[Current trends in fibromyalgia]

Even if associating in single entity polyalgic symptoms remains a matter of discussion, fibromyalgia concept has gained a large acceptance among medical communities and international instances. Its physiopathological background is still in discussion. Its presentation mostly in middle aged women is a chronic, widespread painful syndrome, mostly appendicular of long duration and resistant to any treatment, associated with multiple tender points. Frequently associated are a poor sleep, local and general fatigue and mood disorders. Clinical, biological and radiological search for a definite condition remains negative, at least for primitive presentation. Concomitant forms are accepted by the American College of Rheumatology criteria, position which can be challenged. It seems more accurate to study such cases as differential diagnosis. Physiopathology involves anomalies of perception transmission and integration of painful signals at different levels of nervous system, either peripheral or central. Medical intervention requires first a good deal of empathy and a multidisciplinary approach combining some drugs, insufficient if used alone and different physical cognitive and comportemental measures. Fibromyalgia, which raises difficult social problems, is an evolving concept.