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Query: UMLS:C0016053 (fibromyalgia)
 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A major problem with estimating the impact of chronic generalized pain is that the term remains undefined. It appears to encompass several distinct clinical entities, including rheumatoid arthritis and fibromyalgia, which can exist alone or together in a given individual. Nonetheless, chronic generalized pain appears to have a sizable impact on both the individual and society. Although little is known about causal relationships, demographic risk factors for chronic generalized pain are female sex, age in the forties and fifties, lower income, lower education, and being divorced or separated. Chronic generalized pain affects the individual in several ways, including physical and psychological distress, losses of function, quality of life, employment and income, and prolonged litigation for many. Its impact on society includes increased utilization of health care resources, loss of work productivity, disability and insurance costs, costs of litigation and social policy. Future research into the impact of chronic generalized pain must begin by defining this term in a way that is both valid in construct and convenient to use. Research is also warranted to develop and validate diagnostic tools that may better distinguish various subsets of chronic generalized pain, both to better understand the pathological processes involved and to allow for estimates of the relative contribution of each subset to societal costs.
Baillieres Best Pract Res Clin Rheumatol 1999 Sep
PMID:The occurrence and impact of generalized pain. 1056 68

Patients whose symptoms include widespread, diffuse musculoskeletal pain are commonly referred for rheumatological evaluation, even when the underlying cause may lie out with the remit of rheumatology. A diagnosis of fibromyalgia may seem highly probable even from the referral letter, or after a few leading questions during the consultation. However, the lack of specificity of the many symptoms associated with widespread pain means that other diagnoses have to be considered. The history and examination must bear in mind alternative and concomitant musculoskeletal disorders, such as mild systemic lupus erythematosus, polyarticular osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica, hypermobility syndromes and even osteomalacia. Non-rheumatological diseases may also have symptomatic similarities to fibromyalgia, including neoplastic and neurological diseases, hypothyroidism and other endocrine disorders, chronic infections, as well as a variety of psychiatric conditions. A rational approach to investigation will usually allow other diagnostic possibilities to be excluded without reinforcing the abnormal illness behaviour so common in chronic pain states.
Baillieres Best Pract Res Clin Rheumatol 1999 Sep
PMID:The differential diagnosis of generalized pain. 1056 69

Generalized pain, which is one component of the fibromyalgia syndrome, is a common and disabling problem in the general population. Pain at individual sites, such as the lower back and shoulder, has traditionally been considered distinct from generalized pain and studied separately. This chapter considers first the basic definition and distribution of widespread pain in the population, and second examines the evidence as to whether widespread and regional pain are truly or usefully distinguished.
Baillieres Best Pract Res Clin Rheumatol 1999 Sep
PMID:Generalized pain, fibromyalgia and regional pain: an epidemiological view. 1056 70

The key features of fibromyalgia are chronic widespread pain, general distress and enhanced pain sensitivity as revealed by a tender point count. Fibromyalgia could be considered a distinct entity if the key features defined a patient group with any one of the following: a characteristics feature or cluster of features with a distribution clearly demarcating the group from the rest of the population, identifiable risk factors, a characteristic natural course or prognosis, or a specific response to treatment. This should be seen in population studies, not only in selected clinic series. The available epidemiological evidence suggests that the distributions of the key features are continuous and no clear population groups can be defined. Also, difficulties in identifying changes such as incidence and recovery, and unreliable measurements of the key features themselves, detract from the utility of the concept of fibromyalgia as an epidemiological entity.
Baillieres Best Pract Res Clin Rheumatol 1999 Sep
PMID:Is fibromyalgia a distinct clinical entity? The epidemiologist's evidence. 1056 71

Fibromyalgia syndrome was an attempt to create, for the purposes of investigation, a relatively homogeneous clinical entity out of the clinical phenomena of musculoskeletal pain and tenderness. The attempt has foundered, arising out of circular argument and violation of its own criteria, thus creating an over-inclusive and ultimately meaningless label. The epistemological errors include the failure to distinguish a clinical feature from a disease process, the use of syndromic description without a unifying concept and failure to agree on the importance and biological nature of tenderness itself.
Baillieres Best Pract Res Clin Rheumatol 1999 Sep
PMID:Is fibromyalgia a distinct clinical entity? The disapproving rheumatologist's evidence. 1056 72

