Developments in the fibromyalgia syndrome

Objectives: The goals of this presentation are to document contemporary views and new information about the fibromyalgia syndrome [FMS]. Findings: As the FMS becomes better known and understood, it is increasingly important that agreement be achieved on classification and terminology relating to it and other conditions with which it might be confused. The term "soft tissue pain" is recommended as a general heading for a variety of pain syndromes that involve muscles, nerves, ligaments, tendons and bursae. The American College of Rheumatology research classification for FMS has been critical to the rapid progress in understanding this disorder but there is understandable agitation to develop a clinical case definition [CCD] that can be appropriately applied to community medical practice. It is easier to suggest a CCD than to accomplish the necessary validation study. Many objective physiological and biochemical abnormalities have been described in FMS patients and some have been confirmed by several independent investigators. It is not yet clear which of these should be considered etiologic in its development versus the result of living with chronic pain and insomnia. Genetic subgroups would certainly seem to indicate a genetic predisposition to develop FMS. The management of FMS seems to be improving considerably. Medications are now being shown to correct objective abnormalities. Medications developed to manage neuropathic pain are being prospectively tested in FMS with hopes of achieving formal indication for this condition. Conclusions: The FMS is no longer unknown to the medical practitioner. This new status requires practical diagnostic criteria validated for use in community care, a common nomenclature, a better understanding of pathogenesis, and effective treatment modalities. Remarkably, there is dramatic progress in all of these areas.