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Chronic widespread pain and fibromyalgia: what we know, and what we need to know

https://doi.org/10.1016/S1521-6942(03)00035-4Get rights and content

Abstract

Fibromyalgia (FM) is currently defined as the presence of both chronic widespread pain (CWP) and the finding of 11/18 tender points on examination. Only about 20% of individuals in the population with CWP also have 11/18 tender points; these individuals are considerably more likely to be female, and have higher levels of psychological distress. There is no clear clinical diagnosis for the other 80% of individuals with less than 11/18 tender points, but it is likely that these persons, like FM patients, also have pain that is ‘central’ (i.e. not due to inflammation or damage of structures) rather than peripheral in nature. Research into FM has taught us a great deal about the confluence of neurobiological, psychological and behavioural factors that can cause chronic central pain. These conditions respond best to a combination of symptom-based pharmacological therapies, and non-pharmacological therapies such as exercise and cognitive behavioural therapy. In contrast to drugs that work for peripheral pain due to damage or inflammation (e.g. NSAIDs, corticosteroids), neuroactive compounds [especially those that raise central levels of noradrenaline (norepinephrine) or serotonin] are most effective for treating central pain.

Section snippets

Epidemiological studies suggest that the criteria for fibromyalgia have led to some misconceptions about chronic widespread pain

Population-based studies of CWP that have been performed in the USA and UK have suggested that approximately 10–11% of the population has this symptom at any given time.1., 2. Chronic regional pain is found in 20–25% of the population.3 Both chronic widespread and regional pain occur about 112 times as commonly in women as in men.

The 1990 American College of Rheumatology (ACR) criteria for FM require that an individual has both a history of CWP and the finding of 11 of 18 possible tender points

What is fibromyalgia and how should it be defined?

Population-based studies have conclusively demonstrated that: (1) CWP is very common, (2) it is sometimes accompanied by tenderness, distress and other somatic symptoms, and (3) when this does occur, CWP is more likely to be permanent than transient and to lead individuals to seek health care.

The current definition of FM, which requires 11/18 tender points in addition to CWP, captures only about 20% of those individuals with CWP. We now know that, because of the tender point requirement, it

Who should be treating fibromyalgia, and what are the most effective treatments?

Many rheumatologists express enormous frustration aimed specifically at FM patients, or the FM ‘construct’. The most simplistic reason for this may be psychological distress on the part of patients, physicians or both. Patients with FM, especially those who meet the current criteria and present for secondary or tertiary care, display higher average levels of distress than do individuals with other rheumatic disorders. Previous unsatisfactory interactions with the healthcare system may increase

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