A Concise Overview of Fibromyalgia for Physicians

To quote the University of California San Diego psychiatrist Stephen Stahl, “fibromyalgia is emerging as a diagnosable and potentially treatable syndrome” (Stahl 2001). While acknowledging that psychological influences are powerful modulators of pain related suffering and dysfunction, there is now a growing understanding that fibromyalgia cannot be “written off” as a somatoform pain disorder. Fibromyalgia is a multi-symptomatic syndrome defined by the core feature of chronic widespread pain (Smythe et al. 1977;Bennett 1981;Yunus et al. 1981;Goldenberg 1987;Wolfe et al. 1990). Many of these patients also have severe fatigue and associated symptoms related to visceral hyperalgesia, such as irritable bowel and bladder. This population accounts for about 20% of patients consulting rheumatologists in North America (Marder et al. 1991;White et al. 1995). Contemporary research implicates abnormalities of sensory processing and neuroendocrine dysfunction as being related to the symptomatology of these patients. This refresher course will: 1) trace the historical evolution of the fibromyalgia concept, 2) present the evidence for fibromyalgia being, in part, a manifestation of central sensitization, 3) provide an overview of the clinical features of fibromyalgia, 4) discuss the rational management of fibromyalgia patients.