Fibromyalgia syndrome: definition and diagnostic aspects

Fibromyalgia: Diagnosing and managing a complex syndrome

“…Because there is an absence of absolute, definitive diagnostic criteria with universal applicability, providers often set-tle upon this diagnosis following negative testing for other differentials (Sim & Madden, 2008). Given this, the American College of Rheumatology (ACR) established two points of reference for the diagnosis of FM in response to a study of 558 FM patients: (1) musculoskeletal pain that is present for at least 3 months and located diffusely in all four body regions (divided horizontally at the waistline and vertically at the midline) as well as in the axial skeleton and (2) pain that is elicited on palpation of at least 11 of 18 specified tender points that have been designated by ACR for FM musculoskeletal assessment (Cazzola et al, 2008). This framework for diagnosis has received criticism because it only accounts for the pain aspects of the syndrome.…”

“…With complex and variable symptoms that can mimic several other medical conditions, FM is a common misdiagnosis (Cazzola et al, 2008;Goldenberg, Bradley, Arnold, Glass, & Clauw, 2008;Schneider, Brady, & Perle, 2006). Physical examination findings reveal enhanced pain perception in response to mild sensory stimuli in greater than 10 specific locations dispersed throughout both sides of her upper and lower body.…”

“…The diagnosis is fibromyalgia (FM). With complex and variable symptoms that can mimic several other medical conditions, FM is a common misdiagnosis (Cazzola et al, 2008;Goldenberg, Bradley, Arnold, Glass, & Clauw, 2008;Schneider, Brady, & Perle, 2006).…”

Physiopathology of pain in rheumatology

“…This interpretation is still supported by many rheumatologists despite the repeated clinical evidence of a discrepancy between the intensity and characteristics of the pain reported by patients and the extent of the anatomical alterations detectable at the sites of the perceived pain, as in the case of the radiological grading of osteoarthritis (OA) (6). Over the last 20 years, the greatest advances in interpreting musculoskeletal pain have been made in the ambit of the widespread extra-articular forms of rheumatism, particularly the protypical form of fibromyalgia (FM) (7)(8)(9)(10)(11)(12). Studies of fibromyalgic patients have made it possible to recognise multiple neurophysiological modifications in the perception, transmission and, above all, processing of nociceptive afferents at the level of the central nervous system CNS (13)(14)(15)(16)(17).…”

Fibromyalgia and arthritides

“…n INTRODUCTION F ibromyalgia (FM) is a chronic pain syndrome that affects at least 2% of the adult population, and is characterised by widespread pain, fatigue, sleep alterations, and distress (1). It is currently defined as chronic widespread pain (CWP) with allodynia or hyperalgesia to pressure pain, and classified as one of the large group of softtissue pain syndromes (1)(2)(3). There is growing evidence that it may involve a central nervous system (CNS) malfunction that increases pain transmission and perception (4).…”