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Fibromyalgi

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Sakkunnig:
Definition:
Fibromyalgi är en smärtsjukdom som karakteriseras av långvarig utbredd smärtkänslighet i framförallt muskulatur, hud och leder samt ömhet vid beröring. Faktorer som regionalt smärtsyndrom, stressorer, trauma och infektioner kan föregå/trigga sjukdomen.
Förekomst:
Prevalensen i befolkningen i olika europeiska länder, USA, Kanada och Israel är relativt likartad, cirka 2 % varav cirka 80 % är kvinnor.
Symtom:
Symtombilden är framförallt långvarig utbredd smärta och onormal ömhet i kroppen, ofta i kombination med handikappande trötthet, sömnstörning och störningar i koncentrations- och minnesförmåga.
Kliniska fynd:
Smärtan vid fibromyalgi är lokaliserad i samtliga fyra kroppskvadranter samt axialt (längs ryggraden). Sådan utbredd smärta ska ha förelegat i minst tre månader.
Diagnostik:
Diagnosen ställs genom att patienten uppfyller internationellt fastställda kriterier. En viktig del i diagnostiken är att utesluta andra sjukdomar och att identifiera eventuell samsjuklighet.
Behandling:
Botande behandling saknas. Behandlingen riktar sig mer mot enskilda symtom och samsjuklighet, och kan förutom råd om aktivitetsanpassning och information om sjukdomen bestå av läkemedel, fysioterapi och KBT.
  1. Chinn S, Caldwell W, Gritsenko K. Fibromyalgia Pathogenesis and Treatment Options Update. Curr Pain Headache Rep. 2016 Apr;20(4):25. pmid:26922414 PubMed  
  2. Rahman A, Underwood M, Carnes D. Fibromyalgia. BMJ. 2014 Feb 24;348:g1224. doi: 10.1136/bmj.g1224. DOI  
  3. Clauw DJ. Fibromyalgia: a clinical review. 2014 Apr 16;311(15):1547-55. doi: 10.1001/jama.2014.3266. DOI  
  4. Läkemedelsverket. Läkemedelsbehandling av långvarig smärta hos barn och vuxna. 2017 lakemedelsverket.se  
  5. Bennett RM. Fibromyalgia. JAMA. 1987;257(20):2802-2803. doi:10.1001/jama.1987.03390200142033. DOI  
  6. Smythe HA. `Fibrositis` as a disorder of pain modulation. Clinics in rheumatic diseases 12/1979; 5(3):823-832.
  7. Inanici F, Yunus MB. History of fibromyalgia: past to present. Curr Pain Headache Rep 2004; 8: 369-78. PMID: 15361321 PubMed  
  8. Wolfe F, Smythe HA, Yunus MB, Bennet RM, Bombardier C, Godenberg DL et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum 1990; 33: 160-72. PubMed  
  9. Quintner J. Fibromyalgia: the Copenhagen declaration. Lancet, 340, 1103, 1992. PMID: 1357495. PubMed  
  10. Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep 2013; 17: 356. pmid:23801009 PubMed  
  11. Forseth KO, Husby G, Gran JT, Førre O. Prognostic factors for the development of fibromyalgia in women with self-reported musculoskeletal pain. A prospective study. J Rheumatol 1999; 26: 2458-67. pmid:10555910 PubMed  
  12. Weir PT, Harlan GA, Nkoy FL, et al. The incidence of fibromyalgia and its associated comorbidities: a population-based retrospective cohort study based on International Classification of Diseases, 9th Revision codes. J Clin Rheumatol 2006; 3: 124-8. pmid:16755239 PubMed  
  13. Talotta R, Bazzichi L, Di Franco M et al. One year in review 2017: fibromyalgia. Clin Exp Rheumatol. 2017 May-Jun;35 Suppl 105(3):6-12. PMID: 28681712 PubMed  
  14. Albrecht DS, Forsberg A, Sandström A, et al. Brain glial activation in fibromyalgia - A multi-site positron emission tomography investigation. Brain Behav Immun. 2019;75:72-83. PMID: 30223011 PubMed  
  15. Vaerøy H, Helle R, Førre O, Kåss E, Terenius L. Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis. Pain. 1988 Jan;32(1):21-6. PMID: 2448729. PubMed  
  16. Russell IJ, Vaeroy H, Javors M, Nyberg F. Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis. Arthritis Rheum. 1992 May;35(5):550-6. PMID: 1374252. PubMed  
