eMedicine Specialties > Rheumatology > Soft Tissue and Regional Rheumatic Disease

Fibromyalgia: Differential Diagnoses & Workup

Author: John Buckner Winfield, MD, Herman and Louise Smith Distinguished Professor of Medicine in Arthritis Emeritus, Department of Medicine, Senior Member, Neurosensory Disorders Center, University of North Carolina at Chapel Hill; Consulting Rheumatologist, Appalachian Regional Rheumatology
Contributor Information and Disclosures

Updated: Jul 14, 2009

Differential Diagnoses

Addison Disease
Insomnia
Anxiety Disorders
Interstitial Cystitis
Conversion Disorders
Irritable Bowel Syndrome
Cushing Syndrome
Malingering
Depression
Mitral Valve Prolapse
Dysmenorrhea
Opioid Abuse
Dysthymic Disorder
Panic Disorder
Endometriosis
Personality Disorders
Factitious Disorder
Polymyalgia Rheumatica
Growth Hormone Deficiency
Polymyositis
Gynecologic Pain
Posttraumatic Stress Disorder
Hashimoto Thyroiditis
Rheumatoid Arthritis
Hemochromatosis
Sjogren Syndrome
Hepatitis C
Systemic Lupus Erythematosus
Hyperparathyroidism
Hypochondriasis
Hypothyroidism

Other Problems to Be Considered

Migraine headache
Atypical chest pain
Chronic fatigue syndrome
Multiple chemical sensitivity
Sick building syndrome
Temporomandibular disorder
Vulvar vestibulitis
Mitral valve prolapse
Dysmenorrhea
Vulvodynia

Workup

Laboratory Studies

Patients with fibromyalgia (FM) do not have characteristic or consistent abnormalities as determined by laboratory test results. Laboratory studies are important to help rule out diseases with similar manifestations and to assist in diagnosis of certain inflammatory diseases that frequently coexist with fibromyalgia. In addition to complete blood cell (CBC) count and differential count, basic metabolic panel, and urinalysis, the following limited evaluation is reasonable.

  • Thyroid-stimulating hormone: Hypothyroidism shares many clinical features with fibromyalgia, especially diffuse muscle pain and fatigue.
  • Creatinine phosphokinase (CPK) to exclude inflammatory myopathies
  • Erythrocyte sedimentation rate (ESR): The normal ESR in patients with fibromyalgia contrasts with the high ESR in elderly patients with polymyalgia rheumatica. Obtaining an ESR can assist in identifying an underlying inflammatory disorder or occult malignancy.
  • Antinuclear antibodies (ANAs): Many patients with SLE have comorbid fibromyalgia. A low-titer ANA is common in the general population and may be of no clinical significance if diagnostic features of SLE or related autoimmune disorders are absent.
  • Rheumatoid factor: Many patients with RA have comorbid fibromyalgia. However, a positive result for rheumatoid factor does not support a diagnosis of RA in the absence of objective evidence of characteristic joint inflammation. A positive result for rheumatoid factor is diagnostically nonspecific in other clinical settings.

Other Tests

  • Laboratory sleep assessment: If sleep does not improve with usual conservative measures (eg, elimination of caffeine, prescription of hypnotics or nighttime tricyclics), obtaining a formal assessment by a neurologist experienced in sleep disorders may be useful.
  • Although unusual, diffuse arthralgias and myalgias have been described in patients with hemochromatosis. Consider screening with a serum transferrin saturation and a serum ferritin concentration in patients aged 40-60 years, especially those with small-joint arthropathy in the hands and/or calcium pyrophosphate dihydrate deposition disease (CPPD).

Procedures

  • Obtain a verbal or numerical rating scale or a visual analog scale for pain intensity and the degree of fatigue.
  • While waiting to see the physician, the patient, in a few minutes, can complete a simple self-report form55 that incorporates visual analog scales for pain and fatigue and a global self-assessment of how the patient is doing, along with validated scales for physical and psychologic health status (eg, modified Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, a checklist of current symptoms, scales for helplessness and cognitive performance). Easily adaptable to a busy practice, such information is invaluable for the psychosocial assessment of pain, both for aiding with diagnosis and in monitoring the response to therapy.
  • Using pressure algometry (dolorimetry) for a simple determination of pressure pain thresholds at 4 tender points associated with fibromyalgia (ie, both lateral epicondyles, midpoints of the trapezii) is useful as an aid for diagnosis, as a tool for patient education, and as a semiquantitative guide to therapy. Normal values are equal to or greater than 4 kg/cm2.
  • Psychometric testing includes the Minnesota Multiphasic Personality Inventory, the Social Support Questionnaire, the Sickness Impact Profile, and the Multidimensional Pain Inventory (MPI). In multidisciplinary settings, information obtained from these tests is useful for a more comprehensive assessment. For example, subgroups of patients with chronic pain can be identified based on MPI responses that appear to predict response to interdisciplinary therapeutic interventions.

More on Fibromyalgia

Overview: Fibromyalgia
Differential Diagnoses & Workup: Fibromyalgia
Treatment & Medication: Fibromyalgia
Follow-up: Fibromyalgia
Multimedia: Fibromyalgia
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum. Jun 2007;36(6):339-56. [Medline].

  2. Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum. May 2002;46(5):1333-43. [Medline].

  3. Wood PB. Treating comorbidities in fibromyalgia. Pain Pract. 2008;18(1):pp 42-53.

  4. Wolfe F, Cathey MA, Kleinheksel SM. Fibrositis (Fibromyalgia) in rheumatoid arthritis. J Rheumatol. Dec 1984;11(6):814-8. [Medline].

  5. Buskila D, Press J, Abu-Shakra M. Fibromyalgia in systemic lupus erythematosus: prevalence and clinical implications. Clin Rev Allergy Immunol. Aug 2003;25(1):25-8. [Medline].

  6. Thompson ME, Barkhuizen A. Fibromyalgia, hepatitis C infection, and the cytokine connection. Curr Pain Headache Rep. Oct 2003;7(5):342-7. [Medline].

  7. Diatchenko L, Nackley AG, Slade GD, et al. Idiopathic pain disorders--pathways of vulnerability. Pain. Aug 2006;123(3):226-30. [Medline].

  8. Van Houdenhove B, Egle UT. Fibromyalgia: a stress disorder? Piecing the biopsychosocial puzzle together. Psychother Psychosom. Sep-Oct 2004;73(5):267-75. [Medline].

  9. Van Houdenhove B, Luyten P. Beyond dualism: the role of life stress in chronic pain. Pain. Jan 2005;113(1-2):238-9; discussion 240-2. [Medline].

  10. Turk DC, Vierck CJ, Scarbrough E, et al. Fibromyalgia: combining pharmacological and nonpharmacological approaches to treating the person, not just the pain. J Pain. Feb 2008;9(2):99-104. [Medline].

  11. Winfield JB. Psychological determinants of fibromyalgia and related syndromes. Curr Rev Pain. 2000;4(4):276-86. [Medline].

  12. Pillemer SR, Bradley LA, Crofford LJ, Moldofsky H, Chrousos GP. The neuroscience and endocrinology of fibromyalgia. Arthritis Rheum. Nov 1997;40(11):1928-39. [Medline].

  13. Crofford LJ. The hypothalamic-pituitary-adrenal stress axis in fibromyalgia and chronic fatigue syndrome. Z Rheumatol. 1998;57 Suppl 2:67-71. [Medline].

  14. Martinez-Lavin M. Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther. 2007;9(4):216. [Medline].

  15. Tanriverdi F, Karaca Z, Unluhizarci K, et al. The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome. Stress. Mar 2007;10(1):13-25. [Medline].

  16. Jones KD, Deodhar P, Lorentzen A, Bennett RM, Deodhar AA. Growth hormone perturbations in fibromyalgia: a review. Semin Arthritis Rheum. Jun 2007;36(6):357-79. [Medline].

  17. Clauw DJ. Fibromyalgia: update on mechanisms and management. J Clin Rheumatol. Apr 2007;13(2):102-9. [Medline].

  18. Staud R, Robinson ME, Vierck CJ Jr, et al. Diffuse noxious inhibitory controls (DNIC) attenuate temporal summation of second pain in normal males but not in normal females or fibromyalgia patients. Pain. Jan 2003;101(1-2):167-74. [Medline].

