Fibromyalgia - symptom or diagnosis: A definition of the position

According to the American College of Rheumatology the diagnosis of fibromya lgia is based on criteria for the classification of fibromyalgia consisting entirely of clinical signs and symptoms. For diagnostic reasons autonomic disturbances and mental features have to be considered. The distinction bet ween fibromyalgia (tender points) and myofascial pain syndrome (trigger poi nts) is essential. Internal and neurological disorders as a primary cause o f fibromyalgia have to be excluded. The etiology and pathogenesis of fibrom yalgia still remain uncertain. The myopathological patterns in fibromyalgia are non-specific: type II fiber atrophy, an increase of lipid droplets, a slight proliferation of mitochondria, and a slightly elevated incidence of ragged red fibers. Initial reports on some allelic abnormalities in the ser otonin system seem to highlight the important role of serotonin already pre sumed earlier. Significantly high levels of substance P in the cerebrospina l fluid of FM patients additionally support the impact of these neurotransm itters on both nociceptive and antinociceptive mechanisms.