Article information
Abstract
Objective
To review the scientific literature concerning the classification of fibromyalgia (FM), including previous studies focusing on the gnosologic evaluation of FM, with the aim of proposing a classificatory hypothesis based on the current scientific evidence.
MethodsSystematic review using a baseline MEDLINE search. Search terms included “fibromyalgia” and “classification.” Additional articles were identified through a comprehensive manual search of the references of retrieved articles.
ResultsThis systematic review has identified, on the one hand, several classificatory proposals based on psychopathological aspects, and, on the other hand, the key role of associated diseases. Based on the scientific evidence currently available, the following FM subsets were defined: patients with no associated processes (type I FM), patients with associated rheumatic/autoimmune chronic diseases (type II FM), patients with severe psychiatric disorders (type III FM) and patients with simulated FM (type IV FM).
ConclusionsFew studies have specifically analyzed the classification of FM into subgroups with a more homogeneous clinical expression. Correct classification of patients with FM requires the integration of two key concepts (psychopathological evaluation and coexistence of comorbid processes), with an individual diagnostic evaluation by a multidisciplinary team.
Keywords:
Fibromyalgia
Classification
Chronic pain
Resumen
Objetivo
Recopilar la información existente sobre la clasificación de la fibromialgia (FM), analizar los antecedentes relevantes en relación con una subdivisión nosológica y proponer una hipótesis clasificatoria fundamentada en la evidencia científica existente en la actualidad.
MetodologíaRevisión sistemática de la literatura mediante búsqueda en la página web PubMed. Los términos de búsqueda en MEDLINE fueron «fibromyalgia» y «classification». Se realizó una búsqueda manual adicional entre las referencias de los artículos seleccionados.
ResultadosLa revisión sistemática de la literatura ha permitido identificar, por una parte, la existencia de varias propuestas clasificatorias esencialmente basadas en criterios psicopatológicos y, por otra parte, la importancia de evaluar las enfermedades relacionadas con la FM. Según la evidencia analizada, se han identificado los siguientes subgrupos clasificatorios en el paciente que cumple los criterios vigentes de 1990: pacientes sin ninguna enfermedad concomitante (FM tipo I), pacientes con enfermedades crónicas reumáticas y autoinmunitarias (FM tipo II), pacientes con grave alteración en la esfera psicopatológica (FM tipo III) y pacientes simuladores (FM tipo IV).
ConclusionesSon pocos los estudios que analizan de forma específica cómo identificar subgrupos de pacientes con FM con una expresión clínica más homogénea. El análisis ha permitido identificar que los principales aspectos a evaluar en la clasificación del paciente con FM son el perfil psicopatológico y la coexistencia de otros procesos. Una adecuada clasificación del paciente con FM sólo puede realizarse mediante una evaluación diagnóstica individualizada por parte de un equipo mutidisciplinario.
Palabras clave:
Fibromialgia
Clasificación
Dolor crónico
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