Treating fibromyalgia

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Abstract
Fibromyalgia is a common musculoskeletal disorder, characterized by widespread pain combined with tenderness at multiple tender points. Associated features often include fatigue, unrefreshing sleep, psychological distress, irritable bowel, headaches, paraesthesia and morning stiffness. Although not universally accepted as a discrete entity [1], such patients can be readily classified by using the American College of Rheumatology (ACR) 1990 criteria [2] which require the presence of widespread pain for at least 3 months and pain on palpation of at least 11 of 18 tender points. The syndrome has replaced the label fibrositis and there is a large degree of overlap with other medically unexplained syndromes such as chronic fatigue syndrome. In all cases, a medical explanation for the pain and fatigue needs to be sought, with appropriate investigations undertaken dependent on the presentation. However, despite being the second commonest syndrome seen in some rheumatology clinics [3], treatment has been regarded as unsatisfactory, many patients suffering a chronic or rarely remitting course with significant disability and handicap.

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