Fibromyalgia

Fibromyalgia is a clinical syndrome consisting of diffuse musculoskeletal pain, chronic fatigue, sleep disorders and mood disturbances (depression or anxiety) in a patient with no relevant physical, biological or pathological abnormalities. WHO classifies it both as a musculoskeletal disorder and as a psychiatric disorder. Patients may also complain of irritable bowel, pelvic pain or bladder symptoms. Fibromyalgia cannot be reduced to a simple psychogenic syndrome. Features such as abnormal serum serotonin, spinal fluid 5HIA and growth hormone levels, and the results of brain imaging studies, suggest that fibromyalgia is related to abnormal sensory processing by the central nervous system. The French Academy of Medicine recommends that these patients should not be rejected but, on the contrary, managed individually, with a sympathetic ear and an acknowledgment of the pain he or she is experiencing. Multidisciplinary treatment may be needed, and may combine antidepressant drugs with physical and cognitive therapy, an approach endorsed by the results of randomized controlled studies. Working capacity is diminished but should be maintained if possible by adjusting the working hours and conditions. Only rarely does the fibromyalgia patient qualify for disability allowances or compensation.