title: Fibromyalgia: harmonizing science with clinical practice considerations.
abstract: This review summarizes the present and emerging knowledge base on the pathophysiology, diagnosis, and management of fibromyalgia.
  
  
  BACKGROUND
  Fibromyalgia is the most common chronic pain syndrome encountered in general medicine and rheumatology. Historically, contemporary concepts of fibromyalgia have evolved in terms of its clinical description and parallel advances in the understanding of its pathophysiology.
  
  
  METHODS
  A generally accepted paradigm postulates that fibromyalgia is the clinical expression of a rheumatologic disorder in which the associated pain is driven primarily by central sensitization and possibly through changes in several neuronal systems but not necessarily reliant on peripheral processes.
  
  
  RESULTS
  Several agents, including serotonin-norepinephrine reuptake inhibitors (ie, duloxetine and milnacipran), opioids (ie, tramadol), and the alpha2-delta ligand pregabalin, which recently received U.S. regulatory approval for the treatment of fibromyalgia, have been evaluated in clinical trials, demonstrating benefit in terms of pain reduction and improvement in core symptoms (ie, fatigue and sleep disturbance). The European League Against Rheumatism has developed updated guidelines for the management of fibromyalgia.
authors: Center de la Douleur et Service de Médecine Interne, Hôtel-Dieu, University Paris 5 Descartes, Paris, France. serge.perrot@htd.aphp.fr
authors: Serge
authors: S
authors: Perrot
authors: Anthony H
authors: AH
authors: Dickenson
authors: Robert M
authors: RM
authors: Bennett
mesh_terms: D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D002490:Central Nervous System / Q000503:physiopathology; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003937:Diagnosis, Differential; D019468:Disease Management; D005081:Exercise Therapy; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology; D005356:Fibromyalgia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D000077206:Gabapentin; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D009209:Myofascial Pain Syndromes / Q000503:physiopathology; D015213:Neuroimmunomodulation; D010146:Pain / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012216:Rheumatic Diseases / Q000503:physiopathology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020919:Sleep Disorders, Intrinsic / Q000209:etiology / Q000503:physiopathology; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D000077206:Gabapentin; D006993:Hypnotics and Sedatives; D017367:Selective Serotonin Reuptake Inhibitors; D005680:gamma-Aminobutyric Acid