Old obstacles but new hopes: trying to understand the fibromyalgia construct.

F ibromyalgia is a chronic debilitating disorder characterized by widespread pain, allodynia and hyperalgesia on one hand, with fatigue, unrefreshing sleep accompanied by mood and cognitive disturbances on the other. It affects 5% of the population worldwide with a clear female preponderance [1]. More than two decades ago fibromyalgia was acknowledged and defined by classification criteria that underlined the somatic aspects of the disorder. This set of criteria was adopted by the American College of Rheumatology (ACR) [2]. Within the last 4 years the diagnosis of fibromyalgia has progressed, emphasizing the importance of the symptoms beyond pain. The new suggested criteria take into consideration additional symptoms mentioned above [3]. Despite significant achievements in the field of fibromyalgia research linking it to various neurophysiological mechanisms, many physicians still regard fibromyalgia as a controversial entity since there is no objective test to confirm the diagnosis [4]. The diagnosis is further complicated by the stigmatization of this disorder among treatment providers, the health insurance industry, and the general population. The immense financial and emotional burden of this syndrome reflects the complexity of the disease, its comorbidities, and the difficulties in its diagnosis [1]. The financial burden of fibromyalgia is substantial, with reported health care costs (for 12 months) ranging from $2274 to $9573 in the United States and up to $2298 in Canada, not including indirect costs such as disability claims and loss of work days [5]. The health care system is utilized at significantly higher rates by fibromyalgia patients due to more frequent visits to the physician, laboratory and imaging tests and visits to the emergency department. In addition, these patients are more likely, as mentioned, to suffer from comorbidities and are more prone to receive pain-related medications [1,3,6,7).