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Query: UMLS:C0016053 (fibromyalgia)
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Nonarticular pain syndromes, although not inherently crippling, can have significant impact on patients' comfort, daily activities, and job performance. These syndromes include fibromyalgia, bursitis, tendinitis, and localized myofascial pain syndromes. Although differentiating these conditions from one another may be difficult, early diagnosis and follow-up are important for determining appropriate treatment. Depending on the diagnosis, treatment may include use of nonsteroidal anti-inflammatory drugs, analgesics, or corticosteroid injections; trigger-point desensitization therapy; physical therapy; and patient education.
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PMID:Nonarticular pain syndromes. Differentiating generalized, regional, and localized disorders. 173 52

Orofacial pain can have an inflammatory, neurologic or musculoskeletal cause. Inflammatory diseases include dental abscess, sinusitis, temporal arteritis, sialolithiasis and infections of the parotid gland. Common neurologic diseases that cause facial pain are trigeminal neuralgia, glossopharyngeal neuralgia, paratrigeminal neuralgia and cluster headaches. Musculoskeletal causes include temporomandibular joint syndrome and myofascial pain dysfunction syndrome. A clear understanding of pertinent anatomy and an organized approach to diagnosis will facilitate the evaluation of patients with orofacial pain.
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PMID:Orofacial pain: diagnosis and treatment. 136 Jul 64

The description of psychological aspects of fibromyalgia are similar to those of other patients with chronic pain. Three groups, a chronic pain group (n = 99), a nonchronic pain group (n = 34) and a fibromyalgia group (n = 36) were compared, using a standardized interview and psychological questionnaires (SCL-90R, IBQ and CIPI). It appeared that the chronic pain group and the nonchronic pain group could be easily distinguished from each other with these variables. The scores of the fibromyalgia group and the chronic pain group were very similar. This leads to the conclusion that many psychological aspects of fibromyalgia can be considered as psychological aspects of chronic pain.
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PMID:Psychological aspects of fibromyalgia compared with chronic and nonchronic pain. 179 23

Experiences with food intake, diet manipulations and fast were registered in rheumatic patients. The study was a questionnaire-based survey in which 742 patients participated. It comprised 290 patients with rheumatoid arthritis, 51 patients with juvenile rheumatoid arthritis, 87 patients with ankylosing spondylitis, 51 patients with psoriatic arthropathy, 65 patients with primary fibromyalgia and 34 patients with osteoarthritis. One third of the patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthropathy reported aggravation of disease symptoms after intake of certain foods while 43% of the patients with juvenile rheumatoid arthritis and 42% of the patients with primary fibromyalgia stated the same. Twenty-six percent of the patients with juvenile rheumatoid arthritis and 23% of the patients with rheumatoid arthritis, ankylosing spondylitis and primary fibromyalgia had previously tried certain diets in the attempt to alleviate disease symptoms, whereas 13% of the patients with psoriatic arthropathy and 10% with osteoarthritis had tried diet therapy. Less pain and stiffness were reported by 46% of the patients and 36% reported reduced joint swelling. Similar beneficial effects of diet were also reported in other rheumatic disease groups. Fifteen percent of the patients with rheumatoid arthritis and ankylosing spondylitis had been through a fasting period. Less pain and stiffness were reported by 2/3 of the patients in both groups and half of the patients in both groups reported a reduced number of swollen joints.
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PMID:Diet and disease symptoms in rheumatic diseases--results of a questionnaire based survey. 180 95

Pain related to fibromyalgia may consist of a complex interaction of nociceptive, neuropathic, dysregulatory central nervous system and psychosomatic mechanisms. Nociceptor pain is based on the excitation of nervous sensors specialized to signal potentially harmful stimuli, i.e., the nociceptors. Metabolic deficiencies in muscle and neurogenic inflammation induced by the release of substance P and other neuropeptides from the peripheral nerve endings may result in chemical sensitization of nociceptors and an ensuing hyperalgesia particularly present in tender points. Neuropathic pain is due to pathological mechanisms within nerve cells and fibers in the peripheral and central nervous system. Pathophysiology may be related to compression (such as in the carpal tunnel syndrome or a vertebral disk herniation) or regeneration of nerves, resulting in ectopic impulse discharges and disturbances of axonal transport. The ensuing neuronal hyperexcitability and trophic changes induced by a disturbed axonal transport system may be major factors of pain in fibromyalgia. Dysregulatory pain denotes pain maintained by dysfunction of efferent control loops. Thus, if spinal motoneuron output results in excessive tension of postural muscle, nociceptors in muscles, tendons and joints might become more excited. Persistent abnormal spinal reflex transmission due to, e.g., peripheral trauma or inappropriate postural habits may result in a vicious circle between muscle hypertension and pain. Similarly, a defective sympathetic control may result in disturbed microcirculation and nociceptor excitation (e.g., in sympathetic algodystrophy). Many symptoms of pain in fibromyalgia (trigger points, pain referral, pain associated with muscle spasm or neurogenic joint immobilization) can be attributed to abnormal control mechanisms in a complex cybernetic system.(ABSTRACT TRUNCATED AT 250 WORDS)
Clin J Pain 1991
PMID:Pathophysiological mechanisms of fibromyalgia. 181 May 27

