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The Hub is a device to unlock this knowledge and share it with the wider world. The Hub gives you an opportunity to make a difference. Symptoms have been present at a similar level for at least 3 months. The patient does not have a disorder that would otherwise sufficiently explain the pain. In clinical practice, fibromyalgia should be suspected in patients having multifocal pain not fully explained by injury or inflammation.

Because pain pathways throughout the body are amplified, pain can occur anywhere. Genetics: First degree relatives of patients with fibromyalgia show an increased risk by Vosevi (Sofosbuvir)- Multum of developing the syndrome.

Genes Vosevi (Sofosbuvir)- Multum Catechol-O-methyl-transferase (COMT) Dopamine type 4 receptor 5HT-2A receptor Serotonin transporters (SERT) 2. Environmental Factors Infections: Ebstein Barr virus (EBV), parvovirus, brucellosis and Lyme disease are associated with fibromyalgia.

Childhood abuse and trauma Exposure to war Psychological stressors in daily life 3. Pain Centralisation When a peripheral injury occurs, the nociceptive stimulus lymerix transmitted by primary afferent neurons to the dorsal horn neurons.

Increased glutamate levels 7. Glial cell activation resulting in the production of inflammatory cytokines. Vosevi (Sofosbuvir)- Multum There is considerable evidence that shows that there DMSO (Rimso-50)- Multum genetic and environmental factors that predispose individuals to fibromyalgia or depression. Secondly, environmental stressors such as psychosocial issues, physical injury, infections, and autoimmune disease can also precipitate both depression and fibromyalgia.

Treatment Due to the similar aetiologies of fibromyalgia and depression, the treatment of both conditions is best approached using dual serotoninergic and noradrenergic drugs. Anxiety and Panic Disorder Clinical Features Fibromyalgia is associated with incapacitating Vosevi (Sofosbuvir)- Multum and suffering and as such 78.

Treatment Effect sizes are shown to be greater for pharmacological options rather than for psychotherapy in treating anxiety. PTSD Clinical Features Clinical features include nightmares, intrusive and recurrent thoughts, avoidance behaviours, and increased arousal. Vosevi (Sofosbuvir)- Multum Traumatic life events play a role in the etiopathogenesis of fibromyalgia.

Non-Pharmacological Management Graded exercise Patient education Vosevi (Sofosbuvir)- Multum Behavioural Therapy (CBT) Complementary and alternative therapies: Water therapy (Balneotherapy), acupuncture, yoga, Tai-Chi.

CNS neurostimulation: Transcranial Magnetic stimulation, Transcutaneous electrical nerve stimulation. Tricyclic antidepressants: Amitriptyline (10-70mg nocte). Clinical pearls: They can improve pain, sleep bowel and bladder symptoms. Opioids Vosevi (Sofosbuvir)- Multum (50-100mg qds) Clinical pearls: risk of sedation, dependence and opioid-induced hyperalgesia. If clinicians treat fibromyalgia or other chronic pain conditions with drugs alone, they will fail.

Fibromyalgia: A clinical review Clauw D. Disease primers, 1, 15022-15022. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Modified 2010 ACR Criteria for Fibromyalgia Wolfe, F. The Journal of rheumatology, 38(6), 1113-1122. Stahl's essential psychopharmacology Stahl, S. Comorbidity exelon fibromyalgia and psychiatric disorders Arnold L et al.

Fibromyalgia syndrome and depressive symptoms: comorbidity and clinical correlates Aguglia A et al. Fibromyalgia and depression Gracely R et al. Atypical depression is more common than melancholic in fibromyalgia Ross R et al. Duloxetine and other antidepressants in the treatment of patients with fibromyalgia Arnold L et al. Efficacy of duloxetine in patients with fibromyalgia pooled analysis of 4 placebo-controlled clinical trials Arnold Vosevi (Sofosbuvir)- Multum et al.

Milnacipran monotherapy in the treatment of fibromyalgia Geisser M et al. Comorbid Depression and anxiety in fibromyalgia syndrome Thieme K et al. Fibromyalgia is associated with panic disorder Malt E et al. Is panic disorder associated with clinical severity of fibromyalgia.

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