  17. Russell IJ, Michalek JE, Vipraio GA, et al. Platelet 3H-imipramine uptake receptor density and serum serotonin levels in patients with fibromyalgia/fibrositis syndrome. J Rheumatol. 1992 Jan;19(1):104-9. PMID: 1313504. PubMed  
  18. Roizenblatt S, Neto NS, Tufik S. Sleep disorders and fibromyalgia. Curr Pain Headache Rep 2011; 15: 347-57. pmid:21594765 PubMed  
  19. Rizzi M, Sarzi-Puttini P, Atzeni F, et al. Cyclic alternating pattern: a new marker of sleep alteration in patients with fibromyalgia?. J Rheumatol 2004; 31: 1193. pmid:15170935 PubMed  
  20. Moldofsky H. The significance of dysfunctions of the sleeping/waking brain to the pathogenesis and treatment of fibromyalgia syndrome. Rheum Dis Clin North Am 2009; 35: 275. pmid:19647142 PubMed  
  21. Diatchenko L, Nackley AG, Tchivileva IE, et al. Genetic architecture of human pain perception. Trends Genet 2007;23:605-613. PMID: 18023497 PubMed  
  22. Arnold LM, Hudson JI, Hess EV, et al. Family study of fibromyalgia. Arthritis Rheum 2004;50:944-952. PMID: 15022338 PubMed  
  23. Shmerling RH: Approach to the patient with myalgia. UpToDate. Last updated Jul 31, 2018. Site visited 12.06.2020. [url][url]https://www.uptodate.com/contents/approach-to-the-patient-with-myalgia[/url][/url] UpToDate  
  24. Markkula R, Järvinen P, Leino-Arjas P, et al. Clustering of symptoms associated with fibromyalgia in a Finnish twin cohort. Eur J Pain 2009;13:744-750. PMID: 18938094 PubMed  
  25. Phillips K, Clauw DJ. Central pain mechanisms in chronic pain states--maybe it is all in their head. Best Pract Res Clin Rheumatol 2011; 25: 141-54. doi:10.1016/j.berh.2011.02.005 DOI  
  26. Mork PJ, Nilsen TI. Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis and Rheumatism 2012; 64(1): 281-4. pmid:22081440 PubMed  
  27. Nitter AK, Pripp AH, Forseth KØ. Are sleep problems and non-specific health complaints risk factors for chronic pain? A prospective population-based study with 17 year follow-up. Skand J of Pain 2012; 3: 210-7. PMID: 29913872 PubMed  
  28. McBeth J, Macfarlane GJ, Benjamin S, Morris S, Silman AJ. The association between tender points, psychological distress, and adverse childhood experiences: a community-based study. Arthritis Rheum 1999; 42: 1397-404. PMID: 10403267 PubMed  
  29. Wolfe F, Clauw DJ, Fitzcharles MS, et al. 2016 revision to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46: 319-29. pmid:27916278 PubMed  
  30. Kato K, Sullivan PF, Evengard B, et al. A population-based twin study of functional somatic syndromes. Psychol Med 2009;39:497-505. PubMed  
  31. Kim SE, Chang L. Overlap between functional GI disorders and other functional syndromes: what are the underlying mechanisms? Neurogastroenterol Motil. 2012;24(10):895–913. PMID: 22863120 PubMed  
  32. Reed BD, Harlow SD, Sen A, et al. Relationship between vulvodynia and chronic comorbid pain conditions. Obstet Gynecol. 2012;120(1):145–151. PMID: 22914403 PubMed  
  33. Nickel JC, Tripp DA, Pontari M, et al. Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. J Urol. 2010;184(4):1358–1363. PMID: 20719340 PubMed  
  34. Smorgick N, Marsh CA, As-Sanie S, Smith YR, Quint EH. Prevalence of pain syndromes, mood conditions, and asthma in adolescents and young women with endometriosis. J Pediatr Adolesc Gynecol. 2013;26(3):171–175. PMID: 23507008 PubMed  
  35. Almansa C, Wang B, Achem SR. Noncardiac chest pain and fibromyalgia. Med Clin North Am. 2010;94(2):275–289. PMID: 20380956 PubMed  
  36. Häuser W, Galek A, Erbslöh-Möller B, et al. Posttraumatic stress disorder in fibromyalgia syndrome: prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome. Pain. 2013;154(8):1216–1223. PMID: 23685006 PubMed  
  37. Paras ML, Murad MH, Chen LP, et al. Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. JAMA. 2009;302(5):550–561. PMID: 19654389 PubMed  
