Fibromyalgia-is it a distinct clinical entity? The Debate
Fibromyalgia is defined as chronic musculoskeletal disorder characterized by widespread pain, exquisite tenderness at specific anatomic sites (“tender points”) and other clinical manifestations such as fatigue, sleep disturbance, and irritable bowel syndrome (1). Although fibromyalgia has been recognized for decades with descriptive terms such as fibrositis and psychogenic rheumatism, only after 1990, with the publication of the American College of Rheumatology (ACR) criteria, a burst of research and publications on fibromyalgia started and has been continued to date.
However, debate and controversy about this condition exists. On one hand are those who deny the mere existence of fibromyalgia and consider it as an artificial summation of unrelated symptoms (2). Notably, if fibromyalgia is not a clinical entity but expression of low self esteem and unhappiness, we should change our approach and deal with the patients by psychological and sociological terms. Moreover, the burden of these chronic unsatisfied patients would shift from rheumatology and pain clinics to multidisciplinary teams led by social worker and psychologists.
On the other hand, many clinicians and researchers define fibromyalgia as a distinct clinico-pathological disorder, and even claim that is a genetically based disease with an autosomal-dominant transmission (3). There are various findings, including genetic, neuroendocrine, specific sleep and functional brain abnormalities, which might point to fibromyalgia as a distinct pain syndrome. Notably, if fibromyalgia has a genetically based molecular basis affecting pain regulation, more in depth and thorough research is required for elucidation of pathogenesis and finding specific treatment for this very common disabling syndrome.
We hope that the future research will help the readers to have tools to more knowledgeably approach the care of patients with fibromyalgia.
- Smythe HA. "Fibrositis" as a disorder of pain modulation.Clin Rheum Dis 1979, 5: 823-832.
- Hadler NM. Fibromyalgia: La maladie est morte. Vive le malade. J Rheumtol 1997, 24: 1250-1251. 3. Buskila D, Neumann L. Fibromyalgia syndrome (FM) and nonarticular tenderness in relatives of patients with FM. J Rheumatol 1997,24:941-944.