Fibromyalgia syndrome (FMS) is a complex disorder caused by peripheral and central pain mechanisms with a persistent and widespread history of fibrous tissue myalgia as a clinical feature. The disease is not difficult to diagnose, but the underlying pathophysiological mechanisms are difficult to decipher. Many pain clinicians remain convinced that unexplained chronic pain is a disease unto itself and does not need to be explained; and therefore focus only on clinical treatment, not caring why it is called chronic widespread pain, fibrous tissue myalgia, or a psycho-affective/somatic form disorder. ”They are not psychotic, and their pain is not hallucinatory,” experts have said of these patients. Patients with FMS have pain in many parts of their body: back, arms and legs, and abdomen, even though their organs are healthy. The World Health Organization (WHO) classifies FMS as a disease that cannot be cured. Patients must learn to cope with the pain. For this disease, exercise plays a central role. In Western industrialized countries, 1 to 2 percent of the population suffers from the syndrome. In the recently updated FMS guidelines, which provide treatment recommendations for physicians, it is mentioned that patients are usually middle-aged women. The disease usually develops slowly. “Some patients have frequent pain as children,” said Winfried H user of the German Association for Multidisciplinary Pain Management. At the beginning of the disease, there is usually pain in only one body part. Gradually, however, the pain spreads throughout the body. The slow progression of the disease is one of the reasons why fibromyalgia syndrome can often be diagnosed only after several years. “Many patients start with just hip pain. Then they go to the doctor, get a shot and get temporary relief,” says MargitSettan, president of the German Seka Fibromyalgia Association (DFV). “From a certain point the pain intervals become shorter, the shot no longer works, and the pain appears in multiple parts of the body.” Confirmation of fibromyalgia syndrome Settan said it used to take an average of seven to nine years for patients to be diagnosed with fibromyalgia syndrome. In that time they ran from specialist to specialist because they couldn’t tolerate the pain. Today, it takes patients an average of three to five years to get an accurate diagnosis. To confirm a diagnosis faster, patients must be honest. “For a disease like fibromyalgia syndrome, it is very important that the patient presents all his pain to the doctor.” H user, who works at Saarbrücken Hospital, explains. In addition to pain, this includes sleep disturbances, fatigue or psychological abnormalities such as anxiety and depression. Patients who need to take medication regularly should inform their doctor about this. Diffuse pain can be a side effect of certain medications, such as widely used cholesterol-lowering drugs, says Bernhard Arnold of the Berlin Pain Society in Germany. Experimental analysis of blood can tell whether the pain is due to a physical cause, such as a rheumatic disease or abnormal thyroid function, and the FMS cannot confirm the diagnosis with these studies. Doctors can only use them to rule out other causes of pain. Exercise can be very beneficial Fibromyalgia syndrome is not curable. Once the pain is present, it usually lasts for the rest of the person’s life. However, patients do not have to worry about disability or early death as a result. There are several ways to relieve symptoms in the meantime: guidelines recommend that patients with mild FMS exercise regularly. “Whether it’s samba dancing, exercising with exercise equipment or walking, it doesn’t matter. The key is that the patient gets pleasure from the exercise,” says Arnold, who works in the pain day clinic at Dachau Hospital. That’s the only way to keep exercising regularly. To get exercise, patients must keep exercising two to three times a week for an extended period of time. For patients with severe FMS, the guidelines likewise recommend gentle endurance, functional or strength training and exercise modalities such as Tai Chi or yoga. In addition, a combination of relaxation therapy, aerobic exercise and behavioral therapy is also recommended. This is because physical and psychological abnormalities are often interrelated. Approach medications more critically during this period. They should only be taken for a limited period of time. Guidelines recommend some physical therapy, such as hot baths, spa mud and lymphatic drainage. Time-limited acupuncture is equally effective. Other treatments, such as laser and magnetic field therapy, Reiki therapy, and taking dietary supplements are not recommended because their effectiveness is unclear or because of adverse side effects. The recommendations made in the guidelines are based on large international research studies. However, convincing studies do not exist for every therapy. Therefore Winfried H user together with his colleagues asked about the advantages and disadvantages of certain treatments for patients with FMS. Respondents found benefits in thermal physiotherapy, hot baths and training programs for FMS.