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Further Legitimization Of Fibromyalgia As A True Medical Condition
28 Jun 2007
Fibromyalgia, a chronic, widespread pain in muscles and soft tissues
accompanied by fatigue, is a fairly common condition that does not
manifest any structural damage in an organ. Twenty-five years ago,
Muhammad B. Yunus, MD, and colleagues published the first controlled
study of the clinical characteristics of fibromyalgia syndrome. That
seminal article, published in Seminars in Arthritis and Rheumatism, led
directly to formal recognition of this disease by the medical
community. In the June 2007 issue of Seminars in Arthritis and
Rheumatism, Dr. Yunus once again makes an enormous contribution to the
field of chronic pain and fatigue by meticulously synthesizing and
interpreting the extensive body of scientific literature on
fibromyalgia and his own insights into the concept of central
sensitivity syndromes (CSS).
Fibromyalgia, affecting approximately 2% of the US population, is an
example of a class of maladies called CSS. These diseases are based on
neurochemical abnormalities and include irritable bowel syndrome,
migraine and restless legs syndrome.
Incorporating a critical review of over 225 publications and the
author's broad experience in fibromyalgia and related diseases, Dr.
Yunus describes 13 separate conditions that are related to central
sensitization (CS), where the central nervous system (spinal cord and
brain) becomes extremely sensitized on certain parts of the body, so
that even mild pressure or touch would cause much pain. Such
hypersensitivity may also be associated with other symptoms such as
poor sleep and fatigue.
According to Dr. Yunus, "CSS are the most common diseases that are
based on real neurochemical pathology and cause real pain and
suffering. In some patients stress and depression may contribute to the
symptoms but they are all based on objective changes in the central
nervous system." Dr. Norman L. Gottlieb, Editor of Seminars in
Arthritis and Rheumatism, believes that this article "advances our
understanding of fibromyalgia, unifies and advances concepts, and
suggests that this and several other common disorders have much in
common in terms of their biopsychosocial development. This, hopefully,
will expand both clinical and research interest in this group of
diseases and lead to advances in therapy for many of them."
In an accompanying editorial John B. Winfield, MD,
comments, "Without question, Muhammad Yunus is the father of our modern
view of fibromyalgia". Yunus, who took a rather more biological
approach to fibromyalgia in the past, now emphasizes a biopsychosocial
perspective. "In my view, this is tremendously important because it is
the only way to synthesize the disparate contributions of such
variables as genes and adverse childhood experiences, life stress and
distress, posttraumatic stress disorder, mood disorders, self-efficacy
for pain control, catastrophizing, coping style, and social support
into the evolving picture of central nervous system dysfunction
vis-a-vis chronic pain and fatigue ".Science and medicine now have a
rational scaffolding for understanding and treating chronic pain
syndromes previously considered to be 'functional' or 'unexplained.'
Neuroscience research will continue to reveal the mechanisms of CS, but
only if informed through a biopsychosocial perspective and with the
interdisciplinary collaboration of basic scientists, psychologists,
sociologists, epidemiologists, and clinicians."
Dr. Yunus concludes that CSS is an important new
concept that embraces the biopsychosocial model of disease. He
advocates further critical studies to fully test this concept which
seems to have important significance for new directions for research
and patient care involving physician and patient education. "Each
patient, irrespective of diagnosis," says Dr. Yunus, "should be treated
as an individual, considering both the biological and psychosocial
contributions to his or her symptoms and suffering."
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