Fibromyalgia Syndrome

Fibromyalgia syndrome (FMS) is a chronic, painful condition with several known precipitating events, but no specifically known pathophysiological cause. Cause is different from precipitating event. Cause means a specific pathophysiological basis, while precipitating event simply means something that can trigger a response. The American College of Rheumatology (ACR) has created a set of criteria for the diagnosis of FMS, which include the presence of at least nine of eighteen symmetrical tender points (TPs) that must be present for at least three months, and a sleep disorder. The presence of another painful disease does not rule out the diagnosis of FMS. A newer set of criteria(2010) does not necessarily require the presence of these TPs, but many physicians still recognize the utility of the identification of these painful locations..

FMS patients frequently remain undiagnosed for long periods of time due to the fact that there are no specific diagnostic tests or x-rays that define the diagnosis. This and the frequently vague character of the complaints delay the diagnosis in many cases. These delays can often contribute to anxiety, insomnia, and depression.

The diagnostic dilemma is complicated by the reluctance of insurance companies to recognize conditions that may lack definitely recognizable radiographic or laboratory abnormalities.

FMS can develop de novo or can be precipitated by trauma if pain is untreated. Although emotional problems are well documented in FMS patients, there is a large and growing body of research demonstrating that the pre-morbid distribution of psychiatric abnormalities in FMS patients is no different from that of the general population. This means that emotional problems are caused by FMS, not the other way around.

Treatment consists of normalizing the sleep disorder by using medications capable of restoring deficiencies of deep, dreamless, sleep. Anti-inflammatory agents, analgesics, topical agents, and physical therapy modalities may also be employed. Periodic injections into persistent TPs with various mixtures of anesthetics and steroids should be a centerpiece of therapy for most patients.