纖維肌痛症之診斷及致病機轉

Diagnosis and Pathogenesis of Fibromyalgia

目的：纖維肌痛症的特徵為慢性廣泛性疼痛，並常伴隨有疲勞、認知能力下降及睡眠障礙等症狀。本文主要論述此疾病之臨床評估、實驗室診斷方法、病因及其致病機轉，並對近來主要之治療方法作簡要的敍述。方法：本文以流行病學、危險因子、診斷及致病機轉為關鍵字，經由MEDLINE及UpToDate收集並分析1987年至2014年8月有關纖維肌痛症的相關研究文獻（其中包括5篇實證醫學等級之論述），回顧並討論此慢性疼痛疾病，特別在臨床診斷及其病理生理學。結果：近年來，臨床醫學已建立一套評估及診斷纖維肌痛症的流程，即使病患之實驗室檢驗結果通常為正常。目前並無實質證據顯示單一病因可誘發纖維肌痛症，雖然，曾有研究證據顯示遺傳及精神疾病可能與它的病因有關連性，而最近的研究則較傾向於中樞神經系統疼痛傳導路徑的失衡。結論：近年來，纖維肌痛症已較為清楚地被證實為一中樞神經敏感化的慢性廣泛性疼痛疾病。但是，許多如遺傳、環境因子及周邊神經等病因，皆有可能參與其致病機轉，造成中樞及周邊神經敏感化的狀況。雖然，臨床醫學一直努力於建立一套屬於此疾病的臨床評估及診斷方法，但因常與其他免疫及精神疾病併存，而導致診斷上的因難。

Purposes: Fibromyalgia is diagnosed in patients with chronic widespread pain on examination or associated symptoms of fatigue, non-refreshing sleep, or cognitive dysfunction. The aim of this article was to review the current research evidence regarding the risk factors, diagnosis, pathogenesis, and treatment of fibromyalgia. Methods: By using epidemiology, risk factor, diagnosis, and pathogenesis of fibromyalgia as key words, the medical literature on fibromyalgia was reviewed from 1987 to August 2014 via MEDLINE and UpToDate, with an emphasis on the current concepts of diagnosis and pathophysiology underlying fibromyalgia based on the level of available evidence (five evidence-based systematic review articles were included). Results: There was no evidence that a single event causes fibromyalgia. In patients with fibromyalgia, there were no obvious abnormalities on physical examination, and the laboratory and radiologic studies were normal. Although, fibromyalgia has often been considered to have a genetic or psychogenic basis, ongoing research has led to pathophysiologic concepts of fibromyalgia that focus on alterations in central nervous system pain processing. Conclusions: There is conclusive evidence that alterations in central nervous system pain processing are responsible for many of the features which characterize fibromyalgia. Fibromyalgia may be considered as a discrete diagnosis or as a constellation of symptoms characterized by central nervous system pain amplification with concomitant fatigue, sleep disturbances, and cognitive dysfunction. Genetic and environmental factors likely interact to promote a state of chronic central and peripheral nervous system hyperirritability.