Editor’s Pick: Clinical Management of Fibromyalgia and the Continuum of Polysymptomatic Distress Disorders

In this specially selected article, Fleming gives a fascinating insight into the controversial field of fibromyalgia and polysymptomatic distress disorders. These conditions present with a diverse array of symptoms posing diagnostic challenges which many clinicians will face at some point in their career. The unifying central sensitisation theory discussed provides solace for patients and physicians alike, potentially elucidating the pathophysiology of the disorders and their medically unexplained symptoms. The author goes on to provide useful diagnostic and management strategies which have the potential to raise the standard of care in these common, yet poorly understood, conditions. Dr Harry Thirkettle 

*Kevin C. Fleming

Fibromyalgia and Chronic Fatigue Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
*Correspondence to fleming.kevin@mayo.edu

Disclosure: The author has declared no conflicts of interest.
Received: 12.02.16 Accepted: 18.05.16
Citation: EMJ. 2016;1[3]:51-60.


The evaluation of patients with fibromyalgia (FM) and other functional somatic syndromes can appear intimidating, but a high index of suspicion and a more systematic approach can improve provider efficiency, reduce frustration, and improve the care experience. FM is a dimensional rather than a categorical disorder, reflecting a continuous spectrum of physical symptoms; it is formally diagnosed after reaching a critical mass of widespread pain and symptom severity. Central sensitisation is a maladaptive neuroplastic response in the higher brain neural pain network that accounts for FM symptoms. Rheumatologists are a scarce medical resource, so their involvement in FM can be considered along ‘focussed factory’ or ‘solution shop’ approaches. Multimodal FM treatments should include pharmacologic and nonpharmacologic therapies including cognitive therapies, graded exercise, and stress management.

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