A psychoneuroimmunological view of fibromyalgia

Abstract

Fibromyalgia syndrome (FSM) is the chronic pain syndrome most frequently found in general medicine. Along with a myriad unspecifi c biological and symptomatic alterations, the evidence points at anomalous pain processing at a central level, in the absence of peripheral dysfunction or illness. Emotional or psychiatric alterations affect the nervous, endocrine and immune systems which explains, through the psycho-neuro-immune-endocrinologic axis, the homeostatic imbalance that gives rise to dysautonomia and dysrhythmia and fi nally explains alterations of the vegetative nervous system, of the circadian rhythm and sleep, hormonal and immune rhythms, and opens a new horizon as to handling and treatment of FSM. Non-drug treatments, capable of balancing this homeostatic triangle, go from cognitive-behavior therapy to hypnotherapy, forms of electromyographic biofeedback, moderate physical exercise and acupuncture, not forgetting a special attention to re-establishing the circadian rhythm and to improve sleep quality.