Fibromyalgia syndrome: a relevant recent construction of an ancient condition?

Fibromyalgia is considered the most common chronic pain syndrome. This syndrome is poorly understood and not widely accepted as a distinct clinical entity but an increasing number of pharmacological and nonpharmacological treatments are being developed for its management.

The clinical description of fibromyalgia is now well established, but controversies on diagnostic criteria are increasing. Pathophysiological studies suggest that fibromyalgia is a painful rheumatic disorder in which pain primarily stems from central sensitization and from other neuronal changes, including alterations in peripheral neuronal systems. Central sensitization may also underlie associated symptoms, including anxiety, sleep disorders, fatigue, and other dysfunctions such as irritable bowel syndrome and bladder instability. Several agents, including serotonin-norepinephrine reuptake inhibitors (duloxetine and milnacipran), weak opioids (tramadol), and anticonvulsants (pregabalin), as well as nonpharmacological approaches, have been recently evaluated in clinical trials, demonstrating benefit in terms of pain reduction and improvement of core symptoms (i.e., fatigue and sleep disturbance).

Despite the fact that pathophysiology and diagnostic criteria remain unclear, the level of scientific data collected on this recently described condition should convince clinicians of the existence of this syndrome, allowing improved management of the many patients suffering from chronic pain.