In order to improve the outcome of FMS, first one must acknowledge the problem. Regardless of whether FMS is a single condition/disease or not, it is a major healthcare


Stress and catastrophizing


¿IV Sleep

Altered mood and stress response

Altered HPA axis

¿IV Sleep

Descending inhibition impaired

Altered HPA axis i T3 i GH

i Estrogen i Cortisol î CCTH i IGF-1

Trauma/ injury ?

■ Repetitive -nociceptor stimulation


Peripheral sensitization

Figure 42.2 Contributing factors to the pathophysiology of fibromyalgia.


Voltage-gated calcium channel

Membrane depolarizes ft

ACh receptor

Synaptic cleft

Maximally contracted



Maximally contracted

burden and must be addressed. As previously mentioned, diagnosis of FMS can help reduce the healthcare burden through reduced investigations and referral to specialists.21 Therefore, ignoring the problem is not the solution. Clearly, the diagnosis of FMS can be used constructively to reassure patients, thereby reducing healthcare utilization.

As FMS is a complex syndrome associated with a wide range of symptoms, treatment should be tailored to the individual, addressing their particular needs and targeting their most distressing symptoms. The best strategy is to use a multidisciplinary approach to treatment, using both pharmacological and nonpharmacological interventions as required. It is unlikely that a single treatment will target all of the different symptoms involved. The different subgroups of patients with FMS respond differently to treatment strategies,63 highlighting the fact that patients should be managed according to their individual needs, rather than following a generalized approach.

In the following section we aim to discuss the current evidence for treatment of FMS, which can be selected to suit the individual concerned. This is based on evidence gained from studies using the 1990 ACR criteria for FMS diagnosis in order to study a more homogenous population. The European League Against Rheumatism have also produced guidelines for management of FMS.64

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