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Artículo de Revisión
Current Considerations on Fibromyalgia Syndrome
Consideraciones actuales sobre el síndrome de
fibromialgia
Silvia Leonor Olivera Plaza
1
Juan Esteban Lozano-Plazas
1,2
Lina María Sánchez Piedrahita
1
Nicolas Arturo Núñez Gómez
1
1
Faculty of Health Sciences, Universidad Surcolombiana, Neiva, Colombia.
2*
Faculty of Human and Education Sciences, Universidad de Boyacá, Tunja, Colombia.
Recibido: 02/06/2025
Aceptado: 21/06/2025
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Abstract
Introduction
: Fibromyalgia Syndrome is an idiopathic disease that causes permanent
chronic musculoskeletal pain, stimulating severe impairment in the quality of life, disability,
and alterations in mental and physical health, as well as loss of independence and cognitive
and psychosocial problems in those who suffer from it.
Objective
: Describe the current knowledge on fibromyalgia syndrome, and offer the most
frequent and effective therapeutic perspectives, including the new model of intervention that
could be suggested with a sanological strategy.
Method
: A narrative review of the literature was conducted using PubMed, Scopus, Web of
Science, and Google Scholar databases. 128 articles published from 2017 to 2024 were
selected based on criteria of relevance, topicality, methodological rigor, and high scientific
impact.
Results
: The most relevant findings regarding the pathophysiological and epidemiological
mechanisms, main comorbidities, and the biopsychosocial impact of the disease are
presented, along with pharmacological and non-pharmacological therapeutic interventions.
Likewise,
emerging approaches based on sanology are also described, offering new
perspectives for the comprehensive treatment of this condition.
Conclusions:
The current
understanding of fibromyalgia demands multidimensional therapeutic approaches. The
incorporation of sanological models may represent a promising pathway to improve clinical
management and promote the overall well-being of affected individuals.
Keywords:
fibromyalgia; the impact of the disease; epidemiology; treatment; sanology.
Resumen
Introducción
: El Síndrome de Fibromialgia es una enfermedad idiopática que causa dolor
musculoesquelético crónico permanente, provocando deterioro severo en la calidad de vida,
discapacidad y alteraciones en la salud mental y física, así como pérdida de independencia y
problemas cognitivos y psicosociales en quienes la padecen.
Objetivo
: Describir el conocimiento actual sobre el Síndrome de Fibromialgia y ofrecer las
perspectivas terapéuticas más frecuentes y efectivas, incluyendo el nuevo modelo de
intervención que se podría sugerir con una estrategia sanológica.
Método
: Se realizó una revisión narrativa de la literatura en las bases de datos PubMed,
Scopus, Web of Science y Google Scholar. Se seleccionaron 128 artículos publicados entre
2017 y 2024 que cumplían criterios de relevancia, actualidad, rigor metodológico y alto
impacto científico.
Resultados
: Se presentan los hallazgos más relevantes sobre los mecanismos
fisiopatológicos y epidemiológicos, principales comorbilidades, impacto biopsicosocial de la
enfermedad, y las intervenciones terapéuticas tanto farmacológicas como no farmacológicas.
Asimismo, se describen enfoques emergentes basados en la sanología, proponiendo nuevas
perspectivas para el tratamiento integral de esta patología.
Conclusiones
: La comprensión
actual de la fibromialgia exige enfoques terapéuticos
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multidimensionales. La incorporación de modelos sanológicos puede representar una vía
prometedora para mejorar el abordaje clínico y el bienestar integral de las personas afectadas.
Palabras clave:
fibromialgia; impacto de la enfermedad; epidemiología; tratamiento;
sanología.
Introduction
Fibromyalgia Syndrome (FMS) is a chronic disease that affects the musculoskeletal system,
causing widespread pain, hyperalgesia, and allodynia in sufferers.
(1)
The symptomatological
identification for its diagnosis has been established by the American College of
Rheumatology (ACR), based on Widespread Pain Index (WPI) and Symptom Severity Scale
(SSS), consisting of unrefreshing sleep, fatigue, cognitive and somatic symptoms.
(2)
However, given its idiopathic nature and that it involves rheumatological and nervous system
aspects, it has been related to diffuse widespread chronic musculoskeletal pain syndrome
(3)
,
which can be present for more than three months and be associated with symptoms of fatigue,
affectations in sleep quality, alterations in cognitive functioning and presence of depressive
disorders.