  38. Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017; 76: 318-28. PMID: 27377815 PubMed  
  39. Behandling och rehabilitering vid fibromyalgi. SBU 2021. www.sbu.se  
  40. Clauw DJ. Fibromyalgia and related conditions. Mayo Clin Proc. 2015 May;90(5):680-92. doi: 10.1016/j.mayocp.2015.03.014. DOI  
  41. Moore RA, Derry S, Aldington D, et al. Amitriptyline for fibromyalgia in adults. Cochrane Database Syst Rev. 2015 Jul 31;7:CD011824. Cochrane (DOI)  
  42. Üçeyler N1, Sommer C, Walitt B, Häuser W. Anticonvulsants for fibromyalgia. Cochrane Database Syst Rev. 2013 Oct 16;10:CD010782. doi: 10.1002/14651858.CD010782. DOI  
  43. Cording M, Derry S, Phillips T, et al. Milnacipran for pain in fibromyalgia in adults. Cochrane Database Syst Rev. 2015 Oct 20;10:CD008244. PMID: 26482422. The Cochrane Library  
  44. Häuser W, Bernardy K, et al. Treatment of fibromyalgia syndrome with antidepressants: a meta-analysis. JAMA. 2009 Jan 14;301(2):198-209. doi: 10.1001/jama.2008.944. DOI  
  45. O'Malley PG, Balden E, Tomkins G, Santoro J, Kroenke K, Jackson JL. Treatment of fibromyalgia with antidepressants: a meta-analysis. J Gen Intern Med 2000; 15:659-66. PubMed  
  46. Arnold LM, Keck PE, Welge JA. Antidepressant treatment of fibromyalgia. Psychosomatics 2000;41(2):104-113. PubMed  
  47. Moore RA1, Derry S, et al. Amitriptyline for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2012 Dec 12;12:CD008242. doi: 10.1002/14651858.CD008242.pub2. DOI  
  48. Kosek E. Fibromyalgi – den osynliga sjukdomen. Behandlingsrekommendationer. Fibromyalgiförbundet. Uppdaterad mars 2014. docplayer.se  
  49. Arnold L, Lu Y, Crofford L, Wohlreich M, Detke M, Iyengar S, et al. A doubleblind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis & Rheum. 2004;50(9):2974-2984. PMID: 15457467. PubMed  
  50. Arnold L, Rosen A, Pritchett Y, D’Souza D, Goldstein D, Iyengar S, et al. A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder. Pain 2005;119(1-3):5-15. PMID: 16298061. PubMed  
  51. Russell IJ, Mease PJ, Smith TR, et al. Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain. 2008 Jun;136(3):432-44. PMID: 18395345. PubMed  
  52. Häuser W, Urrútia G, et al. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome. Cochrane Database Syst Rev. 2013 Jan 31;1:CD010292. doi: 10.1002/14651858.CD010292. DOI  
  53. Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014 Jan 3;1:CD007115. DOI: 10.1002/14651858.CD007115.pub3. DOI  
  54. Derry S, Cording M, Wiffen PJ, et al. Pregabalin for pain in fibromyalgia in adults. Cochrane Database Syst Rev. 2016 Sep 29;9:CD011790. Epub ahead of print. pmid: 27684492 www.ncbi.nlm.nih.gov  
  55. Crofford LJ, Rowbotham MC, Mease PJ et al. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2005; 52: 1264-73. PMID: 15818684. PubMed  
  56. Crofford LJ, Mease PJ, Simpson SL, et al.Fibromyalgia relapse evaluation and efficacy for durability of meaningful relief (FREEDOM): a 6-month, double-blind, placebo- controlled trial with pregabalin. Pain 2008;136(3): 419-431. PubMed  
  57. Mease PJ, Russell IJ, Arnold LM, et al. A randomized, double-blind, placebo-controlled, phase III trial of pregabalin in the treatment of patients with fibromyalgia. J Rheumatol. 2008;35(3), 502-514. PMID: 18278830. PubMed  
  58. Wiffen PJ1, Derry S, Moore RA, et al. Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013 Nov 11;11:CD010567. doi: 10.1002/14651858.CD010567.pub2. DOI  
  59. Arnold L, Crofford L, Martin S, et al. The effect of anxiety and depression on improvements in pain in a randomized, controlled trial of pregabalin for treatment of fibromyalgia. Pain Med. 2007;8(8), 633-638. PMID: 18028041. PubMed  
  60. Wiffen PJ, Derry S, Moore RA, et al.Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013 Nov 11;11:CD010567. doi: 10.1002/14651858.CD010567.pub2. The Cochrane Library  
