Book Review

The Fibromyalgia Syndrome: Current research and future directions in epidemiology, pathogenesis, and treatment

N Engl J Med 1995; 333:603August 31, 1995

Article

The Fibromyalgia Syndrome: Current research and future directions in epidemiology, pathogenesis, and treatment
Edited by Stanley R. Pillemer. 184 pp. Binghamton, N.Y., Haworth Press, 1995. $29.95. ISBN: 1-56024-714-2

Thirty years have elapsed since C.K. Meador proposed the concept of nondisease in the Journal (“The Art and Science of Nondisease.” 1965;272:92-5). He suggested that when a specific disease is suspected but not found, the patient has a particular nondisease. Fibromyalgia has enjoyed the reputation of being a nondisease for many years. Known as fibrositis until Yunus correctly renamed it in 1980 because the process was noninflammatory, fibromyalgia has evolved from being a closet rheumatologic syndrome that everybody studied for five minutes in medical school to one of the “fad” diseases of the 1990s that embraces components of chronic fatigue syndrome, irritable colon, repetitive stress disorders, allodynias, and hysteria. When the American Medical Association editorialized in 1987 that fibromyalgia really exists and that specific, reproducible abnormalities are associated with the syndrome, a committee was formed and endorsed by the American College of Rheumatology to define it. Once the working definition was published in 1990, it was only a matter of time before the National Institutes of Health brought together researchers, clinicians, and patient-advocacy groups for a research planning workshop to suggest future directions in epidemiology, pathogenesis, and treatment.

Stanley Pillemer has edited a small volume that encompasses the proceedings of the 1993 conference of the National Institutes of Health. All the giants in the field of fibromyalgia research attended. Frederick Wolfe estimates the prevalence of fibromyalgia in the general population to be 2 percent, that it takes up 20 percent of a clinical rheumatologist's time, and that it is the reason for two to three visits in a primary care doctor's day. He has estimated that work disability related to the disease costs the United States hundreds of millions of dollars a year. Clearly, this is an important syndrome. Mohammed Yunus ably overviews the disease spectrum, and Don Goldenberg cogently probes its psychosocial aspects. The fascinating neurochemical interactions that lead to pain amplification are succinctly reviewed by Jon Russell. The principal treatment approaches are discussed.

The Fibromyalgia Syndrome suffers from omissions and is unevenly edited. The printing is poor and hard on one's eyes. A chapter on exercise and the concluding chapter on future directions consist of pages of printed slides that lack prose. Another section on alternative medicine fails to mention any alternative medicines used for the disease. Receiving only brief mention, or none, are the history of fibromyalgia, juvenile fibromyalgia, regional myofascial syndromes, reports that 20 to 30 percent of patients with breast implants have the syndrome, and the fact that a vocal minority of prominent rheumatologists, such as Nortin Hadler and Sidney Block, do not believe that the disease exists.

In spite of these deficiencies, rheumatologists, internists, and primary care physicians can learn a lot from this book. A nondisease has come a long way.

Daniel J. Wallace, M.D.
Cedars–Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA 90048