New Dimensions in Fibromyalgia

Fibromyalgia is More Than Pain

Daniel Clauw, MD

Fibromyalgia is a condition characterized by a history of diffuse musculoskeletal pain, and the finding of tenderness on examination. Epidemiologic studies suggest that this illness affects approximately 2% of the population, although the prevalence in females is much higher (3.4% of all females, >7% in those between the ages of 60-79).

Although fibromyalgia is defined by its musculoskeletal features, for some time it has been clear that there are a large number of other systemic and localized syndromes that occur commonly in individuals with this illness. There is a significant overlap between fibromyalgia and other systemic illnesses such as chronic fatigue, somatoform disorders, and other entities such as the Persian Gulf Syndrome. Examples of closely related localized or organ-specific conditions include migraine and tension headaches, irritable bowel syndrome, temporomandibular dysfunction, non-cardiac chest pain, myofascial pain syndrome, and a variety of genitourinary syndromes. These illnesses all occur more commonly in females, and can either be triggered or exacerbated by a variety of stressors, including physical trauma, immune stimulation, and emotional stress.

There are several lines of evidence to suggest that these chronic pain and fatigue conditions may share common pathogenic mechanisms, and that instead of being discrete, separate illnesses, these entities are part of a larger spectrum. In this regard, there are several promising areas of research into these conditions, including the hypothesis that there is a strong familial predisposition to develop these conditions, and that the symptoms are caused by aberrations of various components of the central nervous system. Accordingly, there are several types of treatment that have been shown to be effective for this spectrum of conditions, including low dose of tricyclic compounds, aerobic exercise, and cognitive behavioral therapy.

Presented at the National Fibromyalgia Research Association's New Dimensions in Fibromyalgia Symposium, September 14-15, 1997, in Portland, