Current Research & Studies - Background and Rationale

INTRODUCTION: Fibromyalgia is characterized by musculoskeletal aching and stiffness, with multiple points of tenderness on palpation.

Patients complain of pain at multiple sites and frequently state they "hurt all over." Muscle strength, neurological, and joint examinations are normal. Associated symptoms include fatigue, poor restorative sleep patterns, headaches, depression, anxiety, dysmenorrhea (difficult and painful menstruation) and paresthesia. [1]

American College of Rheumatology criteria include:
History of Widespread Pain:
Pain is considered widespread when all of the following are present: pain in the left side of the body, pain in the right side of the body, pain above the waist, and pain below the waist. In addition, axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back) must be present. "Low back" pain is considered lower segment pain. Thus, pain in 3 sites (e.g., right shoulder, low back and left buttock) will qualify for widespread pain.

Pain in 11 of 18 Tender Point Sites On Digital Palpation:
Pain on digital palpation must be present in at least 11 of the following 18 tender point sites: (for diagram, click here).

• Occiput: bilateral, at the [suboccipital] muscle insertion.
• Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7.
• Trapezius: bilateral, at the midpoint of the upper border.
• Supraspinatus: bilateral, at origins, above the scapula spine near the medial border.
• Second rib: bilateral at the second [costochondral junctions], just lateral to the junctions on upper surfaces.
• Lateral epicondyle: bilateral, 2 cm distal to the [epicondyles].
• Gluteal: bilateral, in upper outer quadrants of buttocks.
• Greater trochanter: bilateral, posterior to the [trochanteric prominence].
• Knee: bilateral, at the medial fat pad proximal to the joint line. [1]

Digital palpation should be performed with an approximate force of 4 kg. For a tender point to be considered "positive" the subject must state that the palpation was painful, as compared with mere pressure.

Presenting Features of Fibromyalgia with Confounding Diagnoses and Key Points of Differentiation Presenting Features Confounding Diagnosis Absent in Fibromyalgia Joint pain and subjective Arthritis Objective joint swelling Diffuse muscular aching and stiffness [Polymyalgia rheumatica] Increased [ESR], decreased Hb, weight loss Muscle fatigue, weakness [Myopathy] Objective weakness, increased muscle enzymes Fatigue, sensitivity to cold, muscle pain [Hypothyroidism] Decreased [T4], increased [TSH] Back pain/stiffness [Ankylosing spondylitis] [Sacroilitis] Sciatica-type pain Disc herniation Neurologic & radiologic findings Chest pain Cardiac or pleural pain Typical history of cardiac pain, pleural rub, EKG, chest x-ray or other laboratory findings of an intrathoracic disease.

 

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