Abstract
The concept of fibromyalgia has progressed to achieve a certain consensus regarding the definition of the condition. We summarize what is known in 2020, be it in terms of diagnosis, with the criteria that have changed over the years, or at the level of the psychological profile, via the notions of “catastrophizing” and “coping” and post-traumatic syndrome. The importance of fatigue and sleep disorders is underlined, with the chronological sequence of post-traumatic syndrome, chronic fatigue, and then amplification of the pain and the onset of multiple associated symptoms. The etiopathogenic debate has been enriched thanks to neuro-imaging data to discover the start of the central neurological signature. The many associated symptoms are reanalyzed in the context of so-called sister conditions which form sometimes more or less separate entities, such as chronic fatigue syndrome or restless legs syndrome for example. What these conditions have in common is hypersensitivity, not just to pain, but also to all exteroceptive stimuli, from deep sensitivity in the neuro-vegetative system, the sense organs and certain functions of the central nervous system, to the psychological aspects and sleep control. In summary, it is possible to define fibromyalgia as a cognitive disorder of cortical integration of chronic pain, with amplification of painful and sensory nociception, decrease in the threshold for the perception of pain, and persistence of a stimulus that maintains the process in chronicity. Fibromyalgia is part of a group of chronic hypersensitivity syndromes of central origin, with a very wide range of means of expression.
Highlights
Back in the nineteenth century, there were already descriptions that were perfectly typical of fibromyalgia, for example by Beard [1]
Yunus took up the term in the 1980s, and it remains in use today even though, as we shall see, pain is only one of the components in a complex set of symptoms [4]
Associations were found between the increase in the brain signal of fibromyalgia patients in functional MRI and pain, sensory stimuli, the FIQ and depression
Summary
Other additional examinations are often requested out of excess, even if it is possible to need imaging to screen for bone or enthesitic lesions; an electromyogram to screen for radiculopathies, entrapment syndrome or polyneuritis; an ultrasound to identify synovitis, tenosynovitis, bursitis or tendinitis; a CT scan or MRI, often axial degenerative conditions identified in this way are often misleading because they are very common and asymptomatic, such as osteoarthritis, degenerative disc disease and calcifications This long list of differential diagnoses, classified by organ (Table 1) summarizes the work of the diagnostician who aims to screen for and eliminate all them all, first of all clinically and with the help of any appropriate additional examinations. Associations for fibromyalgia patients have played a part in improving understanding of the condition in both the general public and the medical profession, and recognition of an affection that is not “made up.” Alongside these positive actions, requests for classification of the condition as chronic long-term illness and handicapped status for all, the quest for a miracle drug or a perfect diet that does not exist, as well as belief in sometimes doubtful theories developed by some, all still have a negative impact on the credibility of fibromyalgia patients, who are barely
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