ABSTRACT
Fibromyalgia syndrome (FMS) is a chronic and debilitating musculoskeletal pain disorder of unknown aetiology with usual accompanying features of fatigue, sleep disturbances and stiffness. Its place in medical textbooks was controversial with rheumatologists holding the helm of its management for many years. Over the last decade, abnormalities have been identified at multiple levels in the peripheral, central, and sympathetic nervous systems as well as the hypothalomo-pitutary-adrenal axis stress response system. With the elucidation of these pathways of pain, FMS is known more as a central sensitivity syndrome. This led to tremendous increment in interest in both pharmacological and non-pharmacological treatment of FMS. The United States Food and Drug Administration (FDA) has also successively approved 3 drugs for the management of fibromyalgia – pregabalin, duloxetine and milnacipran. Non-pharmacological modalities showed aerobic exercise, patient education and cognitive behavioural therapy to be most effective. Overall, management of FMS requires a multi-disciplinary approach.
Fibromyalgia syndrome (FMS) has been referred to as a medically unexplained syndrome;1,2 a rheumatological entity described in rheumatology textbooks and taught to all training rheumatologists,3 and lately with newer development in research particularly in neurophysiology, as a central sensitivity syndrome.4 Due to its lack of objective findings on physical examination, laboratory and imaging modalities, FMS was once dismissed by physicians and the public as a psychological disorder. It was thought to be a society-driven disorder, whereby expressions of the distressed patient’s problems are made into a “disease”, hence becoming more legitimate for equal social support and sympathy from the medical community.5 Whether this is actual social or economic medicalisations,6 there are real patients suffering real symptoms.
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