Chronic widespread pain and fibromyalgia syndrome

Chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) overlap with chronic fatigue syndrome (CFS). Several key tender trigger points are used to define FMS. Other symptoms reported commonly by patients with FMS include reduced pain threshold, fatigue, depression, anxiety, sleep disturbance, memory loss and problems with cognition, headache, migraine, diffuse abdominal pain with changes of bowel habit (irritable bowel syndrome), and urinary frequency. The pathogenesis of these syndromes is not clear, but hyperexcitability of the central and peripheral nervous systems, changes in function of pain receptors, altered pain perception and somatization have all been hypothesized. There is functional magnetic resonance imaging evidence of altered pain processing in the fibromyalgia subset of CWP and increased activity in brain areas that code for the sensory intensity of stimuli. Both conditions are a challenge to treat and difficult for patients to handle. Many patients are grateful for an explanation and a diagnosis of their distressing symptoms, which may have been dismissed, or passed from one doctor to another. Winning the patient's confidence is an important starting point in any management strategy. Treatments include analgesia, gabapentin, tricyclic anti-depressants at low dosage for sleep disturbance, anti-depressants at treatment dosage when appropriate, graded exercise and cognitive behavioural therapy. When possible, a multidisciplinary approach is helpful.