  19. Staud R, Spaeth M. Psychophysical and neurochemical abnormalities of pain processing in fibromyalgia. CNS Spectr. Mar 2008;13(3 Suppl 5):12-7. [Medline].

  20. Wood PB, Schweinhardt P, Jaeger E, et al. Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci. Jun 2007;25(12):3576-82. [Medline].

  21. Sarchielli P, Di Filippo M, Nardi K, Calabresi P. Sensitization, glutamate, and the link between migraine and fibromyalgia. Curr Pain Headache Rep. Oct 2007;11(5):343-51. [Medline].

  22. Diatchenko L, Slade GD, Nackley AG, et al. Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet. Jan 1 2005;14(1):135-43. [Medline].

  23. Clauw DJ. Pharmacotherapy for patients with fibromyalgia. J Clin Psychiatry. 2008;69 Suppl 2:25-9. [Medline].

  24. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. Jan 1995;38(1):19-28. [Medline].

  25. Buchwald D, Umali P, Umali J, Kith P, Pearlman T, Komaroff AL. Chronic fatigue and the chronic fatigue syndrome: prevalence in a Pacific Northwest health care system. Ann Intern Med. Jul 15 1995;123(2):81-8. [Medline].

  26. Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJ, Wessely SC. Population based study of fatigue and psychological distress. BMJ. Mar 19 1994;308(6931):763-6. [Medline].

  27. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. Feb 1990;33(2):160-72. [Medline].

  28. Hoffman DL, Dukes EM. The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12. Int J Clin Pract. Jan 2008;62(1):115-26. [Medline].

  29. White LA, Birnbaum HG, Kaltenboeck A, et al. Employees with fibromyalgia: medical comorbidity, healthcare costs, and work loss. J Occup Environ Med. Jan 2008;50(1):13-24. [Medline].

  30. Fillingim RB, Maixner W. Gender differences in the responses to noxious stimuli. Pain Forum. 1995;4:209-221.

  31. Michels H, Gerhold K, Hafner R, et al. [Juvenile fibromyalgia syndrome]. Schmerz. Jun 2008;22(3):339-48. [Medline].

  32. Yunus MB, Holt GS, Masi AT, et al. Fibromyalgia syndrome among the elderly. Comparison with younger patients. J Am Geriatr Soc. Nov 1988;36(11):987-95. [Medline].

  33. [Best Evidence] Stephens S, Feldman BM, Bradley N, Schneiderman J, Wright V, Singh-Grewal D, et al. Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial. Arthritis Rheum. Oct 15 2008;59(10):1399-406. [Medline].

  34. Glass JM. Fibromyalgia and cognition. J Clin Psychiatry. 2008;69 Suppl 2:20-4. [Medline].

  35. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. Apr 8 1977;196(4286):129-36. [Medline].

  36. Arnold LM, Hudson JI, Hess EV, Ware AE, Fritz DA, Auchenbach MB, et al. Family study of fibromyalgia. Arthritis Rheum. Mar 2004;50(3):944-52. [Medline].

  37. Offenbaecher M, Bondy B, de Jonge S, Glatzeder K, Krüger M, Schoeps P, et al. Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region. Arthritis Rheum. Nov 1999;42(11):2482-8. [Medline].

  38. Diatchenko L, Nackley AG, Slade GD, Bhalang K, Belfer I, Max MB, et al. Catechol-O-methyltransferase gene polymorphisms are associated with multiple pain-evoking stimuli. Pain. Dec 5 2006;125(3):216-24. [Medline].

  39. Moldofsky H, Scarisbrick P, England R, et al. Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects. Psychosom Med. Jul-Aug 1975;37(4):341-51. [Medline].

  40. Schrader H, Obelieniene D, Bovim G, Surkiene D, Mickeviciene D, Miseviciene I, et al. Natural evolution of late whiplash syndrome outside the medicolegal context. Lancet. May 4 1996;347(9010):1207-11. [Medline].

  41. Buskila D, Neumann L, Vaisberg G, Alkalay D, Wolfe F. Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury. Arthritis Rheum. Mar 1997;40(3):446-52. [Medline].

