Management of Widespread Pain and Fibromyalgia

Proposed genealogies of the syndrome now known as fibromyalgia (FM) stretch back as far as the late sixteenth century [ 1 ]. Key historical moments in its emergence as a distinct entity include the 1904 debut of fibrositis [ 2 ] and Hench’s introduction of the term “fibromyalgia” in 1976 [ 3 ]. The American College of Rheumatology (ACR) first published classification criteria in 1990 [ 4 ••], characterizing FM as chronic widespread pain (pain in the axial skeleton and on both sides of the body, above and below the waist, for at least 3 months), plus 11 out of a possible 18 tender points on clinical examination. The ACR disseminated revised criteria in 2010, the update shifting the emphasis from classification to diagnosis [ 5 ••]. The tender point requirement was replaced by recognition of the importance of patient-reported symptoms, including somatic, cognitive, and mood disorders. The revised criteria allowed FM to be measured on a continuous scale that incorporated the widespread-ness of pain and the severity of concurrent symptoms. A modified version of the 2010 criteria was published a year later (2011), and these were used to develop a questionnaire for use in clinical and epidemiological studies of the syndrome [ 6 ••]. The mean worldwide prevalence of FM has been estimated to be 2.7 %, with a higher occurrence in women and those of middle or older age and lower socioeconomic status [ 7 ]. US prevalence has been estimated as 2.2 % using the 1990 ACR criteria [ 8 ] and 6.4 % using the 2010 ACR criteria [ 9 ]. Advances in the understanding of the underlying pathophysiology, including recognition of the role of central pain sensitization, have informed FM management. Findings from studies investigating pharmacological, non-pharmacological and complementary, and alternative therapies have been summarized in clinical practice guidelines (CPG). These include The European League Against Rheumatism’s (EULAR) appraisal of the literature, published in 2008 [ 10 •], which is currently being updated. This document was one of six CPGs that contributed to a systematic review of guidelines published up to 2014 [ 11 ••] which forms the basis of the evidence provided below.