Most medical specialities have defined medically unexplained syndromes such as fibromyalgia, to categorize patients with prominent but unexplained symptoms. Other such syndromes include irritable bowel syndrome, chronic fatigue syndrome and atypical chest pain. In this chapter we present evidence to suggest that fibromyalgia is not a unique clinical entity, but shares much with these other syndromes. We use historical, clinical and epidemiological evidence to illustrate this idea. The historical data emphasize the essentially arbitrary way in which fibromyalgia developed. The clinical evidence shows the considerable overlap between patients with fibromyalgia and those with other unexplained syndromes. From an epidemiological perspective we emphasize the strong associations between symptoms such as myalgia and fatigue. We conclude by suggesting that fibromyalgia is one of many medically unexplained syndromes which have more similarities than differences between them.
Baillieres Best Pract Res Clin Rheumatol 1999 Sep
PMID:Is fibromyalgia a distinct clinical entity? Historical and epidemiological evidence. 1056 73

Fibromyalgia is a challenge to the modern day physician. Today's practice of medicine is evidence-based, but fibromyalgia shifts this paradigm. There is even still debate as to whether this diffuse musculoskeletal pain syndrome, with a reduced pain threshold, and tender points on examination constitutes a definitive entity or disease process. We do not have the luxury of measurable abnormal findings on clinical examination or laboratory testing. The diagnosis of this condition is not aided by the use of any modern-day technology, and is simply a clinical syndrome. No treatment which we prescribe for fibromyalgia is universally successful in managing symptoms. Our skills as physicians are constantly challenged by treatment options offered to patients by non-conventional medicine. Even so, as physicians, our role should be to support our patients and continue to pursue scientific study in order to better understand this enigma.
Baillieres Best Pract Res Clin Rheumatol 1999 Sep
PMID:Is fibromyalgia a distinct clinical entity? The approving rheumatologist's evidence. 1056 74

The cause of muscle pain and allodynia may not be the same in all persons fulfilling the American College of Rheumatology (ACR) criteria for fibromyalgia syndrome. In the majority of patients the generalized pain is preceded by localized or regional pain, usually in the musculoskeletal system. In many patients with fibromyalgia there are findings compatible with tissue injury pain with pain mechanisms involving both the primary afferent neuron and the nociceptive system in the central nervous system. Evidence for these mechanisms is described.
Baillieres Best Pract Res Clin Rheumatol 1999 Sep
PMID:Is fibromyalgia a distinct clinical entity? Pain mechanisms in fibromyalgia syndrome. A myologist's view. 1056 76

In the eyes of a person with fibromyalgia syndrome, their pain and other symptoms are real. By the time a patient seeks medical care for fibromyalgia, they will have probably endured criticism and misunderstandings about the invisible nature of their symptoms. Patients are genuinely disturbed that their bodies are not performing up to par, while at the same time, their family, friends and employers are placing demands on them that can't be met. No one would want to be placed in such a frustrating and painful predicament, so naturally this situation becomes the driving force for fibromyalgia patients who are seeking medical advice. Unfortunately, lack of understanding about the neurophysiology of chronic pain syndromes and the advent of evidence-based medicine leads to restricted care for patients who really need a physician's help. The best prescription for aiding people with fibromyalgia undoubtedly includes a physician with an open mind on treatment options.
Baillieres Best Pract Res Clin Rheumatol 1999 Sep
PMID:Is fibromyalgia a distinct clinical entity? The patient's evidence. 1056 77

Fibromyalgia syndrome varies from being a mild intermittent disorder to one that is severe and protracted. Much of the management of the more common milder type is best done at the primary care level with the expectancy of improvement in key symptoms and a generally good prognosis. Careful appraisal of the dimensions of fibromyalgia is needed with an individualized management strategy. Critical to good outcome is the need for an understandable explanation of the mechanism of fibromyalgia and introduction to self-management skills that include exercise and techniques that minimize aberrant responses to psychosocial stressors. The primary care practitioner is well placed to identify risk factors that associate with fibromyalgia in order to minimize emotional distress accompanying illness or psychosocial predicaments. Little formal research has been done on these important areas. In contrast, there is much information on management of fibromyalgia when it presents to specialist practice. More complex and expensive approaches result in variable changes in the outcome of fibromyalgia.
Baillieres Best Pract Res Clin Rheumatol 1999 Sep
PMID:Primary care and specialist management options. 1056 78


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