  42. Obelieniene D, Schrader H, Bovim G, Miseviciene I, Sand T. Pain after whiplash: a prospective controlled inception cohort study. J Neurol Neurosurg Psychiatry. Mar 1999;66(3):279-83. [Medline].

  43. Tishler M, Levy O, Maslakov I, Bar-Chaim S, Amit-Vazina M. Neck injury and fibromyalgia-- are they really associated?. J Rheumatol. Jun 2006;33(6):1183-5. [Medline].

  44. Shir Y, Pereira JX, Fitzcharles MA. Whiplash and fibromyalgia: an ever-widening gap. J Rheumatol. Jun 2006;33(6):1045-7. [Medline].

  45. Crombez G, Eccleston C, Van den Broeck A, et al. Hypervigilance to pain in fibromyalgia: the mediating role of pain intensity and catastrophic thinking about pain. Clin J Pain. Mar-Apr 2004;20(2):98-102. [Medline].

  46. Keefe FJ, Lefebvre JC, Maixner W, Salley AN Jr, Caldwell DS. Self-efficacy for arthritis pain: relationship to perception of thermal laboratory pain stimuli. Arthritis Care Res. Jun 1997;10(3):177-84. [Medline].

  47. Gracely RH, Geisser ME, Giesecke T, Grant MA, Petzke F, Williams DA, et al. Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain. Apr 2004;127:835-43. [Medline].

  48. Bradley LA. Psychiatric comorbidity in fibromyalgia. Curr Pain Headache Rep. Apr 2005;9(2):79-86. [Medline].

  49. Arnold LM, Hudson JI, Keck PE, Auchenbach MB, Javaras KN, Hess EV. Comorbidity of fibromyalgia and psychiatric disorders. J Clin Psychiatry. Aug 2006;67(8):1219-25. [Medline].

  50. Giesecke T, Williams DA, Harris RE, Cupps TR, Tian X, Tian TX, et al. Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors. Arthritis Rheum. Oct 2003;48(10):2916-22. [Medline].

  51. Giesecke T, Gracely RH, Williams DA, Geisser ME, Petzke FW, Clauw DJ. The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. Arthritis Rheum. May 2005;52(5):1577-84. [Medline].

  52. Fassbender K, Samborsky W, Kellner M, Müller W, Lautenbacher S. Tender points, depressive and functional symptoms: comparison between fibromyalgia and major depression. Clin Rheumatol. Jan 1997;16(1):76-9. [Medline].

  53. Hassett AL. Psychosocial aspects of fibromyalgia: psychological stress, psychiatric morbidity, and personality subgroups. 2008;pp 55-61.

  54. McBeth J, Macfarlane GJ, Benjamin S, Morris S, Silman AJ. The association between tender points, psychological distress, and adverse childhood experiences: a community-based study. Arthritis Rheum. Jul 1999;42(7):1397-404. [Medline].

  55. Pincus T, Yazici Y, Bergman M. Development of a multi-dimensional health assessment questionnaire (MDHAQ) for the infrastructure of standard clinical care. Clin Exp Rheumatol. Sep-Oct 2005;23(5 Suppl 39):S19-28. [Medline].

  56. Staud R. Treatment of fibromyalgia and its symptoms. Expert Opin Pharmacother. Aug 2007;8(11):1629-42. [Medline].

  57. Sarzi-Puttini P, Buskila D, Carrabba M, et al. Treatment strategy in fibromyalgia syndrome: where are we now?. Semin Arthritis Rheum. Jun 2008;37(6):353-65. [Medline].

  58. [Best Evidence] Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. Apr 2008;67(4):536-41. [Medline].

  59. Goldenberg DL. Pharmacological treatment of fibromyalgia and other chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. Jun 2007;21(3):499-511. [Medline].

  60. Goldenberg DL. Multidisciplinary modalities in the treatment of fibromyalgia. J Clin Psychiatry. 2008;69 Suppl 2:30-4. [Medline].

  61. Burckhardt CS. Multidisciplinary approaches for management of fibromyalgia. Curr Pharm Des. 2006;12(1):59-66. [Medline].

