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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We do not know what led Dr&#46; A Olive and <span class="elsevierStyleSmallCaps">Reumatolog&#237;a Cl&#237;nica</span> to publish an editorial which aims to revive an old concept&#44; psychogenic rheumatism&#44; that was used from 1960 to 1980 by certain leading rheumatologists to classify patients with fibromyalgia&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although it is hard to understand the scientific contributions this new paper makes which justify its inclusion as an editorial in the journal&#44; if the aim is to remind us of historic facts&#44; we should also point out that the time in question was one of the most frustrating periods for patients due to their resulting lack of comprehension&#46; Use of the term &#8220;psychogenic&#8221; to identify a rheumatic disease was probably selected at the time as no clinical diagnostic criteria were available&#44; due to a lack of relevant knowledge on the mechanisms by which chronic pain develops&#44; and because of the mistaken confusion between patient symptoms and their behaviour&#46; The mistaken attribution of their psychological situation as the cause of the disease&#44; instead of seeing this as a consequence of the same&#44; caused major distancing between rheumatologists and their patients&#44; with an almost complete absence of research over several decades&#44; contributing to disregard of its treatment which in many cases has lasted up to now&#46; These facts do not merit vindication and fortunately are being overshadowed by the recognition of the disease by the WHO in 1992&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The lack of knowledge shown by the author&#44; who confuses the &#8220;trigger points&#8221; intrinsic to the reported or radiated pain with &#8220;sensitive points&#8221;&#44; which refer to the nociceptive threshold&#44; and the acceptance of certain unproven hypotheses&#44; undermine the authority of the author in the analysis of this subject&#46; The reality is that fibromyalgia is the second most common rheumatic disease in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Patients undergo a 6-year delay in diagnosis&#44; and the disease disables 40&#37; of them for the long-term performance of their work&#44; while 23&#37; are recognised as having a permanent disability&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The current state of knowledge regarding the mechanisms of pain has changed how we view fibromyalgia&#46; This disease is characterised by abnormal pain processing&#44; in which descending inhibitory and facilitating control responses correspond to a central state of sensitisation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Nevertheless&#44; the interesting functional and structural alterations are also observed at peripheral level&#44; in the form of small fibre neuropathy&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a> reducing the degree of psychological involvement in its main mechanism&#46; Many patients with fibromyalgia have no psychopathological diagnosis&#44; and when they do have such a diagnosis&#44; it is often associated with an adaptive disorder due to the difficulties deriving from control of the same&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This knowledge about pain and its consequences for the emotional situation of patients&#44; together with the exacerbating functional pattern of the disease&#44; has allowed us to identify certain pharmacological therapeutic guidelines within the field of neuropathic pain&#44; as well as non-pharmacological interventions in behavioural education&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Although these are able to improve the symptoms&#44; they do not eliminate the disease&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We do agree with this editorial that fibromyalgia gives rise to high direct and indirect medical costs&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and that these may be attributed in part to poor management of the disease within the healthcare system&#46; The political intervention due to patient demand for fair treatment has not fully counterbalanced the lack of support by medical professionals&#46; The current lack of rheumatology specialists who are interested in treating chronic pain and patients with fibromyalgia can be attributed to the distancing from the condition that has arisen&#44; due in part to the injudicious psychogenic theory for a disease whose neurobiological mechanisms are becoming increasingly comprehensible&#46;</p></span>"
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Letter to the Editor
Fibromyalgia. Old opinions versus new knowledge
Fibromialgia. Viejas opiniones frente a nuevos conocimientos
Antonio Colladoa,b,
Corresponding author
acollado@clinic.cat

Corresponding author.
, Javier Riveraa,b, Cayetano Alegrea,b, Benigno Casanuevaa,b
a Miembro de la Sociedad Española de Fibromialgia y Síndrome de Fatiga Crónica (SEFIFAC)
b Miembro Grupo (GEFISER), Sociedad Española de Reumatología
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We do not know what led Dr&#46; A Olive and <span class="elsevierStyleSmallCaps">Reumatolog&#237;a Cl&#237;nica</span> to publish an editorial which aims to revive an old concept&#44; psychogenic rheumatism&#44; that was used from 1960 to 1980 by certain leading rheumatologists to classify patients with fibromyalgia&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although it is hard to understand the scientific contributions this new paper makes which justify its inclusion as an editorial in the journal&#44; if the aim is to remind us of historic facts&#44; we should also point out that the time in question was one of the most frustrating periods for patients due to their resulting lack of comprehension&#46; Use of the term &#8220;psychogenic&#8221; to identify a rheumatic disease was probably selected at the time as no clinical diagnostic criteria were available&#44; due to a lack of relevant knowledge on the mechanisms by which chronic pain develops&#44; and because of the mistaken confusion between patient symptoms and their behaviour&#46; The mistaken attribution of their psychological situation as the cause of the disease&#44; instead of seeing this as a consequence of the same&#44; caused major distancing between rheumatologists and their patients&#44; with an almost complete absence of research over several decades&#44; contributing to disregard of its treatment which in many cases has lasted up to now&#46; These facts do not merit vindication and fortunately are being overshadowed by the recognition of the disease by the WHO in 1992&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The lack of knowledge shown by the author&#44; who confuses the &#8220;trigger points&#8221; intrinsic to the reported or radiated pain with &#8220;sensitive points&#8221;&#44; which refer to the nociceptive threshold&#44; and the acceptance of certain unproven hypotheses&#44; undermine the authority of the author in the analysis of this subject&#46; The reality is that fibromyalgia is the second most common rheumatic disease in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Patients undergo a 6-year delay in diagnosis&#44; and the disease disables 40&#37; of them for the long-term performance of their work&#44; while 23&#37; are recognised as having a permanent disability&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The current state of knowledge regarding the mechanisms of pain has changed how we view fibromyalgia&#46; This disease is characterised by abnormal pain processing&#44; in which descending inhibitory and facilitating control responses correspond to a central state of sensitisation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Nevertheless&#44; the interesting functional and structural alterations are also observed at peripheral level&#44; in the form of small fibre neuropathy&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a> reducing the degree of psychological involvement in its main mechanism&#46; Many patients with fibromyalgia have no psychopathological diagnosis&#44; and when they do have such a diagnosis&#44; it is often associated with an adaptive disorder due to the difficulties deriving from control of the same&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This knowledge about pain and its consequences for the emotional situation of patients&#44; together with the exacerbating functional pattern of the disease&#44; has allowed us to identify certain pharmacological therapeutic guidelines within the field of neuropathic pain&#44; as well as non-pharmacological interventions in behavioural education&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Although these are able to improve the symptoms&#44; they do not eliminate the disease&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We do agree with this editorial that fibromyalgia gives rise to high direct and indirect medical costs&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and that these may be attributed in part to poor management of the disease within the healthcare system&#46; The political intervention due to patient demand for fair treatment has not fully counterbalanced the lack of support by medical professionals&#46; The current lack of rheumatology specialists who are interested in treating chronic pain and patients with fibromyalgia can be attributed to the distancing from the condition that has arisen&#44; due in part to the injudicious psychogenic theory for a disease whose neurobiological mechanisms are becoming increasingly comprehensible&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Collado A&#44; Rivera J&#44; Alegre C&#44; Casanueva B&#46; Fibromialgia&#46; Viejas opiniones frente a nuevos conocimientos&#46; Reumatol Clin&#46; 2021&#59;17&#58;554&#46;</p>"
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