(4)
Additionally, concomitance with neuropathic pain
(5)
, rheumatoid arthritis and
psoriatic arthritis has been reported
(6,7)
, and in recent research on neurophysiological and
morphological mechanisms, it has been suggested that FMS given its characteristics, should
be classified as central sensitization syndrome.
(8,9)
Consequently, its etiology and diagnostic
clarity still seem challenging for health professionals and scientific research.
Given the complexity and heterogeneity of fibromyalgia syndrome, and the ongoing debate
surrounding its pathogenesis, classification, and optimal treatment strategies, it is essential to
consolidate and critically examine the current scientific literature. A comprehensive narrative
review can provide an integrative perspective on the latest evidence, identify prevailing
therapeutic approaches, and highlight innovative frameworks—such as sanological models
—that may offer promising alternatives for improving clinical management and patient
outcomes. This type of synthesis is particularly relevant in the context of evolving
multidisciplinary interventions and the need for personalized approaches in chronic pain
syndromes.
The objective of this narrative review is to describe the current knowledge on fibromyalgia
syndrome and offer the most frequent and effective therapeutic perspectives, including the
new model of intervention that could be offered with a sanological strategy.
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Method
A descriptive narrative synthesis of the literature was carried out to integrate and analyze the
most relevant scientific evidence on fibromyalgia syndrome. The search was conducted in
four major databases: PubMed, Scopus, Web of Science, and Google Scholar. The review
focused on articles published between 2017 and 2024.
The inclusion criteria were: (a) peer-reviewed original articles or systematic reviews; (b)
studies published in English or Spanish; (c) research that addressed pathophysiological,
clinical, therapeutic, or psychosocial aspects of fibromyalgia; and (4) articles with high
methodological quality, corresponding to levels of evidence 1 and 2, according to the Oxford
Centre for Evidence-Based Medicine.
Priority was given to publications in high-impact
journals indexed in Q1 or Q2 quartiles.
Exclusion criteria included: (1) conference abstracts, opinion pieces, or non-peer-reviewed
sources; and (2) studies with unclear methodologies or low scientific rigor.
A total of 128 articles meeting these criteria were selected.
The information was organized
and presented narratively, emphasizing the most robust and recent evidence available in the
scientific literature.
Development
Pathophysiology
The etiology and pathophysiology of FMS are still uncertain despite the many studies that
have been performed. The factors related to its occurrence may be genetic, environmental,
hormonal, neural, and immunological, and although in most patients, it is not possible to
distinguish any specific cause
(10,11)
, the most notable and influential are mechanical and
psychological stress.
(12)
Within the genetic factors, polymorphisms have been reported in several genes, such as
Catechol-O-Methyltransferase
(13)
, and in those related to the reception, transport, and
degradation of the catecholamine group, specifically dopamine and serotonin.
(14)
Additionally, FMS appears to have an eightfold higher heritability factor for those with
immediate family members diagnosed.
(15)
Environmental factors studies have reported an increased likelihood of developing the
disease in people with a history of childhood sexual abuse, exposure to catastrophes or
war
(16,17)
, as well as family conflict and parental death during childhood, and low economic
income.
(15,18,19)
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Neural factors are the most studied and supported by neurophysiological, morphological, and
functional imaging techniques. Within the field, some authors have called
Central Pain
Amplification
or
Central Sensitization
the process by which repeated and constant lesions are
caused in the peripheral nociceptive fibers from the medulla to the dorsal, causing
widespread pain over time
(20)
, and generating the famous hypersensitivity to pain mediated by
amplification of such neuronal signaling in the central nervous system.
(21)
However, other
authors disagree with this distinction since, on the one hand, Häusser et al.
(11)
have suggested
a pathogenesis model in which biological and psychosocial variables interact in
predisposition, triggering, and aggravation, while other authors argue for a different
mechanical triggering process, giving the protagonism not at the brain or central nervous
system level but as a stress-induced neuropathic pain syndrome
(22)
, and also in the dorsal root
ganglia as the primary source of pain in FMS.
(23)
From a neuroanatomical point of view, changes in thalamic structures and functions have
been reported.
(24)
These alterations are due to reduced connectivity between the lateral and
posterior thalamus and the periaqueductal grey matter, as well as increased connectivity of
the posterior thalamus and bilateral inferior parietal areas, which are associated with
maladaptive processing of external stimuli and amplification of pain.
