Clinical Management of Fibromyalgia and the Continuum of Polysymptomatic Distress Disorders

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.