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

Chronic musculoskeletal pain syndromes are common problems, but the etiology, pathogenesis, and pathology of many of them are very poorly understood. Because the currently used nomenclature suggests an understanding that we do not have, I propose that names like "myofascial pain," "tension myalgia," and "FM" be abandoned in favor of the more indefinite (but more honest) terms like "regional" and "generalized rheumatism." No matter what we rheumatologists call it, however, the condition of chronic generalized musculoskeletal pain probably is only one part of an even more generalized condition that includes IBS, chronic headaches, regional migratory numbness, TMJ syndrome, and a whole host of other somatic pain syndromes. The same patients end up seeing many specialists who themselves feel frustrated with the labels at their disposal, and these specialists end up resembling the blind men confronting the elephant. In this regard, the new ACR criteria for the diagnosis of fibrositis, by emphasizing tenderness and ignoring the presence of these other syndromes, are too circumscribed and represent a step backward in our attempts to understand. Although the chronic rheumatisms are problems difficult to manage and frustrating for both the patient and the physician, when patience can be applied and confidence achieved, a positive relationship can result and the patient can be helped.
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PMID:Fibromyalgia and the rheumatisms. Common sense and sensibility. 835 61

Variable blood pressure responses, manifesting either as a "white-coat" phenomenon or lability between office visits, confound hypertension management decisions. An attempt was made to determine whether these phenomena are associated with concurrent diagnoses of psychosocial dysfunction, therefore mitigating against antihypertensive medical therapy. Forty-seven patients with such variable blood pressure responses were identified in a rural family practice over a three-year period and compared to randomly selected age- and sex-matched controls for the following concurrent diagnoses: generalized anxiety, psychogenic spastic bladder, panic disorder, depression, alcohol use, chronic headache, fibromyalgia, temporomandibular joint syndrome, irritable bowel syndrome, and premenstrual syndrome. No statistical associations between white-coat hypertension and these diagnoses were demonstrated although a small sample size tempers conclusions. However, chi-square analysis (P < 0.01) of the phenomenon characterized by lability of blood pressure between different office visits demonstrated a statistical association with alcoholic hepatitis in men. White-coat hypertension is a diagnosis that may warrant disassociation from other psychosocial disorders, although further study is indicated. Physicians should remain attuned to the presence of lability of blood pressure in males and consider possible associations with alcoholism.
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PMID:A pilot study of white-coat and labile hypertension: associations with diagnoses of psychosocial dysfunction. 848 44

The relationship between headaches and sleep disturbances is complex and difficult to analyze. Both symptoms may have causal relations, or may be associated in the same patient with mutual reinforcements. We studied 25 patients presenting with morning or nocturnal headaches. Standard headache diagnosis and polysomnography were performed. After polysomnography, the diagnoses were reevaluated. The main headache entities were cluster, chronic paroxysmal hemicrania, migraine, tension, combined headache, and chronic substance abuse headache. For each group, headache, sleep data, and changes in diagnosis are discussed. The diagnosis was changed in 13 patients; the final diagnoses were periodic movements of sleep, fibromyalgia syndrome, and obstructive sleep apnea. The diagnoses of cluster headache and chronic paroxysmal hemicrania were not modified by polysomnography. The migraine and tension headache groups had a relative male preponderance, and the diagnosis was changed in approximately half of the patients. This was also observed in combined headaches. Patients who had chronic substance abuse headaches had mainly insomnia, which in some cases, was relieved by stopping medication. Data were also analyzed in terms of simple models linking headache and sleep disturbances. Such an approach allowed the identification of several modes of mutual interaction. In summary, morning or nocturnal headaches are frequent indicators of a sleep disturbance and their presence might justify polysomnography, and the use of simple clinical models may be useful for understanding the complex relationship between headache and sleep.
Headache
PMID:The relationship between headaches and sleep disturbances. 855 Mar 59

