Fibromyalgia: a complex syndrome requiring a multidisciplinary approach.

Fibromyalgia is a pain syndrome which is not due to tissue damage or inflammation and is thus fundamentally different from rheumatic disorders and many other pain conditions. In addition to widespread pain it is associated with a range of other symptoms such as sleep disturbance, fatigue, cognitive disturbance, stiffness and depressive symptoms. A number of multidisciplinary therapeutic programmes involving education, exercise and cognitive therapy have been shown to be effective in bringing relief. The various medications that are currently being developed for the treatment of fibromyalgia are based on different mechanistic approaches. In particular, serotonin noradrenaline reuptake inhibitors (SNRI) such as duloxetine and milnacipran and alpha2-delta receptor ligands such as pregabalin have been shown, in a variety of placebo-controlled studies, to bring significant relief from pain and other symptoms. The complex symptomatology of fibromyalgia will, however, continue to require a multidisciplinary approach including education and exercise in addition to drug therapy to achieve the most efficient management of fibromyalgia.