Fibromyalgia. A critical review.

Fibromyalgia Is a chronic pain syndrome, more common in women. Its pre-vale nce is estimated around 2 % in the general population, and up to 20 So amon g rheumatology outpatients. Besides musculoskeletal pain, symptoms as fatig ue and sleep disturbance are considered characteristic. Research criteria h ave been set up, but their seemingly preciseness is unable to distinguish c learly between fibromyalgia and other functional somatic syndromes (chronic fatigue syndrome, irritable bowel syndrome) and psychiatric disorders (dep ression, anxiety), with which a striking comorbidity is documented. The dia gnosis of fibromyalgia does not theoretically require the exclusion of musc le, joint, or metabolic diseases, but in clinical practice this problem pro ves to be of crucial importance. There are numbers of pathophysiological hy pothesis for fibromyalgia, but none of them is fully satisfying: muscle is probably innocent; sleep disturbance, although sometimes considered a landm ark of the syndrome, is unspecific; stress response studies show subtle ano maly : psychiatric disorders may represent factors of vulnerability and per petuation rather than causes. We propose to include some of these etiologic al contributors in vicious circles leading to a "final common pathway" char acterized by generalized hyperalgesia. Treatments of fibromyalgia, whether pharmacological (antidepressants) or psychological (cognitive-behavioral th erapies) are of little efficacy, and the global prognosis of fibromyalgia i s poor. However, the outcome might prove better outside the specialized cli nics In which studies of chronic sufferers with severe abnormal illness beh aviors are done. The social consequences of the popularization of the diagn osis of fibromyalgia should not be neglected.