Fibromyalgia (FM), Chronic Fatigue Syndrome (CFS), & myofascial pain (MPS)

Epidemiologic studies continue to provide evidence that fibromyalgia
is part of a spectrum of chronic widespread pain. The
prevalence of chronic widespread pain is several times higher
than fibromyalgia as defined by the 1990 American College of
Rheumatology guidelines. There is now compelling evidence of a
familial clustering of fibromyalgia cases in female sufferers;
whether this clustering results from nature or nature remains
to be elucidated. A wide spectrum of fibromyalgia- associated
symptomatology and syndromes continues to be described. During
the past year the association with interstitial cystitis has
been explored, and neurally mediated hypotension has been
documented in both fibromyalgia and chronic fatigue syndrome.
Abnormalities of the growth hormone-insulin-like growth
factor-1 axis have been also documented in both fibromyalgia
and chronic fatigue syndrome. The commonly reported but
anecdotal association of fibromyalgia with whiplash-type neck
trauma was validated in a report from Israel. However, unlike
North America, 100% of Israeli patients with posttraumatic
fibromyalgia returned to work. Basic research in fibromyalgia
continues to pinpoint abnormal sensory processing as being
integral to understanding fibromyalgia pain. Drugs such as
ketamine, which block N-methyl-D-aspartate receptors (which
are often upregulated in central pain states) were shown to
benefit fibromyalgia pain in an experimental setting. The
combination of fluoxetine and amitriptyline was reported to be
more beneficial than either drug alone in patients with
fibromyalgia. A high prevalence of autoantibodies to
cytoskeletal and nuclear envelope proteins was found in
chronic fatigue syndrome, and an increased prevalence of
antipolymer antibodies was found in symptomatic silicone
breast implant recipients who often have fibromyalgia.

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