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Fibromyalgia (FM) is a clinical entity of unknown cause characterized by chronic diffused pain referred to the soft musculoskeletal tissues. Patients with FM also have allodynia, fatigue, sleep disorders, cognitive disturbances, psychological distress and headache. Important doubts subsist on the pathophysiological mechanisms of this disorder.
FM is highly prevalent in adults (2 to 13% of general population), females being five to nine times more affected than males, and constitutes a serious public health problem and major social economical burden.
Subjective complaints are largely predominant and as a consequence FM diagnosis is essentially clinical. Complementary diagnosis tests are normal or negative. The absence of objective signs allied with the psychological need of organicity typical from today’s medicine practice, turns FM existence controversial.
FM is one of several causes of widespread chronic pain and probably is the end of a pain and tenderness continuum.
Clinical picture of FM is described in medical and general literature throughout the ages but only in last century’s seventies did the systematization of symptoms lead to proposal of first criteria, and in 1990 the American College of Rheumatology (ACR) FM Classification Criteria were published. These criteria offered until today the uniformity needed to perform clinical and epidemiological studies. Although not purposed as a diagnostic tool these criteria are largely and may be improperly used with that intention.
No single therapeutic scheme fits all patients and there are no approved drugs by health authorities for FM. Varied management strategies are needed to address its multiple symptom domains. Currently there is not a practical outcome measurement index to assess with accuracy FM severity, which integrates the main symptoms (e.g. pain and tenderness, fatigue, live quality, psychological status, functional problems). Such an instrument is of crucial importance regarding the increasing performance of clinical and therapeutic trials on FM.
This and other problems must be settled in order to better define what is FM, how can FM patients be identified, FM progression be quantified and what can be done for those patients.
Concerned with these needs and uncertainties, a group of European medical doctors, pain researchers and other experts met at “Les Entretiens du Carla” in order to contribute to its resolution. This meeting constituted a very important step inserted in a broader strategy to increase the knowledge on FM and to improve the management of FM patients.
From left to right and from bottom up:
Dan Buskila, Bente Danneskiold-Samsøe, Simon Wessely,
Eva Kosek, Jaime Branco, Ernest Choy, Anne Cazorla,
Lars Arendt-Nielsen, Serge Perrot, Michael Spaeth,
Alarcos Cieza, Francis Blotman, Karl Henriksson,
Yves Mainguy, Jean-Paul Caubère, Étienne André,
Chris Henriksson, Eric Myon, Olivier Vitton,
Peter White, Henning Bliddal
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