  62. [Best Evidence] Häuser W, Bernardy K, Arnold B, Offenbächer M, Schiltenwolf M. Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Arthritis Rheum. Feb 15 2009;61(2):216-24. [Medline].

  63. Benca RM, Ancoli-Israel S, Moldofsky H. Special considerations in insomnia diagnosis and management: depressed, elderly, and chronic pain populations. J Clin Psychiatry. 2004;65 Suppl 8:26-35. [Medline].

  64. Bigatti SM, Hernandez AM, Cronan TA, et al. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. Jul 15 2008;59(7):961-7. [Medline].

  65. Moldofsky H. The significance, assessment, and management of nonrestorative sleep in fibromyalgia syndrome. CNS Spectr. Mar 2008;13(3 Suppl 5):22-6. [Medline].

  66. Thieme K, Flor H, Turk DC. Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments. Arthritis Res Ther. 2006;8(4):R121. [Medline].

  67. Thieme K, Turk DC, Flor H. Responder criteria for operant and cognitive-behavioral treatment of fibromyalgia syndrome. Arthritis Rheum. Jun 15 2007;57(5):830-6. [Medline].

  68. Jones KD, Adams D, Winters-Stone K, Burckhardt CS. A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988-2005). Health Qual Life Outcomes. Sep 25 2006;4:67. [Medline].

  69. [Best Evidence] Busch AJ, Schachter CL, Overend TJ, et al. Exercise for fibromyalgia: a systematic review. J Rheumatol. Jun 2008;35(6):1130-44. [Medline].

  70. [Best Evidence] Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. Dec 2008;89(12):2250-7. [Medline].

  71. Thomas AW, Graham K, Prato FS, et al. A randomized, double-blind, placebo-controlled clinical trial using a low-frequency magnetic field in the treatment of musculoskeletal chronic pain. Pain Res Manag. Winter 2007;12(4):249-58. [Medline].

  72. Callahan LF, Freburger JK, Mielenz TJ, Wiley-Exley EK. Medical skepticism and the use of complementary and alternative health care providers by patients followed by rheumatologists. J Clin Rheumatol. Jun 2008;14(3):143-7. [Medline].

  73. Winfield JB. Pain and arthritis. N C Med J. Nov-Dec 2007;68(6):444-6. [Medline].

  74. Sadreddini S, Molaeefard M, Noshad H, et al. Efficacy of Raloxifen in treatment of fibromyalgia in menopausal women. Eur J Intern Med. Jul 2008;19(5):350-5. [Medline].

  75. Broughton RJ, Fleming JA, George CF, et al. Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of excessive daytime sleepiness in narcolepsy. Neurology. Aug 1997;49(2):444-51. [Medline].

  76. Schwartz TL, Rayancha S, Rashid A, et al. Modafinil treatment for fatigue associated with fibromyalgia. J Clin Rheumatol. Feb 2007;13(1):52. [Medline].

  77. Skrabek RQ, Galimova L, Ethans K, et al. Nabilone for the treatment of pain in fibromyalgia. J Pain. Feb 2008;9(2):164-73. [Medline].

  78. Holman AJ, Myers RR. A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Arthritis Rheum. Aug 2005;52(8):2495-505. [Medline].

  79. Rooks DS. Fibromyalgia treatment update. Curr Opin Rheumatol. Mar 2007;19(2):111-7. [Medline].

  80. Scharf MB, Hauck M, Stover R, et al. Effect of gamma-hydroxybutyrate on pain, fatigue, and the alpha sleep anomaly in patients with fibromyalgia. Preliminary report. J Rheumatol. Oct 1998;25(10):1986-90. [Medline].

  81. [Best Evidence] Russell IJ, Perkins AT, Michalek JE. Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial. Arthritis Rheum. Jan 2009;60(1):299-309. [Medline].

  82. Gendreau RM, Thorn MD, Gendreau JF, Kranzler JD, Ribeiro S, Gracely RH, et al. Efficacy of milnacipran in patients with fibromyalgia. J Rheumatol. Oct 2005;32(10):1975-85. [Medline].

  83. Arnold LM, Rosen A, Pritchett YL, D'Souza DN, Goldstein DJ, Iyengar S, et al. A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder. Pain. Dec 15 2005;119(1-3):5-15. [Medline].

