Fibromyalgia is still a controversial issue in the medical profession worldwide. Although
relevant health organizations proposed useful diagnostic criteria about two decades ago,
it is still a case of exclusion diagnosis, and many health professionals dispute its entity as a
real disease. We still do not know its cause, there are no objective tests for diagnosis, no
abnormalities are found in physical normal exploration, symptoms are varied, and often
include comorbidity with psychological or psychiatric disorders and conditions (mainly
mood disorders like depression and stress). Research too often yields correlation results, so
abnormalities found in the central nervous system of patients diagnosed with fibromyalgia,
especially related to neurotransmitters' function, can be interpreted either as source or effect
-no causative conclusions reached.

There is a very interesting and lengthy word, though, for anyone involved in understanding
fibromyalgia: psychoneuroimmunoendochrinology. This discipline studies the relations
between our emotions, cognitive function and behavior on one side, and the bodily systems
more directly related to them -nervous, immune and endochrine- on the other. And, of course,
the external events and circumstances that, so often, trigger our responses. To put it simply,
we are not physiologically designed to function properly under all possible circumstances:
our body cannot breathe naturally underwater, neither can we go without sleep, and there
is also a price to pay if we find ourselves chronically stressed. Our environment (natural,
urban, social, familiar, etc.) is a source of stressful events, but also the way we think and react
emotionally to them add to the physiological response.

According to psychoneuroimmunoendochrinology, fibromyalgia, chronic fatigue and other
sensitivity syndroms mirror a chemical non-adaptive bodily response. Confronted with a
traumatic event or stressful situation, our body responds accordingly, as it is prepared to do
so, activating chemical substances like cortisol and noradrenalin that help us to overcome
what is happening. But a constant state of excessive demand damages this response system,
and disorders like fibromyalgia can develop. There is not an only form of the syndrome,
nor an only therapeutic approach. Physical exercise, cognitive-behavioral therapy and
pharmacological treatment have proved useful, especially when combined and suited
to the specific symptoms and needs of the patient. Drugs used for fibromialgya include
antidepressants, anti-seizure medication, analgesics (non-opioid), muscle relaxants, dopamine
agonists and the well-known pregabalin, duloxetin and milnacipran.

Psychoneuroimmunoendochrinology specialists keep working, both in the clinical and the
scientific research arenas, in trying to pin down the exact chemical chain that leads to these
disorders, known as central sensitivity syndromes, and find thus the ultimate therapeutic
approach that will stop the physiological reaction involved -and, if possible, revert it back to
normal.