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The second meeting of “Fibromyalgia: from Mechanism” at les Entretiens du Carla is a logical progression from the first meeting, “Fibromyalgia: from Complaints to Evidence”. In 2004, at the time of first meeting, there was major debate over the legitimacy of fibromyalgia as a diagnosis. The assembled experts from different specialties, epidemiology, rheumatology, psychiatry, neurology and pain, reviewed the literature on the diagnosis, epidemiology, clinical features and management of fibromyalgia. Their deliberation and conclusion were published and presented at a symposium during the 2004 Annual Congress of the European League Against Rheumatism.
The first meeting “Fibromyalgia: from Complaints to Evidence” concluded that fibromyalgia is common, affecting 2-3% of the population.
Healthcare utilization associated with fibromyalgia is high and predates the diagnosis for some years. Fibromyalgia
is not a new diagnosis; symptoms and signs of the disease have been described
in the literature for 100 years under different names such as “muscular reumatisme”, “interstitial
myofibrositis”, “myofascial pain syndrome” and “myofascitis”. Although currently
there is no objective diagnostic test for fibromyalgia and this heterogeneous
condition overlaps with many other diseases that are characterized by somatisation,
there is substantial evidence of altered pain perception in fibromyalgia. Most
patients have increased sensitivity to painful blunt pressure and this sensitivity
is associated with increased psychosocial stress. The presence of abnormal sensitivity
and the effects of distress are supported by objective imaging with functional
MRI scans. Moreover, effective treatments for fibromyalgia are available. Randomized
control trials and meta-analyses have confirmed that treatment of fibromyalgia
by exercise; cognitive therapy and anti-depressants are effective. Based on an
epidemiological study in the UK, the diagnosis of fibromyalgia does not increase
health-care utilization as alleged by some critics. Rather, the diagnosis of
fibromyalgia helps clinicians to reassure and manage patients positively. The
end result is reduced healthcare utilization. The meeting concluded that fibromyalgia
is probably heterogeneous with many factors contributing to its development,
indeed recent studies suggested patients may be categorized into different subtypes
based on pressure pain sensitivity, mood and control over pain. Nonetheless,
the health-care burden of patients with fibromyalgia is enormous. Diagnosing
fibromyalgia contributes positively to patient education and understanding.
Although treatment such as exercise and anti-depressants are effective, most patients remain in pain, which
reduce their quality of life and ability to carry out daily chores. Improving
treatment will require better understanding of the underlying disease pathophysiology.
With these conclusions from the first les Entretiens du Carla meeting, the second meet-ing examined the biopsychosocial mechanisms leading to the symptoms and signs in more detail.. Topics included the current evidence for peripheral and central pathophysiological mechanisms of widespread pain and increased pain sensitivity. The group also considered the role of psychological distress and of genetic traits as risk factors for initiation of fibromyal-gia and as factors influencing treatment approach and efficacy. The goals of the meet-ing were to integrate the increasing amount of scientific evidence, summarize the current understanding of this disorder, and recom-mend future studies of etiology, mechanism, diagnosis and treatment.
From left to right and from bottom up:
Jorge Alberto Costa e Silva,
Kati Thieme,
Robert Cancro,
Richard Gracely,
Ernest Choy,
Jaime Branco,
Yves Mainguy,
Jean-Paul Caubère,
Jackie Brunet,
Harvey Moldofski,
Lars Arendt-Nielsen,
Michael Späth,
Dan Buskila,
Manuel Quartilho,
Juan Antonio Micó,
Étienne André,
Frank Petzke, William Maixner,
Laurence Bradley,
Thorsten Giesecke,
Olivier Vitton,
François Brackman,
Roland Staud
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