Three hundred consecutive women with silicone breast implants (SBI), referred to the arthritis clinic with a variety of musculoskeletal complaints, were evaluated for the presence of underlying connective tissue disease. A complete history and physical examination were performed, as well as laboratory testing for C-reactive protein, rheumatoid factor; and autoantibody determination by indirect immunofluorescence and immunodiffusion. The group mean age was 44.4 years (range 25-69), the mean time from initial implant surgery to appearance of symptoms was 6.8 years (range: 6m-19y) and 83.3% of women studied had clinical manifestations highly suggestive of an underlying connective tissue disorder. Fifty-four percent met criteria for fibromyalgia and/or chronic fatigue syndrome, distinct connective tissue diseases was detected in 11%, undifferentiated connective tissue disease or human adjuvant disease was found in 10.6%, and a variety of disorders such as angioneurotic oedema, frozen shoulder, multiple sclerosis-like syndrome were present. Several other miscellaneous conditions including recurrent unexplained low grade fever, hair loss, skin rash, sicca symptoms, Raynaud's phenomenon, carpal tunnel syndrome, memory loss, headaches, chest pain, and shortness of breath were also seen accompanying specific and non-specific conditions. Seventy percent of patients who underwent explanation of the implants reported improvement of their systemic symptomatology. A significant proportion of SBI patients referred for rheumatic evaluation have clinical manifestations highly suggestive of an underlying connective tissue disease. Furthermore, improvement of their symptomatology follows explanation of the implants in over half of the patients.
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PMID:Silicone breast implant--associated musculoskeletal manifestations. 860 86

A variety of conditions are frequently associated with the occurrence of head and neck pain. The purposes of this review are: to describe the characteristics of several musculoskeletal, neurological, and systemic conditions frequently cited as possible causes of head and neck pain and to suggest a new technique for treating head and neck pain. The characteristics of musculoskeletal conditions, such as muscle spasm, tendinitis, trigger points, and joint inflammation, and their relationship to head and neck pain are considered. The features and clinical implications of neurologic conditions, such as atypical facial pain, trigeminal and glossopharyngeal neuralgia, reflex sympathetic dystrophy, and neurogenic inflammation, are also described. The distinguishing characteristics of headaches, including cluster, tension, chronic daily, rebound, posttraumatic, and postlumbar puncture, are detailed. This review also addresses the contributions of systemic disorders, such as osteoarthritis, rheumatoid arthritis and the variants, and rheumatoid-related conditions, like dermatomyositis, temporal arteritis, Lyme's disease, and fibromyalgia, to head and neck pain. The results of a recent pilot study of the effectiveness of intraoral circulating ice water for resolving symptoms related to head and neck pain secondary to neurogenic inflammation are presented in this work. Ice water circulating through hollow metal tubes was placed intraorally for 15 minutes in the posterior maxillary area on 12 individuals with cervical pain and muscle spasm. In nine of these individuals, reduced cervical pain perception, upper trapezius electromyography signal reduction, and increased cervical range of motion was produced. Six out of 12 individuals had accompanying headache, which was reduced or eliminated in four cases. These findings suggest a strong trigemino-cervical relationship to neck pain and headache.
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PMID:Head and neck pain review: traditional and new perspectives. 889 41

The major purpose of this study was to determine if 31 patients with fibromyalgia syndrome (FS) reported different pain intensity and Health Locus of Control (HLC) scores than 30 patients with rheumatoid arthritis (RA). Another purpose was to determine the relationship among experienced actual pain (present, usual, worse, least), recalled prior episodes of pain (worse toothache, headache, and stomach ache), HLC orientation, age and the duration of the actual pain. Visual Analogue Scales were used to measure pain intensity. The Health Locus of Control Scale was used to determine external/internal orientation. The results showed that the FS patients reported significantly more intense actual pain, recalled pain for worse toothache and headache, and were more externally oriented than the RA patients. Present pain intensity was significantly correlated to actual intensity ratings, but not to reported earlier experienced pain, except for worse stomach ache in the RA group. The findings' implications for treatment and education are discussed.
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PMID:Pain intensity and health locus of control: a comparison of patients with fibromyalgia syndrome and rheumatoid arthritis. 900 34

