Definition and classification

According to the criteria of the American College of Rheumatology (ACR), fibromyalgia syndrome is defined as chronic (>3 months) widespread pain (CWP) (including pain on both sides of the body, above and below the waist, and axial pain) and tenderness on manual palpation in at least 11 out of 18 defined tender points [4]. Chronic widespread pain and tender points do not capture the essence of all FMS-associated symptoms [5, 6]. Other key symptoms of FMS are fatigue and nonrestorative sleep. Most patients complain of additional somatic and psychological symptoms [7, 8].

The term "fibromyalgia syndrome" is preferable to "fibromyalgia" because the definition of FMS according to the ACR-criteria is based on a combination of symptoms (CWP) and clinical findings (tenderness). Because no consistent anatomic or specific pathophysiological mechanisms have yet been identified [9], FMS can be classified as a functional somatic syndrome [10, 11]. "Fibromyalgia" is listed in the International Classification of Diseases of the World Health Organization within Chapter M, "Diseases of the musculoskeletal system and connective tissue," with the code M 79.7 [12].

Fibromyalgia syndrome is not a distinct nosologic entity like a myocardial infarction following an occlusion within the coronary vasculature. Symptoms of FMS are more like other continuous medical variables such as blood pressure or coronary sclerosis for which clinically relevant limits have been defined to differentiate normal from borderline and pathological conditions. Within this context, FMS can be conceptualized as the extreme of a continuum of distress caused by pain, fatigue, sleeping problems, and cognitive disturbances [13-15]. Chronic pain in different sites of the body and fatigue are common symptoms in the general population as well as in several somatic diseases and mental disorders [16, 17]. CWP has been the focus of independent research and results have been included in this review. Tender points can be found in painful conditions other than FMS as well as in a small percentage of subjects without pain [18]. FMS, according to the ACR criteria, defines a distinct clinical syndrome at the end of a continuum of pain sites, fatigue and tender points[18, 19].

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