Introduction to fibromyalgia
Chronic diffuse noninflammatory musculoskeletal pain, unlike inflammatory connective tissue disease syndromes, is very common. While the best way to define this problem is still debated, fibromyalgia is the current preferred term for the common and well-defined clinical syndrome of chronic widespread noninflammatory musculoskeletal pain accompanied by a variety of typical symptoms including fatigue, sleep disturbance and cognitive clouding.
The pathophysiology of fibromyalgia is complex and poorly understood. Altered levels of neurotransmitters in the cerebrospinal fluid (CSF), and abnormalities on functional imaging studies, have been demonstrated in people with fibromyalgia. These findings suggest that central nervous system mechanisms (including central sensitisation) are fundamental to the development of the symptoms of fibromyalgia.
Despite the evolving understanding of the pathophysiology, fibromyalgia remains a clinical diagnosis. The absence of laboratory or imaging abnormalities can be challenging for both patients and practitioners, particularly if a simple biomedical causal model has been sought. A more nuanced biopsychosocial understanding of fibromyalgia is preferred; however, this does not imply that symptoms are a direct consequence of psychological distress.
For information on paediatric fibromyalgia, see Diffuse amplified musculoskeletal pain.