(25)
Likewise, low
cortical thickness has been reported in the cingulate gyrus and inferior occipital gyrus,
probably associated with excitotoxicity due to high levels of glutamate.
(26)
Other findings
have been decreased volume in all prefrontal cortex regions and grey matter with each year of
age.
(27)
Consequently, high levels of substance P have been found in cerebrospinal fluid in patients
with FMS, which could be closely related to a poor inhibitory response to pain, increasing its
perception and inflammation in tissues.
(28,29)
In addition, this abnormal sensation of pain and
anodynia may be mediated by sensitization processes of ascending fibers of the
spinothalamic bundle to continuous stimuli and the potential production of inflammatory
substances related to the subcutaneous superficial fascia.
(30)
On the other hand, inhibitory
neurotransmitters such as serotonin, dopamine, and norepinephrine have been found in low
levels in descending anti-nociceptive pathways in the spinal cord.
(31,32)
Coupled with possible
alterations in pain modulation due to low levels of endogenous opioids and dopamine
dysregulation, these contribute to the manifestation of hyperalgesia.
(33,34)
The study of other FMS triggers has reported alterations in the descending modulation of pain
mechanism and increased cortisol levels
(20,35)
, hypertension and cardiac alterations
(36,37,38)
,
oxidative stress with elevated nitric oxide levels, lipid peroxidation and mitophagy
(39)
, as well
as sleep disturbances and low melatonin levels.
(40,41)
Given the multiple triggers studied, they
have led researchers to analyze with equal importance the perspectives of central, peripheral,
and integrative mechanisms that generate pain in FMS.
(42,43)
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Parvovirus, Epstein Barr virus (EBV), Lyme disease
(20)
, herpesvirus HHV-6
(44)
, Chagas
disease
(45)
, Covid-19
(46)
, and other infections such as HIV, hepatitis virus, influenza, or
bacteria such as Borrelia burgdorferi
(47)
, have been linked as triggering or coexisting factors
of FMS in some studies.
Although pathophysiological research has made significant findings in the understanding of
the FMS development and onset, some authors recognize that these mechanisms are not
precisely known and grant it a multifactorial character or even doubt its existence, associating
it with the manifestation of other pathologies.
(48)
Comorbidities
The comorbidities involved in FMS are wide-ranging and could be understood in two
directions, given the clinical manifestations of its onset. On the one hand, FMS can be a
comorbid disease in other pre-existing diseases, as has been consistently reported in cases of
rheumatoid arthritis and in other rheumatologic pathologies such as spondyloarthritis,
psoriatic arthritis and ankylosing spondylitis
(49,50)
, and in non-rheumatologic such as
Ménière's disease, small intestinal bacterial overgrowth (SIBO) and systemic lupus
erythematosus.
(51,52,53)
On the other hand, FMS as a pre-existing disease has been associated with comorbidity with
irritable bowel syndrome and migraine, temporomandibular disorders, cardiovascular
diseases such as hypertension, coronary artery and heart rhythm diseases, and endocrine
diseases such as diabetes mellitus and hypothyroidism.
(54,55,56)
Psychological and psychiatric disorders have also been extensively studied. It has been
reported that 25% of patients with FMS have a major depressive disorder, and 65%
experience this disorder in their lifetime
(57)
, as well as alexithymia in 48% of them.
(58)
The
risks and prevalence of suicidal ideation, suicide attempts, and completed suicide, associated
with functional impairment, unemployment, comorbidities, and drug dependence, among
others, have even been reported.
(59,60,61)
Additionally, it has been associated with a high prevalence of anxiety, mood disorders, post-
traumatic stress disorder, borderline personality, and obsessive-compulsive personality,
evidencing a mutual reinforcement between the main symptoms of FMS and affective and
emotional comorbidities.
(62)
As a result, it has been reported that these psychopathological
manifestations generate neuroanatomical changes in these patients, with negative
correlations observed in the volume of the grey matter between trait anxiety and the
amygdala, as well as positive correlations in the white matter between depression, the
brainstem, and the postcentral gyrus.
(63)
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Furthermore, problems have been reported in cognitive functioning, specifically in attention,
memory, and executive functions, such as planning and processing speed
(64)
, which worsen
with higher levels of depression and anxiety
(65)
, causing alterations in their quality of life and
activities of daily living (Montoro et al., 2016).