  61. Biasi G, Manca S, Manganelli S, Marcolongo R. Tramadol in the fibromyalgia syndrome: a controlled clinical trial versus placebo. Int J Clin Pharm Res 1998;18:13-19. PubMed  
  62. Bennett RM, Kamin M, Karim R, Rosenthal N. Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study. Am J Med 2003;114:537-45. PubMed  
  63. Bennett R, Schein J, Kosinski M, et al. Impact of fibromyalgia pain on health-related quality of life before and after treatment with tramadol/acetaminophen. Arthritis Rheum 2005;15(53):519-527. PubMed  
  64. Walitt B, Klose P, Üçeyler N, Phillips T, Häuser W. Antipsychotics for fibromyalgia in adults. Cochrane Database Syst Rev 2016; 6: CD011804. pmid:27251337 PubMed  
  65. Meiworm L, Jakob E, Walker U, Peter H, Keul J. Patients with fibromyalgia benefit from aerobic endurance exercise. Clin Rheumatol 2000;19:253-257. PubMed  
  66. Häuser W, Thieme K, Turk DC. Guidelines on the management of fibromyalgia syndrome - a systematic review. Eur J Pain. 2010 Jan;14(1):5-10. doi: 10.1016/j.ejpain.2009.01.006. PMID: 19264521. PubMed  
  67. Bidonde J, Busch AJ, Schachter CL, Overend TJ, Kim SY, Góes SM, Boden C, Foulds HJA. Aerobic exercise training for adults with fibromyalgia. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD012700. DOI: 10.1002/14651858.CD012700 onlinelibrary.wiley.com  
  68. García-Hermoso A, Saavedra JM, Escalante Y. Effects of exercise on functional aerobic capacity in adults with fibromyalgia syndrome: A systematic review of randomized controlled trials. J Back Musculoskelet Rehabil. 2015;28(4):609-19. PMID: 25408119. PubMed  
  69. Busch AJ, Barber KA, et al. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003786. PMID: 17943797. PubMed  
  70. Busch AJ, Webber SC, Richards RS, et al. Resistance exercise training for fibromyalgia. Cochrane Database Syst Rev. 2013 Dec 20;12:CD010884. doi: 10.1002/14651858.CD010884. DOI  
  71. Nuesch E, Hauser W, Bernardy K, Barth J, Juni P. Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis. Ann Rheum Dis2013;72:955-62. PubMed  
  72. Bidonde J, Busch AJ, Webber SC, et al. Aquatic exercise training for fibromyalgia. Cochrane Database Syst Rev. 2014 Oct 28;10:CD011336. doi: 10.1002/14651858.CD011336. The Cochrane Library  
  73. Wang C, Schmid CH, Fielding RA, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. 2018 Mar 21;360:k851. (Original) PMID: 29563100 PubMed  
  74. Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med 2010; 363: 743-54. New England Journal of Medicine  
  75. Jensen KB, Kosek E, Wicksell R, et al. Cognitive Behavioral Therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia. Pain 2012:153(7):1495-503. PMID: 22617632. PubMed  
  76. Wicksell R.K, Kemani M, Jensen K, et al. Acceptance and Commitment Therapy for Fibromyalgia: A randomized controlled trial. Eur J Pain 2013 Apr;17(4):599-611. PubMed  
  77. Rossy L, Buckelew S, Dorr N, et al. A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med 1999;21(2):180-191. PubMed  
  78. Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW, et al. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev2013;5:CD007070. Cochrane (DOI)  
  79. Yeh SW, Hong CH, Shih MC, et al. Low-Level Laser Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis. Pain Physician. 2019 May;22(3):241-254. PMID: 31151332 PubMed  
  80. Samartin-Veiga N, Pidal-Miranda M, Gonzales-Villar AJ, et al. Transcranial direct current stimulation of three cortical targets is no more effective than placebo as treatment for fibromyalgia: a double-blind sham-controlled clinical trial. Pain 2021. pmid:34561393 PubMed  
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet

Tidigare sakkunniga

  • Michael Matousek, med dr och överläkare, Gottfriesmottagningen, Mölndal
  • Olof Zachrisson, med dr och överläkare, Gottfriesmottagningen, Mölndal