[Fibromyalgia: a challenge for neuroscience].

Abstract

AIMS: In this survey we present the most recent findings regarding the physiopathology and therapeutic guidelines of a disease we still know very little about: fibromyalgia. This disorder is characterized by a chronic process of generalized musculoskeletal pain accompanied by chronic fatigue, sleep disorders and, on many occasions, neuroendocrine disorders. DEVELOPMENT: Most research on the physiopathology of fibromyalgia points towards some kind of pain transmission disorder in the dorsal horn of the spinal cord. In chronic pain processes, a resonance effect is produced in the synapse of the dorsal horn and this gives rise to allodynia and hyperalgesia. From a biochemical point of view, glutamate and substance P receptors, as well as the main systems involved in the transmission of pain, serotonin and noradrenaline, seem to play a fundamental role. Patients with fibromyalgia have generally been seen to have lowered 5HT activity and an increase in substance P. In addition to these alterations in the perception of pain, serotonin could also be responsible for the frequently occurring sleep, hormone and neuropsychiatric disorders observed in these patients. CONCLUSIONS: Nowadays fibromyalgia is still a challenge for modern medicine. Indeed, the neuroscientific community must design a basic scientific approach carried out at the patient s bedside in order to find pharmacological tools with which to relieve these symptoms. Of the extensive therapeutic arsenal that has been tested in these patients to date, classical antidepressants and serotonin and noradrenaline reuptake inhibitors, used in sub antidepressant doses, seem to be the most effective.