Fibromyalgia is a complex condition that is characterized by chronic widespread
pain and multiple other symptoms, including
fatigue, sleep disturbances,
cognitive dysfunction, stiffness, and depressive episodes.
Fibromyalgia may coexist and/or overlap with other conditions that may involve central sensitivity, including
chronic fatigue syndrome,
irritable bowel syndrome, irritable bladder syndrome or
interstitial cystitis, and
temporomandibular disorder. The pathophysiology of
fibromyalgia remains uncertain but is believed to be partly the result of central systems affecting afferent processing as well as impaired endogenous
pain-inhibitory systems. Abnormal central nociceptive processing may contribute to
fibromyalgia, producing heightened responses to various noxious stimuli with resulting
mechanical hyperalgesia.
Fibromyalgia remains a clinical diagnosis. There has been a recent paradigm shift away from requiring 11 or more out of 18 tender points and instead focusing on the presence of chronic widespread
pain as well as symptoms of
fatigue, unrefreshed sleep, and other somatic complaints. Although there is no known cure for
fibromyalgia, multidisciplinary team efforts using combined treatment approaches, including patient education, aerobic exercise, cognitive behavioral therapy, and pharmacologic
therapies (
serotonin norepinephrine reuptake inhibitors [eg,
duloxetine,
milnacipran] and alpha 2-
delta receptor ligands [eg,
pregabalin]) may improve symptoms as well as function of patients with
fibromyalgia.