Fibromyalgia
Özet
Fibromyalgia (FM) is a complex, heterogeneous central sensitivity syndrome characterized by chronic widespread pain, sleep disturbances, fatigue, and cognitive difficulties, predominantly affecting females aged 40–60. Its exact pathophysiology remains unclear, though genetic predisposition, central sensitization, and hypothalamic-pituitary-adrenal axis dysregulation are considered major contributing factors. Diagnostic standards have significantly evolved from the American College of Rheumatology (ACR) 1990 criteria, which relied strictly on finding tenderness in at least 11 of 18 specific tender points, to the 2010, 2011, and revised 2016 criteria that utilize the Widespread Pain Index (WPI) and Symptom Severity Score (SSS) to evaluate FM as a multi-symptom, generalized pain disorder. The condition frequently coexists with various comorbidities, including alpha-delta sleep anomalies, anxiety, depression, migraines, and irritable bowel syndrome (IBS). Effective management necessitates a patient-tailored, multidisciplinary approach integrating nonpharmacologic strategies—such as patient education, cognitive behavioral therapy, and gradual aerobic exercise—with targeted pharmacologic interventions. Medications typically include tricyclic antidepressants, selective serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine, and antiepileptics like pregabalin to modulate dysfunctional neural pathways, whereas opioids and traditional nonsteroidal anti-inflammatory drugs (NSAIDs) are generally ineffective for core central pain relief.
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