Patients reporting sensitivity to multiple chemicals at levels usually tolerated by the healthy population were administered standardized questionnaires to evaluate their symptoms and the exposures that aggravated these symptoms. Many patients were referred for medical tests. It is thought that patients with chemical sensitivity have organ abnormalities involving the liver, nervous system (brain, including limbic, peripheral, autonomic), immune system, and porphyrin metabolism, probably reflecting chemical injury to these systems. Laboratory results are not consistent with a psychologic origin of chemical sensitivity. Substantial overlap between chemical sensitivity, fibromyalgia, and chronic fatigue syndrome exists: the latter two conditions often involve chemical sensitivity and may even be the same disorder. Other disorders commonly seen in chemical sensitivity patients include headache (often migraine), chronic fatigue, musculoskeletal aching, chronic respiratory inflammation (rhinitis, sinusitis, laryngitis, asthma), attention deficit, and hyperactivity (affected younger children). Less common disorders include tremor, seizures, and mitral valve prolapse. Patients with these overlapping disorders should be evaluated for chemical sensitivity and excluded from control groups in future research. Agents whose exposures are associated with symptoms and suspected of causing onset of chemical sensitivity with chronic illness include gasoline, kerosene, natural gas, pesticides (especially chlordane and chlorpyrifos), solvents, new carpet and other renovation materials, adhesives/glues, fiberglass, carbonless copy paper, fabric softener, formaldehyde and glutaraldehyde, carpet shampoos (lauryl sulfate) and other cleaning agents, isocyanates, combustion products (poorly vented gas heaters, overheated batteries), and medications (dinitrochlorobenzene for warts, intranasally packed neosynephrine, prolonged antibiotics, and general anesthesia with petrochemicals). Multiple mechanisms of chemical injury that magnify response to exposures in chemically sensitive patients can include neurogenic inflammation (respiratory, gastrointestinal, genitourinary), kindling and time-dependent sensitization (neurologic), impaired porphyrin metabolism (multiple organs), and immune activation.
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PMID:Profile of patients with chemical injury and sensitivity. 916 75

Eighty-one patients suffering from neck pain and tension-type headaches were treated by the application of a unique physical therapy device combining transcutaneous electrical nerve stimulation (TENS), traction, massage, vibration, and acupressure applied to the forehead, posterior cervical spine, and scapula. The device employed eight silver silicone electrodes for modality application. Its safety and effectiveness were assessed by evaluating patients before and after treatment. No complication ensued. Statistical analysis of visual analog scales for neck pain and headache yielded p values < 0.0001. Analysis of fibromyalgia neck and shoulder trigger points with three controls gave nonsignificant results. Conclusions were that 1) the device is safe and effective as judged by subjective patient input and 2) fibromyalgia trigger points are unaffected by the treatments. More objective measures are needed to provide evidence of efficacy.
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PMID:Simultaneous multiple-modality therapy for tension headaches and neck pain. 918 Dec 45

Interstitial cystitis (IC) is a relatively uncommon and enigmatic disorder characterized by pain in the bladder and pelvic region, typically accompanied by urinary urgency and frequency. Fibromyalgia is a more common disorder, with the prominent symptoms being diffuse musculoskeletal pain and fatigue, and it has been well established that there is substantial clinical overlap between fibromyalgia and chronic fatigue syndrome (CFS). Although genitourinary and musculoskeletal symptoms predominate in IC and fibromyalgia respectively, both disorders share a number of features, including similar demographics, "allied conditions" (e.g. irritable bowel syndrome, headaches, etc.), natural history, aggravating factors, and efficacious therapy. We hypothesized that there was substantial clinical overlap between fibromyalgia and IC, and examined cohorts of individuals with these two disorders in parallel, to compare the spectrum of symptomatology. Sixty fibromyalgia patients, 30 IC patients, and 30 age-matched healthy controls were questioned regarding current symptomatology. A dolorimeter examination was also performed in the three groups to assess peripheral nociception. We found that the frequency of current symptoms was very similar for the fibromyalgia and IC groups. Both the fibromyalgia and IC patients displayed increased pain sensitivity when compared to healthy individuals, at both tender and control points. These data suggest that IC and fibromyalgia have significant overlap in symptomatology, and that IC patients display diffusely increased peripheral nociception, as is seen in fibromyalgia. Although central mechanisms have been suspected to contribute to the pathogenesis of fibromyalgia for some time, we speculate that these same types of mechanisms may be operative in IC, which has traditionally been felt to be a bladder disorder.
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PMID:The relationship between fibromyalgia and interstitial cystitis. 920 54

Sphenopalatine blocks have been used to treat pain for more than 80 years. Anecdotal support for sphenopalatine ganglion blocks has been very strong in those who believe in the technique, but the research results have been inconclusive. Therefore, a double blind, placebo-controlled study was performed on 61 patients, 42 with fibromyalgia and 19 with myofascial pain syndrome. Pain was measured using visual analogue scales prior to treatment, during treatment, and 28 days after the treatment. Headaches were evaluated in frequency and location prior to and after treatment. Sphenopalatine ganglion blocks were performed under direct vision using 4% lidocaine and sterile water as a placebo. Analysis of the results showed no statistical differences between the lidocaine and the placebo groups.
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PMID:Sphenopalatine blocks in the treatment of pain in fibromyalgia and myofascial pain syndrome. 933 24


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