10Chronic widespread pain and fibromyalgia: what we know, and what we need to know
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 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
References (82)
- et al.
Does chronic pain predict future psychological distress?
Pain
(2002) - et al.
Is there a Persian Gulf War syndrome? Evidence from a large population-based survey of veterans and nondeployed controls
American Journal of Medicine
(2000) - et al.
Health of UK servicemen who served in Persian Gulf War
Lancet
(1999) A pragmatic approach to cost-effective use of laboratory tests and imaging procedures in patients with musculoskeletal symptoms
Primary Care
(1993)- et al.
A community-based survey of fibromyalgia-like pain complaints following the World Trade Center terrorist attacks
Pain
(2002) - et al.
Reduced hypothalamic-pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome
American Journal of Medicine
(1999) - et al.
Multi-method assessment of experimental and clinical pain in patients with fibromyalgia
Pain
(1994) - et al.
Modulation of pressure pain thresholds during and following isometric contraction
Pain
(1995) - et al.
Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients
Pain
(2002) - et al.
Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome
Pain
(2001)
Middle and long latency somatosensory evoked potentials after painful laser stimulation in patients with fibromyalgia syndrome
Electroencephalography and Clinical Neurophysiology
Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis
Pain
Chronic fatigue syndrome differs from fibromyalgia. No evidence for elevated substance P levels in cerebrospinal fluid of patients with chronic fatigue syndrome
Pain
Toward an integrated understanding of fibromyalgia syndrome. I. Medical and pathophysiological aspects
Pain
A randomized, placebo-controlled, double-blind, flexible-dose study of fluoxetine in the treatment of women with fibromyalgia
American Journal of Medicine
Treatment of fatigue in fibromyalgia
Rheumatic Diseases Clinics of North America
Behavioral approaches in the multidisciplinary management of chronic pain: programs and issues
Clinical Psychology Review
The prevalence and characteristics of fibromyalgia in the general population
Arthritis & Rheumatism
The prevalence of chronic widespread pain in the general population
Journal of Rheumatology
Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms
Journal of Rheumatology
The American College of Rheumatology Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee
Arthritis & Rheumatism
The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario
Journal of Rheumatology
The relation between tender points and fibromyalgia symptom variables: evidence that fibromyalgia is not a discrete disorder in the clinic
Annals of the Rheumatic Diseases
Chronic widespread musculoskeletal pain with or without fibromyalgia: psychological distress in a representative community adult sample
Journal of Rheumatology
Population study of tender point counts and pain as evidence of fibromyalgia
British Medical Journal
Risk factors for persistent chronic widespread pain: a community-based study
Rheumatology (Oxford)
Factor analysis of unexplained severe fatigue and interrelated symptoms: overlap with criteria for chronic fatigue syndrome
American Journal of Epidemiology
Chronic multisymptom illness affecting Air Force veterans of the Gulf War
Journal of the American Medical Association
Chronic widespread pain: a three year followup of pain distribution and risk factors
Journal of Rheumatology
A general population study of fibromyalgia tender points in noninstitutionalized adults with chronic widespread pain
Journal of Rheumatology
Psychologic distress and low back pain. Evidence from a prospective study in the general population
Spine
The influence of work related psychosocial factors and psychological distress on regional musculoskeletal pain: a study of newly employed workers
Journal of Rheumatology
Chronic widespread pain in the population: a seven year follow up study
Annals of the Rheumatic Diseases
An update on the epidemiology of knee and hip osteoarthritis with a view to prevention
Arthritis & Rheumatism
Spine radiographs in patients with low-back pain. An epidemiological study in men
Journal of Bone & Joint Surgery (Am)
Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation
Journal of Bone & Joint Surgery (Am)
Magnetic resonance imaging of the lumbar spine in people without back pain
New England Journal of Medicine
Tenderness as a determinant of outcome in individuals with chronic low back pain (CLBP)
Arthritis & Rheumatism
Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behavior rather than to illness
Arthritis & Rheumatism
Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder
Archives of Internal Medicine
Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms
Neuroimmunomodulation
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