要約

Fibromyalgia syndrome (FMS) is a generalized musculoskeletal pain disorder with multiple functional and psychological problems. Despite extensive efforts during the last 30 years to uncover the etiology, the mechanisms underlying FMS remain elusive. Similarly, no single treatment has proven to be universally effective for FMS. FMS is considered to be a medical enigma, and millions of patients continue to suffer from debilitating pain and disability. The primary objective of this article is to present a thorough review of the current FMS literature. We discuss three primary hypotheses on the pathophysiologic mechanisms: peripheral, psychological, and central. We attempt to integrate the findings and suggest a heuristic model of FMS, integrating the physiological and psychological variables with the predispositional, stress, and time factors associated with FMS. This article also includes a review of clinical trials testing various therapy modalities for FMS. The review emphasizes the importance of understanding the multifactorial nature of FMS; different modalities seem to target different areas of the disorder. We suggest that clinical decisions need to reflect the diversity of the FMS symptom profiles. Interdisciplinary treatments tailored to target a patient's specific needs are likely to improve the clinical efficacy and cost-effectiveness of the therapy.