MECHANISMS OF FIBROMYALGIA PAIN

Fibromyalgia (FM) is a common condition in the population occurring in 2% to 4% of adults living in the United States. Characterized by chronic widespread pain for at least 3 months and the presence of widespread mechanical tenderness, FM typically affects women and can be found in patients of varying ages who present in both primary care and psychiatric settings. As there are a number of other clinical syndromes which often occur with FM, it is important for clinicians to have a current understanding of the etiology of the syndrome and its diagnostic criteria. Conditions that occur comorbid with FM include lupus, rheumatoid arthritis, Sjogren's syndrome, and osteoarthritis, among others. Due to its chronic nature, FM often occurs highly comorbid with anxiety and depression, which can also worsen patient pain ratings. The optimal management of FM is comprised of both pharmacologic and nonpharmacologic approaches, including use of serotonin-norepinephrine reuptake inhibitors and/or cognitive-behavioral therapy. In this Expert Review Supplement, Roland Staud, MD, reviews the clinical manifestations of FM and provides an overview of the pain mechanisms in FM, prevalence of the syndrome, and current thinking on deficiencies in pain centers involved in FM; Philip J. Mease, MD, reviews comorbidities that commonly occur with FM, assessment of FM, and well-studied drug therapies targeting symptoms of FM; and David A. Williams, PhD, provides a rationale for optimal care involving a combination of pharmacologic and non-pharmacologic interventions. Lastly, a case study related to the overall diagnosis and treatment of FM in a typical patient is presented and discussed.