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Jurado-Priego LN, Cueto-Ureña C, Ramírez-Expósito MJ, Martínez-Martos JM. Fibromyalgia: A Review of the Pathophysiological Mechanisms and Multidisciplinary Treatment Strategies. Biomedicines 2024; 12:1543. [PMID: 39062116 PMCID: PMC11275111 DOI: 10.3390/biomedicines12071543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Fibromyalgia is a syndrome characterized by chronic widespread musculoskeletal pain, which may or may not be associated with muscle or joint stiffness, accompanied by other symptoms such as fatigue, sleep disturbances, anxiety, and depression. It is a highly prevalent condition globally, being considered the third most common musculoskeletal disorder, following lower back pain and osteoarthritis. It is more prevalent in women than in men, and although it can occur at any age, it is more common between the ages of thirty and thirty-five. Although the pathophysiology and etiopathogenesis remain largely unknown, three underlying processes in fibromyalgia have been investigated. These include central sensitization, associated with an increase in the release of both excitatory and inhibitory neurotransmitters; peripheral sensitization, involving alterations in peripheral nociceptor signaling; and inflammatory and immune mechanisms that develop concurrently with the aforementioned processes. Furthermore, it has been determined that genetic, endocrine, psychological, and sleep disorders may influence the development of this pathology. The accurate diagnosis of fibromyalgia remains challenging as it lacks specific diagnostic biomarkers, which are still under investigation. Nonetheless, diagnostic approaches to the condition have evolved based on the use of scales and questionnaires for pain identification. The complexity associated with this pathology makes it difficult to establish a single effective treatment. Therefore, treatment is multidisciplinary, involving both pharmacological and non-pharmacological interventions aimed at alleviating symptoms. The non-pharmacological treatments outlined in this review are primarily related to physiotherapy interventions. The effectiveness of physical exercise, both on land and in water, as well as the application of electrotherapy combined with transcranial therapy and manual therapy has been highlighted. All of these interventions aim to improve the quality of life of patients highly affected by fibromyalgia.
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Affiliation(s)
| | | | | | - José Manuel Martínez-Martos
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Experimental and Health Sciences, University of Jaén, E-23071 Jaén, Spain (C.C.-U.); (M.J.R.-E.)
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Arfuch VM, Aguilar Martín C, Berenguera A, Caballol Angelats R, Gonçalves AQ, Carrasco-Querol N, González Serra G, Sancho Sol MC, Fusté Anguera I, Friberg E, Pettersson E, Casajuana M. Cost-utility of a multicomponent intervention for fibromyalgia versus usual care: a pragmatic randomised controlled trial. J Rehabil Med 2023; 55:jrm12361. [PMID: 38111994 PMCID: PMC10753594 DOI: 10.2340/jrm.v55.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To perform an economic evaluation on a multicomponent intervention programme for patients with fibromyalgia syndrome compared with usual clinical practice in primary care. DESIGN A cost-utility analysis was conducted alongside a pragmatic randomised controlled trial (ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/record/NCT04049006) from a societal perspective, a human capital approach, and a 1-year time horizon. PATIENTS Patients diagnosed with fibromyalgia syndrome from the public health system in south Catalonia, Spain. METHODS Crude and adjusted incremental cost- utility ratios were estimated to compare the treatment strategies based on cost estimations (direct medical costs and productivity losses) and quality-adjusted life years. One-way and 2-way deterministic sensitivity analyses were performed. RESULTS The final analysed sample comprised 297 individuals, 161 in the intervention group and 136 in the control group. A crude incremental cost-utility ratio of € 1,780.75 and an adjusted ratio of € 851.67 were obtained, indicating that the programme significantly improved patients' quality of life with a cost-increasing outcome that fell below the cost-effectiveness threshold. The sensitivity analysis confirmed these findings when varying large cost components, and showed dominance when increasing session attendance. CONCLUSION The proposed multicomponent intervention programme was cost-effective compared with usual care for fibromyalgia, which supports its addition to standard practice in the regional primary care service.
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Affiliation(s)
- Victoria Mailen Arfuch
- Terres de l'Ebre Research Support Unit, Jordi Gol I Gurina Primary Health Research Institute Foundation (IDIAPJGol), Tortosa, Spain; Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Autonomous University of Barcelona, Bellaterra, Spain; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Carina Aguilar Martín
- Terres de l'Ebre Research Support Unit, Jordi Gol I Gurina Primary Health Research Institute Foundation (IDIAPJGol), Tortosa, Spain; Evaluation Unit, Directorate of Primary Care Terres de l'Ebre, Territorial Management of Terres de l'Ebre, Catalan Institute of Health (ICS), Tortosa, Spain
| | - Anna Berenguera
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Autonomous University of Barcelona, Bellaterra, Spain; Central Research Unit, Jordi Gol I Gurina Primary Health Research Institute Foundation (IDIAPJGol), Barcelona, Spain; Department of Nursing, University of Girona, Plaça de Sant Domènec, Girona, Spain
| | - Rosa Caballol Angelats
- Primary Care Center (CAP) El Temple, Territorial Management of Terres de l'Ebre, Catalan Health Institute (ICS), Tortosa, Spain; Unit of Expertise in Central Sensitization Syndromes Terres de l'Ebre, Territorial Management of Terres de l'Ebre, Catalan Institute of Health (ICS), Tortosa, Spain
| | - Alessandra Queiroga Gonçalves
- Terres de l'Ebre Research Support Unit, Jordi Gol I Gurina Primary Health Research Institute Foundation (IDIAPJGol), Tortosa, Spain; Tortosa, Spain, 9Family and Community Medicine Teaching Unit Tortosa-Terres de L'Ebre, Catalan Institute of Health (ICS), Tortosa, Spain
| | - Noèlia Carrasco-Querol
- Terres de l'Ebre Research Support Unit, Jordi Gol I Gurina Primary Health Research Institute Foundation (IDIAPJGol), Tortosa, Spain
| | - Gemma González Serra
- Rehabilitation and Physical Medicine Service, Tortosa Verge de la Cinta Hospital, Territorial Management of Terres de l'Ebre, Catalan Health Institute (ICS), Tortosa, Spain
| | - Maria Cinta Sancho Sol
- Unit of Expertise in Central Sensitization Syndromes Terres de l'Ebre, Territorial Management of Terres de l'Ebre, Catalan Institute of Health (ICS), Tortosa, Spain; Adult Mental Health Center (CSMA) of Fundació Pere Mata Terres de l'Ebre, Tortosa, Spain
| | - Immaculada Fusté Anguera
- Primary Care Center (CAP) El Temple, Territorial Management of Terres de l'Ebre, Catalan Health Institute (ICS), Tortosa, Spain; Unit of Expertise in Central Sensitization Syndromes Terres de l'Ebre, Territorial Management of Terres de l'Ebre, Catalan Institute of Health (ICS), Tortosa, Spain
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Emma Pettersson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marc Casajuana
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Autonomous University of Barcelona, Bellaterra, Spain; Central Research Unit, Jordi Gol I Gurina Primary Health Research Institute Foundation (IDIAPJGol), Barcelona, Spain
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