(66)
Given the difficulties in diagnosis and treatment, genetic studies have confirmed possible
predispositions to psychiatric conditions, autoimmune conditions, and pain tenderness
associated with FMS (Moscati et al., 2023).
(67)
Finally, mortality studies have reported suicide, accidents, infections, chronic liver disease,
cerebrovascular disease, chronic respiratory tract disease, heart disease, and, to a lesser
extent, cancer as the leading causes of death in patients with FMS.
(68,69)
Epidemiology
Epidemiological studies have described FMS as having a prevalence of approximately 2% to
7% in the general population
(70,71)
, and the estimated mean incidence of the diagnosis is 4.5
per 1,000 persons per year seen by a physician.
(72)
A rigorous study on the epidemiology of FMS in the general population reported that the
prevalence in women reaches up to 6.8%, in urban and rural areas up to 11.4% and 5.2%,
respectively, and an alarming prevalence of up to 15% in special populations.
(70)
Although a historically higher prevalence has been demonstrated in women, changes in
diagnostic criteria and its diverse etiology have further balanced the scales, with an
approximate 2:1 ratio to men observed in recent studies.
(73)
Associated risk factors expose a higher prevalence in the female population
(74)
, pre-existing
medical disorders, presenting middle or old age, overweight, smoking and alcohol
abstinence, and especially, history of sleep disorders, depression, headaches, and other pain.
(72)
It should be clarified that FMS does not exclusively affect the adult population. Juvenile
Primary Fibromyalgia Syndrome, or JPFS as its acronym, has been termed the onset and
suffering of symptoms in children and adolescents, with an estimated prevalence as high as
5.5% to 6.2% in Turkey and North American countries.
(75,76,77)
Although the average age of
symptom onset is between 11 and 13 years, its diagnosis does not come before 14 to 15 years
of age, suggesting, as is usual in FMS, that due to its multifactorial etiological nature, it may
affect diagnostic clarity and an insidious onset at younger ages may be suspected, widening
the prevalence ranges, and generating alterations in the quality of life, depression and school
difficulties in these minors.
(75,78,79)
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In Latin America, epidemiological data on FMS are limited. However, in Chile, the highest
prevalence was estimated at 3.3%
(80)
, followed by Brazil at 2.0%
(81)
, Peru at 1.09%
(82)
, Mexico
0.68%
(83)
, while in Venezuela a reduced 0.2%.
(84)
In Colombia, a point estimate of prevalence
was determined at 0.72%, that is, a projection to the population between 51,387 and 121,409
people, a study conducted in the cities of Bogota, Medellin, Cali, Barranquilla, Bucaramanga,
and Cucuta, where a prevalence of 2.27% in women and 0.05% in men was obtained.
(85)
It is evident that countries such as the United States with 6.4%
(86)
, Scotland with 5.4%
(87)
,
France, Italy, Germany, Spain, and Portugal between 2.9% and 4.7%
(88)
, present possibly the
highest prevalences, distinguishing the Caucasian ethnic population as those affected mainly
by FMS (Marques et al., 2017).
(70)
Disease Impact
Given all the clinical manifestations of FMS mentioned above and the onset of its symptoms
generally appearing in adulthood, it is understandable that it generates unfavorable
consequences in all areas of those suffering from it. First, it is expected that the diagnosis of
FMS can take up to 2 years from the onset of symptoms
(89)
, with frequent repeated visits to
specialists, clinical examinations, various diagnoses, and medication consumption during
this time, aspects that probably generate uncertainty, changes in quality of life and daily
activities, both in these people and in their families.
After diagnosis, unfavorable changes are not necessarily suppressed. Although treatments
can partially or temporarily diminish symptoms, the physical, psychological, and social
consequences generate alterations in patients' individual, family, and work aspects.
(62)
Positive coping strategies are the primary way to accept the disease and maintain an adequate
quality of life.
(90)
From the individual point of view, it has been reported that depression and anxiety are the
symptoms of FMS that decisively predict the quality of life. Physical pain and vitality are the
most affected aspects.
(91)
Another fundamental aspect is the sleep disturbances they
experience, given the direct consequences on pain inhibition
(92)
, fatigue, and mental health,
triggering, with high probability, a worse impact of the disease. It has even been described
that people with FMS have higher pain intensity and more severe symptom consequences
affecting activities of daily living compared to people with chronic widespread
musculoskeletal pain.