  84. Arnold LM, Pritchett YL, D'Souza DN, Kajdasz DK, Iyengar S, Wernicke JF. Duloxetine for the treatment of fibromyalgia in women: pooled results from two randomized, placebo-controlled clinical trials. J Womens Health (Larchmt). Oct 2007;16(8):1145-56. [Medline].

  85. Arnold LM. Duloxetine and other antidepressants in the treatment of patients with fibromyalgia. Pain Med. Sep 2007;8 Suppl 2:S63-74. [Medline].

  86. Russell IJ, Mease PJ, Smith TR, Kajdasz DK, Wohlreich MM, Detke MJ, et al. Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain. Jun 2008;136(3):432-44. [Medline].

  87. [Best Evidence] Häuser W, Bernardy K, Uçeyler N, Sommer C. Treatment of fibromyalgia syndrome with antidepressants: a meta-analysis. JAMA. Jan 14 2009;301(2):198-209. [Medline].

  88. Arnold LM, Goldenberg DL, Stanford SB, et al. Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial. Arthritis Rheum. Apr 2007;56(4):1336-44. [Medline].

  89. Crofford LJ, Rowbotham MC, Mease PJ, Russell IJ, Dworkin RH, Corbin AE, et al. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. Apr 2005;52(4):1264-73. [Medline].

  90. Arnold LM, Russell IJ, Diri EW, Duan WR, Young JP Jr, Sharma U, et al. A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia. J Pain. Sep 2008;9(9):792-805. [Medline].

  91. Crofford LJ, Mease PJ, Simpson SL, et al. Fibromyalgia relapse evaluation and efficacy for durability of meaningful relief (FREEDOM): a 6-month, double-blind, placebo-controlled trial with pregabalin. Pain. Jun 2008;136(3):419-31. [Medline].

  92. Turk DC, Okifuji A, Sinclair JD, et al. Pain, disability, and physical functioning in subgroups of patients with fibromyalgia. J Rheumatol. Jul 1996;23(7):1255-62. [Medline].

  93. Turk DC, Okifuji A, Sinclair JD, et al. Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment. Arthritis Care Res. Oct 1998;11(5):397-404. [Medline].

  94. Crofford LJ. Violence, stress, and somatic syndromes. Trauma Violence Abuse. Jul 2007;8(3):299-313. [Medline].

[ CLOSE WINDOW ]

Further Reading

Additional resources on fibromyalgia are available at Medscape's Fibromyalgia Resource Center.

[ CLOSE WINDOW ]

Keywords

fibromyalgia, fibromyalgia syndrome, FM, FMS, fibrositis, widespread chronic pain syndrome, tension myalgia, diffuse myofascial pain, chronic pain, chronic fatigue, psychologic distress, poor sleep, chronic fatigue syndrome, allodynia, hyperalgesia, biopsychosocial disorder, central sensitivity disorder, central sensitivity syndrome, CSS

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

John Buckner Winfield, MD, Herman and Louise Smith Distinguished Professor of Medicine in Arthritis Emeritus, Department of Medicine, Senior Member, Neurosensory Disorders Center, University of North Carolina at Chapel Hill; Consulting Rheumatologist, Appalachian Regional Rheumatology
John Buckner Winfield, MD is a member of the following medical societies: American Association of Immunologists, American Clinical and Climatological Association, American College of Rheumatology, American Society for Clinical Investigation, Association of American Physicians, and North Carolina Medical Society
Disclosure: Pfizer Honoraria Speaking and teaching; Jazz Pharmaceuticals Consulting fee Consulting; Lilly Honoraria Speaking and teaching; Lilly Grant/research funds Independent contractor; Forest Grant/research funds Independent contractor

Medical Editor

Kristine M Lohr, MD, MS, Program Director, Professor, Department of Internal Medicine, Division of Rheumatology and Women's Health, University of Kentucky School of Medicine
Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians, American College of Rheumatology, and American Medical Women's Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; UCB  Speaking and teaching; Omnicare Consulting fee Consulting; Centocor Consulting fee Consulting; Roche Grant/research funds Other

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.