medication, patient education, aerobic exercise and cognitive behavioral therapy have been shown to be effective in alleviating pain and other fibromyalgia-related symptoms. Antidepressants are "associated with improvements in pain, depression, fatigue, sleep disturbances, and health-related quality of life in people with FMS. A small number of people benefit significantly from the SNRIs duloxetine and milnacipran and the tricyclic antidepressants TCAs , such as amitriptyline.
However, many people experience more adverse effects than benefits. It can take up to three months to derive benefit from the antidepressant amitriptyline and between three and six months to gain the maximal response from duloxetine, milnacipran, and pregabalin.
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Some medications have the potential to cause withdrawal symptoms when stopping so gradual discontinuation may be warranted particularly for antidepressants and pregabalin. There is tentative evidence that the benefits and harms of selective serotonin reuptake inhibitors SSRIs appear to be similar.
Tentative evidence suggests that monoamine oxidase inhibitors MAOIs such as pirlindole and moclobemide are moderately effective for reducing pain. The anti-convulsant medications gabapentin and pregabalin may be used to reduce pain. The use of opioids is controversial. As of , no opioid is approved for use in this condition by the FDA. They strongly advise against using strong opioids. They discourage the use of strong opioids and only recommend using them while they continue to provide improved pain and functioning.
Healthcare providers should monitor people on opioids for ongoing effectiveness, side effects and possible unwanted drug behaviors.
Miniatlas Anatomia by Luis Raúl Lépori
The European League Against Rheumatism in recommends tramadol and other weak opioids may be used for pain but not strong opioids. A large study of US people with fibromyalgia found that between and A review concluded that a period of nine months of growth hormone was required to reduce fibromyalgia symptoms and normalize IGF However, this medication was not approved by the FDA for the indication for use in people with fibromyalgia due to the concern for abuse. The muscle relaxants cyclobenzaprine , carisoprodol with acetaminophen and caffeine and tizanidine are sometimes used to treat fibromyalgia; however as of they are not approved for this use in the United States.
Dopamine agonists e. There is some evidence that 5HT 3 antagonists may be beneficial. Very low-quality evidence suggests quetiapine may be effective in fibromyalgia.
No high-quality evidence exists that suggests synthetic THC nabilone helps with fibromyalgia. Intravenous Iloprost may be effective in reducing frequency and severity of attacks for people with fibromyalgia secondary to scleroderma. Due to the uncertainty about the pathogenesis of FM, current treatment approaches focus on management of symptoms to improve quality of life,  using integrated pharmacological and non-pharmacological approaches.