(93)
Work capacity is undoubtedly an area of concern that affects and generates discomfort in
people with FMS. The clinical symptoms of the disease interfere directly with the execution
of work responsibilities since they generate an increase in the intensity of pain, feelings of
fatigue, distrust in the performance of activities that were previously performed commonly,
fear of losing their job, disappointment, higher levels of anxiety, stress and physical overload.
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Still, at the same time, they identify work relationships with their colleagues and family
support in the face of work as factors that generate satisfaction and well-being amid their
disease.
(94)
However, there is a high risk of unemployment and prolonged disability in people
with FMS
(95)
, which can generate a direct impact on the personal and family economy, in
addition to having to deal with the high financial costs of their treatment.
(96,97)
For this reason,
adaptation in workplaces and working conditions is always recommended; however, these
adjustments hardly ever come to fruition.
(95)
Regarding the family and social environment, the symptomatological manifestations of FMS
directly or indirectly affect family and social relationships. Still, good support in these
dimensions represents an excellent opportunity to facilitate coping and obtain a better quality
of life. Specifically, it has been investigated that beyond the impact of the disease on the
patient, family members are also affected, experiencing emotional exhaustion and states of
overprotection that make it difficult for them to set limits on the care they provide.
(98)
On the
other hand, it has been reported that high levels of depressive symptomatology and self-
perceived pain in patients with FMS are associated with worse levels of interpersonal
support.
(99)
However, those patients who report excellent social support have more self-
compassion and better quality of life and mental health.
(100)
Consequently, the relationship
between positive coping strategies and good marital relationships is generative of good
mental quality of life in patients.
(101)
In general terms, social support networks such as families
can facilitate adequate coping with the disease by stimulating integration activities,
emotional support, and support for caregiving and by establishing limits that reduce
overprotection.
(102)
The impairment in the performance of activities of daily living is possibly one of the
significant changes that patients with FMS must experience. Pain has been shown to play a
leading role in decreasing the ability to perform activities of daily living, no matter how basic
they may be.
(103)
Unfortunately, more than 50% of people with these pathologies involving
chronic pain have reported limitations in activities of everyday living.
(104)
However, there has
been research on the positive effects of intensive treatments based on daily activities in
relieving stiffness and feeling good in patients.
(105)
Consequently, no significant gender differences have been reported regarding the impact of
the disease.
Still, some results suggest a greater affectation in men than women, specifically
in pain tenderness, sleep, and mental health.
(106)
Numerous studies have evidenced that patients with FMS present alterations and difficulties
in their quality of life, activities of daily living, work situation, and family and social
environment.
(91,107)
Pharmacological and Non-Pharmacological Treatment Approaches
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Table 1 presents some pharmacological treatments and their main benefits in reducing pain
and improving the quality of life reported in the literature.
Table 1 -
Pharmacological treatments and main benefits in patients with FMS
Medication
Reported Benefits
References
Gabapentin (extended release).
It significantly relieves pain, reduces the
impact of the disease, and improves the
quantity and quality of sleep.
108
Pregabalin
It improves clinically significant pain, the
patient's general condition, and sleep
quality.
109
Amitriptyline
It is practical and acceptable for
improving health-related quality of life,
sleep, and fatigue.
110,111
Milnacipran
Significant improvement of symptoms
and reduction of fatigue.
112
Cyclobenzaprine
Significant relief of daily pain, reduced
impact of the disease, and improved sleep
quality.
113
Duloxetine
Efficacy in the treatment of depression
and pain.
110,111
Tramadol, in combination with
analgesic
Positive effect on pain and improvement
in life quality.
114
Note
. As raised on the scarce pharmacological evidence by Häuser and Fitzcharles
(48)
and Welsch et al.
(115)
, a comprehensive
review of benefits, dosage, efficacy, side effects, contraindications, and medical agency approval is suggested for each
country.
The pharmacological approach to FMS is very heterogeneous. Different groups have
different pharmacodynamic and pharmacokinetic properties and levels of efficacy within
each group. Some groups are antidepressants, anticonvulsants, muscle relaxants, hormonal,
monoamine oxidase inhibitors, nonsteroidal anti-inflammatory drugs, serotonin-
norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and, of course,
opioids.
