Fibromialgia para neurólogos. Controversias sobre una consulta frecuente

Fibromyalgia (FM) was accepted as an entity by WHO in 1992. Diagnostic criteria were stated initially in 1990 and modified recently in 2010. The clinical feature is characterized by widespread chronic pain in muscles, joints, and in soft tissues and is associated to sleep, attention and mood disorders. Moreover, FM affects functional activities and decrease quality of life and leads to psycho-social conflicts. The course of the disease fluctuates along months to many years. There is a long delay between the onset of the symptoms and its correct diagnosis. FM involves 2 - 4.7% of the general population with a high prevalence in women. Patients feel pain at lesser stimulation intensity than most healthy subjects. Not specific biological marker has been found to diagnose FM, but through brain Functional Magnetic Resonance, focal hyperactivity has been identified, which correlates with clinical features in FM. Different patophysiological mechanisms have been proposed as genetic predisposition and a failure of the central inhibitory pathway of pain. Several authors have objected to that theory and have postulated psychogenic factors as poor pain adaptation. FM treatment includes pregabalin, duloxetine and milnacipran, combined with educational, psychotherapy and gradual physical exercising. This review presents a critic vision of FM aimed at the practitioner Neurologist who assists daily patients with FM.