Article: First-line comprehensive care III: update on immune system lab tests for fibromyalgia-chronic fatigue-metabolic syndrome continuum of treatment-resistant pain and fatigue; Optimum clinical management improves outcomes and reduces risks and treatment complications as supported by new data.

This report is an update of a previous contribution to the Townsend Letter. With the benefit of five more years of data, the hypothesis offered in that article is now more strongly supported. (1) New information suggests this approach is highly cost- and outcome-effective, due to the use of more precise predictive and personalized tests.

Fibromyalgia (FM) is a "medical mystery syndrome," characterized by disabling, treatment-resistant pain localized in tender ("trigger") points. (2) The classic definition requires that 11 or more of 17 specific points show significant tenderness. (3) Concurrent substantial fatigue is common. (4) Chronic fatigue immune dysfunction syndrome ...

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