(71)
Additionally, although cannabinoids and NMDA antagonists currently offer
important expectations on pain modulation, quality of life, and well-being of patients with
FMS, the results of their efficacy and effectiveness are still premature and controversial, so
further research has been suggested to support their therapeutic potential.
(116)
However,
institutions such as the U.S. Food and Drug Administration (FDA) have approved only three
drugs, pregabalin, duloxetine, and milnacipran, for treating FMS.
(116)
Currently, patients with FMS report a greater acceptance of non-pharmacological treatments
compared to pharmacological treatments despite similar effectiveness ratings
(117)
, which
could be related to the side effects of drugs, polypharmaceutical consumption and lack of
education about the treatments, probably due to fear or uncertainty regarding the
pharmacological approach.
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Psychologists are one of the professions involved in the multidisciplinary team for patients
with FMS. This profession has been reported to carry out three main activities: assessment
measures, intervention, and research.
(118)
The categories in the assessment measures include
cognitive, emotional, coping, and activity patterns, and finally, relationship/contextual
variables.
(118)
Regarding interventions, numerous studies and institutions in various countries
have rated cognitive behavioral therapy (CBT) with the highest level of evidence-based
confidence, demonstrating outstanding effectiveness.
(119)
Other non-pharmacological
treatments from psychological interventions are shown in Table 2.
Table 2 -
Non-pharmacological treatments - most commonly used psychotherapies
Psychotherapies
Reported Benefits
References
Cognitive behavioral therapy
(CBT)
It positively impacts quality of life and daily
activities, pain relief, stress reduction,
depression, anxiety, fatigue, stiffness, and
associated insomnia.
Long-term effect
120
Reduction in pain catastrophizing, pain
interference, and symptom impact.
Adaptive
alterations in neural functional connectivity
121
It significantly decreased proinflammatory
cytokines (primary proinflammatory mediators
in the pathogenesis of FMS).
122
It has a positive effect on the physical,
emotional, and behavioral condition of
patients.
123
Internet-based Cognitive
Behavioral Therapy
A clinically significant benefit is reduced
negative mood and disability at the end of
treatment.
124
Acceptance and Commitment
Therapy
Improvement in pain and disability. Decrease
in anxiety, depression, and fatigue.
125
It has a significant impact on depression,
chronic fatigue, and pain intensity.
126
Mindfulness
Reduction of pain symptoms and pain
perception
127,128
It reduces the interference of pain and the
impact of the disease and improves
psychological health and quality of life.
129
Improved sleep quality and less interference
from pain, anxiety, and depression
130
It shows immune regulatory effects and a
reduction of medical severity.
131
Psychoeducation
It reduces emotional and clinical symptoms, as
well as increases functional condition.
132
Improvement in pain management and intensity
and related emotions, symptom relief,
improvement in functional condition, and
133
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health-related quality of life
Brief Psychodynamic Therapy
Decrease in the impact of the disease and the
associated depression and anxiety.
Improved
health-related quality of life
134
Effective and significant reduction of
uncertainty intolerance and depression
135
Hypnosis and Hypnotherapy
Self-administered audio-recorded hypnosis: a
significant decrease in intensity, pain
interference, fatigue, and depression
136
Symptom-oriented hypnosis: control and
reduction of pain, fatigue, anxiety, depression,
disability, and sleep disorders.
Hypnotherapy: Resolving emotional conflicts
associated with FMS
137,138
Note
. The empirical and randomized controlled trial studies of psychotherapies for FMS generally reported that patients
maintained their standard pharmacological treatment.
Non-pharmacological treatments without psychological intervention are diverse and are
increasingly receiving more and more research interest. In this group, aerobic exercise,
chiropractic, hydrotherapy, massage, homeopathy, and meditative movements such as yoga,
tai-chi, and body awareness therapy, among others, are observed. These are considered safe,
without adverse events, and effective against symptom reduction. However, more research is
required to provide definitive results.
(71)
Multicomponent treatment, with great expectations at
present, involves the combination of relaxation, education, exercise, yoga or massage,
cognitive behavioral therapy (CBT), among others, evidencing so far, no adverse events,
clinical improvement after the intervention, relief of suffering, holistic, beneficial to health
and good cost-utility ratio, being promising as well as mindfulness, hydrotherapy and
acupuncture.
