Fibromyalgia: revisiting the literature.

Fibromyalgia has a distinct clinical presentation. With no distinct characteristic beyond the presence of 11 or more tender points and chronic pain in all four quadrants of the body, it represents one extreme of a normal distribution of pain states. Research exploration utilizing the ACR criteria has not found solid empirical evidence to link the finding of multiple tender points to a specific pathological process. These points may be present as a concomitant finding with psychological disease states but they have not lead to further etiological understanding. Measurement of outcomes is difficult and the prognosis for patients in the specialty care setting is poor, however in the general population the prognosis is variable, and includes improvement without treatment. The success of treatments has been limited mainly to helping patients improve their ability to cope with, but not to eliminate the tender points.