Fibromyalgia: A Clinical Update

In clinical practice the diagnosis of “fibromyalgia” is often given to individuals with chronic widespread pain for which no alternative cause can be identified. The 1990 classification criteria of the American College of Rheumatology (ACR) for fibromyalgia syndrome (FMS) combine chronic widespread pain (CWP), which indicates pain on both sides of the body, above and below the waist, and axial pain for at least 3 months, and tenderness on manual palpation in at least 11 out of 18 defined tender points. Most clinicians would recognize that FMS, in its typical manifestation, is accompanied by a combination of additional symptoms such as sleep disturbance, fatigue, and anxiety, and by other clinical manifestations such as depression, gastrointestinal symptoms, and headache. In addition, FMS is often associated with chronic fatigue syndrome, irritable bowel syndrome (IBS), irritable bladder syndrome or interstitial cystitis, and temporomandibular disorder. The common theme is that patients have chronic pain and other somatic symptoms, but without apparent tissue damage or inflammation.