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Fibromyalgia is one of the most common musculoskeletal disorders seen in rheumatology practice as well as primary care. It is often classified among the functional somatic syndromes (FSSs), which include irritable bowel syndrome, chronic fatigue syndrome, temporomandibular joint disorder, interstitial cystitis, and other symptom-based conditions manifested by a cluster of symptoms for which the pathophysiological mechanism is not well understood (Aaron and Buchwald 2001). Patients with one FSS often suffer from one or more other FSSs as well as psychological comorbidity, including depression, anxiety, and histories of abuse during childhood or as adults. The distinction between FSS and somatoform disorders is also being revisited (Kroenke et al. 2007). However, it does not appear that FSSs are entirely explained by psychological factors (Henningsen et al. 2003), and emerging research also shows biological factors that may be causative or contributory.

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Table Reference Number
TABLE 66–5. Efficacy of SNRI antidepressants and anticonvulsants in fibromyalgia: summary of randomized, placebo-controlled clinical trials

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