An overview of fibromyalgia syndrome: Mechanisms, differential diagnosis and treatment approaches

Fibromyalgia syndrome (FMS) is a common source of chronic musculoskeletal pain, but has hitherto received little attention in the UK physiotherapy literature. This paper reviews the epidemiology, aetiology, and differential diagnosis of FMS and discusses approaches to the physical management of FMS of relevance to physiotherapists. Chronic pain, fatigue, disturbed sleep acid bilateral tender points are the cardinal features of FMS. This symptomatology is thought to arise through a combination of physiological acid psychological mechanisms, acting both centrally and peripherally. The principal differential diagnoses are chronic fatigue syndrome and myofascial pain syndrome, and the relationship of these syndromes to each other is controversial. Systematic and rigorous studies of the effectiveness of non-pharmacological management of FMS are few. However, evidence supports the use of cardiovascular fitness training, EMG biofeedback, electroacupuncture and cognitive-behavioural therapy as methods of gaining short- or medium-term relief of symptoms. Long-term management by such means has not generally been shown to be successful. From the empirical evidence available, it seems that effective physiotherapy for FMS is likely to embrace both physical and psychological approaches, pay particular attention to the restoration of function, and take place within a multi-disciplinary context.