Documented abnormalities include evidence of peripheral sensitization and wind-up phenomenon, central sensitization with changes in functional magnetic resonance imaging and single-photon emission computed tomography scans of the brain, increased levels of substance P in the cerebrospinal fluid and impairment of descending noxious inhibitory control ( 11, 12). Ideal management includes both nonpharmacological and pharmacological treatments using a multimodal approach, with active patient participation fostered by a strong patient-centred locus of control ( 10).Ībnormalities in pain processing have been identified at various levels in the peripheral, central and sympathetic nervous systems, as well as the hypothalamo-pituitary-adrenal axis stress-response system. In the United States, the cost for service utilization in an individual FM patient was >$2000 in 1997, with reports in the order of $4000 per year per patient for Canada and Europe ( 6– 9). Due to the nature of FM, many patients experience problems with their activities of daily living (ADL) and poor quality of life, and may end up on disability, which has a significant impact on them and their families. Mood disorders, including depression and anxiety, are present in up to three-quarters of patients with FM ( 5). Sleep abnormalities result in changes in sleep latency, sleep disturbance and fragmented sleep, leading to impaired daytime function ( 3, 4). Fatigue is the most common associated complaint and is present in >90% of patients ( 1). Pain is the primary complaint in patients with FM. FM is a common pain disorder estimated to affect 2% to 4 % of the population, of whom 80% are women ( 2) it is most prevalent in the third to fifth decade of life. Fibromyalgia (FM) is a syndrome involving diffuse body pain with associations of fatigue, sleep disturbance, cognitive changes, mood disturbance and other variable somatic symptoms ( 1).
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