My wife has fibromyalgia (9 yrs) and is getting some pain relief from two docs. are we any closer to understanding its etiology?

Yes, bit by bit...: I agree with my colleague that it is multifactorial and likely more than one etiology presenting in a similar fashion and labeled 'fibromyalgia'. That said, there appears to be a low-level inflammatory state present in many of the patient diagnosed with FBS. CSF from some FBS pts. compared to normals show small but altered: levels of IL-1, IL-2, IL-6, TNF and gene to include CB-2.

Yes and no: At least its no longer considered a purely psychological disorder! The promising leads mostly involve cns dysfunction, probably similar to the dysfunction that is involved in CRPS (which is now classed as type I or II...i don't think those distinctions will hold up causally). But I wouldnt go for ketamine coma quite yet. Check out Mindfulness Based Stress Reduction (MBSR) if you havent already.

We are not there yet: Although alot is going on, but still we are stuck between infectious etiology or altered pain response. Jury is also out on other aspects. The treatment modalities are still to improves the way people feel and to make them as functional as possible.

? lack of DPPIV enzy: I would strongly consider a trial of casein free gluten free diet, absent enzyme DPPIV leads to maldigestion of these proteins, the dx itself remains vague

A bit closer: See Dr. Badgley's detailed answer and comments. But I wanted to mention that many who have been diagnosed with fibromyalgia actually have chronic Lyme Disease which has not been diagnosed, as Lyme often manifests with classic fibromyalgia symptoms and standard screening tests for Lyme commonly have false negatives. See http://tinyurl.com/qjkw5wj for a detailed discussion of this complex issue.

Different: I believe the 'causes' may be different for different people. For some, it may be hypothyroidism, for others, low magnesium. Others may have it triggered by physical trauma such as a car accident.

EBV, IGF-1, seroton: https://umm.edu/health/medical/reports/articles/fibromyalgia Link above gives nice summary of possible associations including EBV, low IGF-1, serotonin levels and a few others. VERY tough disease to treat. It really for some becomes a throw it against the wall and see if it sticks process of trial and error re treatment. My thoughts and prayers to you and your wife as you battle this.

Emotional component: While the basic pathophysiological mechanism behind fibromyalgia is likely NOT significantly better known now than it was 15 years ago, what we're better at is recognizing the positive effect physical activities (especially aerobic exercise) can have on emotional well being which in turn results in patients reporting improvements in daily pain and insomnia ratings/scores.

Understanding: PET studies and spinal fluid chemistries do support diagnosis of fibromyalgia, and some experts think it to be a variation of a primary sleep disorder. However, we have done skin punch biopsies, and many of these types of patients do have occult small fiber neuropathies, leading to a different diagnosis and treatment. So, might behoove you to wonder about other diagnoses. All the best.

Sadly no: While we do not understand it well. Using a biopsychosocial model seems to help those suffering from it.