Fibromyalgia: harmonizing science with clinical practice considerations

Pain Pract. 2008 May-Jun;8(3):177-89. doi: 10.1111/j.1533-2500.2008.00190.x. Epub 2008 Mar 18.


This review summarizes the present and emerging knowledge base on the pathophysiology, diagnosis, and management of fibromyalgia.

Epidemiology: Fibromyalgia is the most common chronic pain syndrome encountered in general medicine and rheumatology. Historically, contemporary concepts of fibromyalgia have evolved in terms of its clinical description and parallel advances in the understanding of its pathophysiology.

Pathophysiology: A generally accepted paradigm postulates that fibromyalgia is the clinical expression of a rheumatologic disorder in which the associated pain is driven primarily by central sensitization and possibly through changes in several neuronal systems but not necessarily reliant on peripheral processes.

Management: Several agents, including serotonin-norepinephrine reuptake inhibitors (ie, duloxetine and milnacipran), opioids (ie, tramadol), and the alpha2-delta ligand pregabalin, which recently received U.S. regulatory approval for the treatment of fibromyalgia, have been evaluated in clinical trials, demonstrating benefit in terms of pain reduction and improvement in core symptoms (ie, fatigue and sleep disturbance). The European League Against Rheumatism has developed updated guidelines for the management of fibromyalgia.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Amines / therapeutic use
  • Analgesics / therapeutic use
  • Central Nervous System / physiopathology
  • Clinical Trials as Topic
  • Combined Modality Therapy
  • Cyclohexanecarboxylic Acids / therapeutic use
  • Diagnosis, Differential
  • Disease Management
  • Exercise Therapy
  • Fatigue / etiology
  • Fatigue / physiopathology
  • Fibromyalgia* / complications
  • Fibromyalgia* / diagnosis
  • Fibromyalgia* / epidemiology
  • Fibromyalgia* / physiopathology
  • Fibromyalgia* / psychology
  • Fibromyalgia* / therapy
  • Gabapentin
  • Humans
  • Hyperalgesia / physiopathology
  • Hypnotics and Sedatives / therapeutic use
  • Myofascial Pain Syndromes / physiopathology
  • Neuroimmunomodulation
  • Pain / physiopathology
  • Practice Guidelines as Topic
  • Prevalence
  • Rheumatic Diseases / physiopathology
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Sleep Disorders, Intrinsic / etiology
  • Sleep Disorders, Intrinsic / physiopathology
  • gamma-Aminobutyric Acid / therapeutic use


  • Amines
  • Analgesics
  • Cyclohexanecarboxylic Acids
  • Hypnotics and Sedatives
  • Serotonin Uptake Inhibitors
  • gamma-Aminobutyric Acid
  • Gabapentin