Preface

Summary

This book describes the clinical characteristics and the available treatments for a group of nine conditions often seen in primary care practice. The entities are chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, premenstrual syndrome, temporomandibular joint pain and dysfunction syndrome, interstitial cystitis, nonischemic chest pain syndrome, repetitive strain injuries and multiple chemical sensitivities. Their common denominators are the presence of multiple somatic symptoms, the lack of defining structural defects or laboratory abnormalities, the frequent association with psychiatric disorders, the absence of proven pathophysiological mechanisms and the paucity of effective therapeutic interventions.

The book is addressed to primary care physicians, because they are seeing patients with these vexing, puzzling and disabling conditions every day in the office and clinic; to physicians practicing psychiatry, neurology and physical rehabilitation, to whom these patients are often referred for consultation and treatment; to the postgraduate trainees in the above-mentioned fields; and to the relatively large number of patients with one or more of these syndromes who perceive the need to educate themselves and their families.

In selecting the format for the presentation of the state of the science we have been guided by the principles of evidence-based medicine and combined in-depth review of the best available publications with the rich clinical experience of our group of expert collaborators. We start with the definition of functional symptoms, syndromes and illnesses and the evaluation of the way in which paradigmatic shifts of the past decade have influenced perception and practice.