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Fibromyalgia

Abstract

Fibromyalgia is a common illness characterized by chronic widespread pain, sleep problems (including unrefreshing sleep), physical exhaustion and cognitive difficulties. The definition, pathogenesis and treatment are controversial, and some even contest the existence of this disorder. In 1990, the American College of Rheumatology (ACR) defined classification criteria that required multiple tender points (areas of tenderness occurring in muscles and muscle–tendon junctions) and chronic widespread pain. In 2010, the ACR preliminary diagnostic criteria excluded tender points, allowed less extensive pain and placed reliance on patient-reported somatic symptoms and cognitive difficulties. Fibromyalgia occurs in all populations worldwide, and symptom prevalence ranges between 2% and 4% in the general population. The prevalence of people who are actually diagnosed with fibromyalgia (‘administrative prevalence’) is much lower. A model of fibromyalgia pathogenesis has been suggested in which biological and psychosocial variables interact to influence the predisposition, triggering and aggravation of a chronic disease, but the details are unclear. Diagnosis requires the history of a typical cluster of symptoms and the exclusion of a somatic disease that sufficiently explains the symptoms by medical examination. Current evidence-based guidelines emphasize the value of multimodal treatments, which encompass both non-pharmacological and selected pharmacological treatments tailored to individual symptoms, including pain, fatigue, sleep problems and mood problems. For an illustrated summary of this Primer, visit: http://go.nature.com/LIBdDX

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Figure 1: Pain processing and its modulation.
Figure 2: Potential pathophysiological processes in fibromyalgia.
Figure 3: Potential therapies for fibromyalgia.

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Acknowledgements

D. Clauw provided useful discussions and contributions to the writing and editing process but chose not to be credited with authorship. This manuscript was supported (in part) by the Intramural Research Program of the US NIH, National Center for Complementary and Integrative Health (NCCIH) and National Institute of Nursing Research (NINR). J.V.L. has a Miguel Servet research contract awarded by the Institute of Health Carlos III (CP14/00087; ISCIII, Madrid, Spain).

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Introduction (W.H.); Epidemiology (W.H. and C.U.); Mechanisms/pathophysiology (J.A. and B.W.); Diagnosis, screening and prevention (G.L. and W.H); Management (M.-A.F. and J.V.L.); Quality of life (B.W. and G.L); Outlook (all authors); overview of Primer (W.H.).

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Correspondence to Winfried Häuser.

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B.W., J.V.L. and C.U. declare no competing interests. J.A. has received research funding and participated in educational activity sponsored by Pfizer. M.-A.F. has received consulting fees, speaking fees and/or honoraria from BioVale, Janssen, Eli Lilly, Pfizer, Purdue and Valeant. W.H. received one consulting fee from Daiichi Sankyo and honoraria for educational lectures by Abbott, MSD, Sharp & Dohme and Pfizer. G.L. has been involved in clinical trials for Pfizer and Eli Lilly at Monash Health and received consulting and/or speaking fees from Pfizer, Eli Lilly, Mundipharma, Grünenthal, bioCSL and Pierre Fabre Medicament Australia.

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Häuser, W., Ablin, J., Fitzcharles, MA. et al. Fibromyalgia. Nat Rev Dis Primers 1, 15022 (2015). https://doi.org/10.1038/nrdp.2015.22

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