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Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-55. PMID 24737367

One-paragraph summary

Single-author review of the epidemiology, pathophysiology, diagnosis, and treatment of fibromyalgia, covering literature from 1955 to March 2014 (MEDLINE + Cochrane CENTRAL), with emphasis on meta-analyses and contemporary evidence-based guidelines; treatment recommendations are graded 1–5 by level of evidence following the Canadian Pain Society guidelines. Headline positions: FM affects 2–8% of the population depending on criteria; it is characterized by widespread pain with fatigue, memory problems, and sleep disturbance; it can be considered either a discrete diagnosis or a constellation of symptoms characterized by central nervous system pain amplification; and effective treatment exists — education, exercise, and cognitive behavioral therapy among non-drug options, and tricyclics, SNRIs, and gabapentinoids among drugs, all supported by high-quality evidence.

Key findings

  • Population prevalence stated as 2–8%, explicitly criteria-dependent.
  • Frames FM as the flagship "centralized pain" state — CNS pain amplification with co-occurring fatigue, memory, sleep, and mood symptoms — the framing that fed the nociplastic-pain descriptor adopted two years later (Kosek 2016, PMID 26835783; Fitzcharles 2021, PMID 34062144).
  • Treatment hierarchy: non-pharmacologic (education, exercise, CBT) and pharmacologic (tricyclics, SNRIs, gabapentinoids) options graded by evidence level; implicitly demotes peripherally targeted analgesia.
  • Presents diagnosis as clinical and symptom-based, usable in primary care without tender point examination.

Limitations

  • Narrative, single-author review — synthesis reflects the author's centralized-pain research program; the periphery-vs-center debate is not adjudicated (see the peripheral evidence in the wiki's pathophysiology pages).
  • Effect sizes for endorsed therapies are not the review's focus; subsequent NNT-focused syntheses show modest absolute benefits (tracked in the pharmacologic-therapy page).
  • Predates the 2016 criteria revision, AAPT, ICD-11 chronic primary pain, and the nociplastic-pain literature it helped precipitate.
  • The 2–8% prevalence span mixes criteria sets with very different case definitions (cf. Jones 2015, PMID 25323744; Heidari 2017, PMID 28447207).

Why it matters

The most-cited modern clinical summary of FM and the clearest statement of the "centralized pain" framing in a general-medicine venue. It marks the field's pivot from rheumatologic curiosity to mainstream chronic-pain neuroscience, packaged FM for non-specialist diagnosis and management, and supplied the conceptual template (CNS amplification, criteria-based bedside diagnosis, multimodal therapy) that the nociplastic-pain descriptor, ICD-11 chronic primary pain, and current guidelines all elaborate.

Cited by wiki pages

  • overview
  • epidemiology