Fibromyalgia as a diagnosis was first conceived in 1981 to label a syndrome characterised by widespread pain and increased sensitivity to pressure at various specific anatomical locations known as "tender points". During the subsequent 10 years, the spectrum of fibromyalgia expanded to include non-musculoskeletal clinical features, such as fatigue, sleep disturbance, headache, and irritable bowel. In an attempt to facilitate epidemiological study, the American College of Rheumatology (ACR) announced classification criteria for fibromyalgia in 1990 to distinguish it from other rheumatic conditions. We have previously argued that these criteria were developed out of circular reasoning, with the result that fibromyalgia has become a proposition so broad that it includes all possibilities. Despite this objection, fibromyalgia seems to be an entrenched diagnostic label--at least in rheumatological circles--but it is a label so easily abused as to have become meaningless. We aim to expose the major flaws in the proposed entity of fibromyalgia, to trace its conceptual evolution, and to propose an alternative model that draws on current understanding of the neurobiology of chronic pain.
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