(139,140)
Nevertheless, although controversial, routine acupuncture could improve the quality of life
and relieve pain. However, more studies are needed to support it.
(141)
Finally, other non-
pharmacological treatments that have employed technological devices such as smartphones
or wearable devices have demonstrated effectiveness in monitoring and reducing pain and
disease impact.
(142)
In general, combined multidisciplinary rehabilitation treatments benefit patients' life
dimensions, usually including psychoeducation programs, aerobic and resistance exercise,
stretching, relaxation techniques, biofeedback, and cognitive behavioral therapy (CBT).
(143)
However, there may be barriers to access to health and rehabilitation services in low-income
contexts, specialized training for FMS in the professional team, and patients' unwillingness to
attempt treatment, possibly due to the emotional and physical impact of the disease itself.
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Sanology: A hopeful therapeutic approach
Sanology currently comprises a new paradigm of understanding and intervention in human
health. It conceives the health-disease process from a perspective that is not reductionist or
hegemonic but inclusive of the multitude of variables and dimensions that may be mediating
both the concept that a person gives to their health and the pressing needs and vital objectives
that the subject wishes to face or overcome when facing an illness. Among the dimensions,
we can find not only the physical-biological position but also the psychological,
environmental, spiritual, and, above all, the social, historical, and cultural, recognizing the
inherent behavioral dynamism that makes up the various stages of the life cycle and, of
course, the coexistence of disease in the daily spaces that people face.
(144)
From this point of view, the patient is responsible for establishing their therapeutic purpose
and achieving their highest satisfaction, well-being, and quality of life by coping with and
overcoming their symptoms. Consequently, the multidisciplinary health professional team
would be a guide, companion, and permanent provider of therapeutic resources based on
scientific evidence, which seeks to integrate the coping of the disease and the re-
establishment of satisfaction in the patient's life categories. From the above, an eminently
educational approach can be appreciated, which seeks, among other things, to intervene to
achieve patients' well-being from a position that attempts to articulate axiological, ethical,
family, motivational, cultural, and salutogenic aspects.
(145)
The intervention model with a sanological strategy has shown outstanding results in people
with mental disorders, evidencing significant increases in positive health states, decreasing
limitations due to emotional problems, and improving the modulation of mood states.
(146)
Additionally, significant changes in health status, health concepts and use of physical
exercise in overweight people have been reported
(147,148)
, improvement in the perception of
health and well-being, and changes in healthy lifestyle habits in mothers caring for children
with congenital disabilities
(149)
, and various health promotion, prevention and intervention
programs with outstanding results.
(150)
Consequently, multidisciplinary intervention with a sanological strategy, either exclusively
or combined with other treatments, may greatly benefit the comprehensive treatment of
people diagnosed with FMS. Given the characteristics of this new model's clinical approach,
patients with FMS could participate as protagonists in defining their therapeutic objectives,
increasing their perception of autonomy, adherence to treatment, and establishing behaviors
that promote the individual achievement of the highest level of well-being, satisfaction, and
quality of life in the context of coping with their diagnosis.
Conclusions
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For all of the above, FMS should be assumed as an idiopathic nosological entity with clearly
defined comorbidities that impact activities of daily living and diminish the quality of life of
those who suffer from it. Its interest in clinicians, researchers, and society has increased along
with its incidence and prevalence in the general population.
Significant advances have been made in efficacy and efficiency in the pharmacological and
non-pharmacological treatments reported; however, effectiveness continues to be debated
and, at times, controversial.
Integrative, evidence-based treatments that consider each person's individual needs are
required. A methodology that could favor this
person-to-person
treatment is that established
by sanology or
sanological strategy
, where each patient is aware of their state of health and is
an active part of their treatment, establishing with the support of their treating clinician, the
most favorable and available therapeutic approach about their most pressing needs.
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Conflict of Interest
The authors declare that there is no conflict of interest.
Declaration of authorship
Silvia Leonor Olivera Plaza:
Conceptualization
, formal analysis, research, project
administration, validation, visualization, writing-original draft, writing-review and editing.
Juan Esteban Lozano-Plazas: Formal analysis, research, methodology, visualization, writing-
original draft, writing-review and editing.
Lina María Sánchez Piedrahita: Conceptualization, project administration, resources,
validation, writing-review and editing.
Nicolas Arturo Núñez Gómez: Conceptualization, project administration, resources,
supervision, writing-review and editing.