Childhood disability and chronic disease are common, and their prevalence is increasing as children survive with conditions that were previously fatal. It is important that physicians in training learn about disability and handicap, and the functioning of multidisciplinary teams to manage these problems. Chronic ill-health is often very expensive to manage, and some serious and creative thinking about the best way to fund such health care is urgently needed. Pediatric rheumatologists are involved with the care of many children with chronic and recurrent musculoskeletal pain; however, they have not perhaps focused enough research effort on the investigation of pain and its management. Whether reflex neurovascular dystrophy, fibromyalgia, and chronic fatigue syndrome are part of a disease continuum is unclear, but it seems probable that psychosocial problems are often important contributing factors in all three conditions. Immunoglobulin subclass deficiencies are being increasingly delineated, occurring in chronic fatigue syndrome as well as many other disease states. Their clinical relevance still remains, for the most part, uncertain. Short stature occurs in many chronic illnesses, and the role of growth hormone treatment in these conditions is beginning to be investigated.
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PMID:Pain syndromes, disability, and chronic disease in childhood. 183 44

We studied the pain, Stanford Health Assessment Questionnaire functional disability, pain/disability ratio, and psychological scores in 1,522 patients with rheumatic disease with 7 distinct disorders. Individual differences between patients were more striking than differences among diagnostic groups. Patients with rheumatoid arthritis (RA) had the greatest disability, least pain, lowest pain/disability ratio, and least abnormal psychological scores. Highest pain and psychological distress was noted in low back pain, neck pain, and fibromyalgia (axial disorders). Disability in activities of daily living was as high in fibromyalgia as in RA, but low in axial skeletal disorders. There appears to be a continuum for disability that begins with axial but not articular disease (neck and back pain) and ends with multiple articular and periarticular involvement (RA and fibromyalgia).
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PMID:Pain, disability, and pain/disability relationships in seven rheumatic disorders: a study of 1,522 patients. 183 15

Low back pain and fibromyalgia represent two of the most common disorders in developed countries. On the whole, up to 75% of the general population has, at some time, suffered from low back pain. A percentage ranging between 5 and 10% of them develops a chronic illness. In most countries, the incidence rate per year of low back pain is 5%. Most low back pain episodes occur between the ages of 25 and 55 years. Most studies have not found any clear influence between genders and frequency of low back pain. There is a relationship between low back pain and occupation, with those who have physically demanding jobs being more at risk. As regards fibromyalgia, the prevalence rates range between 6 and 20%, with a higher frequency among females and between the ages of 25 and 55 years. The direct and indirect costs of low back pain approach $24 billion per year in the U.S. It is in view of its high prevalence among populations of developed countries, of its heavy psychosocial and financial implications, and of the burden imposed on health services, that low back pain represents a severe public health problem.
Clin J Pain 1991
PMID:Epidemiology and social costs of low back pain and fibromyalgia. 183 74

Muscle pain occurs in various neuromuscular disorders with characteristic physiological or biochemical abnormalities. There is, however, a group of patients in whom there is no clear physiological or structural basis for their pains. This syndrome has been called fibrositis or fibromyalgia. Sleep abnormalities have been reported in some of these patients, but have not been confirmed by others. We studied 8 patients with this disorder and found sleep abnormalities that were characterized by nocturnal myoclonus, alpha-delta sleep, and abnormalities compatible with depression. Polysomnography was, therefore, instrumental in helping direct the treatment of these patients. Therapeutic approaches aimed to correct the specific disorders were effective in improving the pain symptoms.
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PMID:Polysomnography in idiopathic muscle pain syndrome (fibrositis). 184 93

The purpose of this article is to inform the general dentist treating the temporomandibular joint complex about fibrositis (fibromyalgia syndrome). Patients may present with spasms in the muscles of mastication, which may mimic joint pain or cause joint dysfunction. Tooth pain, which may mimic endodontic pain, may also be referred from a trigger pain in a muscle.
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PMID:Fibrositis (fibromyalgia syndrome) and the dental clinician. 184 81


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