Fibromyalgia syndrome, idiopathic widespread persistent pain or syndrome of myalgic encephalomyelopathy (SME): what is its nature?
BACKGROUND
Fibromyalgia is a disorder that is appearing more and more in the clinical practice but is poorly understood.


OBJECTIVE
This paper attempts to look at all available and reliable data on these conditions and will outline current, scientifically sound understanding of these disorders, treatment modalities and future directions for research. It also attempts to analyze the social and cultural implications.


METHODS
Various terms used to describe these syndromes are fibromyalgia (FMS), and myalgic encephalomyelitis (ME). PubMed search was performed. Pertinent articles published in past 25 years and The National Academy of Sciences colloquium on Neurobiology of Pain was also reviewed. In addition, news-articles in the lay press as well as the Internet were monitored for material posted by sufferers of these disorders.


METHODS
Studies were reviewed for clinical presentations, history of these disorders, comorbid conditions, etiology, biochemical and microbiologic abnormalities, abnormalities found on neuroimaging and functional neurophysiologic techniques. In addition patient postings on the Internet and articles appearing in lay press were reviewed and social implications are discussed.


RESULTS
Upon analysis of these materials the review was organized based on the quality of data and it's contextual scientific, cultural and political meaning for this disorder. This review appears to be pointing towards an entirely new paradigm in pain disorders; therefore, a hypothesis and future direction of research is repeatedly suggested.


CONCLUSIONS
This study proposes an entirely new paradigm in these disorders based on scientific and cultural data.
Mehendale
Anand W
AW
Neurobiology Research Unit, Phoenix Medical Associates, Kerrville, Texas 78028, USA.
Goldman
Mark P
MP