Is fibromyalgia a distinct clinical entity? The clinical investigatorʹs evidence

Consider three views: Subjective—Chronic widespread pain with multiple tender points (fibromyalgia syndrome) is a common clinical presentation. Criteria for inclusion of fibromyalgia patients into research studies have led to a medical model which integrates symptoms, signs, epidemiology, pathogenesis, responses to treatment, and prognosis. Controversy regarding fibromyalgia relates mostly to issues of compensation. Theoretical—The diagnosis of fibromyalgia has been challenged as an inappropriate extraction from an epidemiological continuum of subjective discomfort. There are many conditions in which normally distributed measures exhibit distinctly unique outcomes at their extremes. Objective—Since fibromyalgia patients exhibit lowered pain thresholds, the process of nociception was studied. Samples of fibromyalgia urine, blood, and spinal fluid disclosed abnormalities consistent with a biomedical model of failed neuroregulatory inhibition, altered nociception, central sensitization, and allodynia. All three views support fibromyalgia as a distinct clinical syndrome deserving of informed medical care and continued research to better understand chronic widespread pain.