Fibromyalgia syndrome

SUMMARY Fibromyalgia is a clinical syndrome with a widely heterogeneous presentation that can present significant difficulty in diagnosis and management. It is becoming clear that patients with fibromyalgia experience pain at a higher intensity than normal healthy individuals, and that the difference in their experience of pain is likely secondary to abnormalities in central pain processing rather than dysfunction in the peripheral tissues. However, the exact cause of these abnormalities remains unclear. What we do know is that fibromyalgia syndrome is a complex condition that requires a unique, well-coordinated and multidisciplinary approach to treatment with the understanding that it is not a disease that can be cured, but rather a clinical syndrome that can be managed. The goal of this article is to review our current understanding of the etiology, pathophysiology and diagnosis of fibromyalgia syndrome as well as to review the evidence for current treatment strategies. While we do not provide any novel research, where available, the results of published meta-analyses are summarized as are some original studies. This article also discusses the new preliminary diagnostic criteria for fibromyalgia syndrome, which was proposed by Wolfe et al. in 2010. It is the opinion of the senior author of this paper that, while these criteria are proposed with good intentions and are likely to be helpful in the area of clinical and epidemiological research, in the clinical setting they are likely to add more confusion than clarity and lead to an increased diagnosis of fibromyalgia syndrome at a time when few physicians are interested in and willing to properly care for these individuals. Many of the patients who would be diagnosed under the new criteria are likely to be sidelined, poorly served and treated inappropriately and excessively, adding stress to an already over-burdened healthcare system. The senior author of this paper warns that caution should be undertaken before widespread use of these proposed criteria is implemented in the clinical setting.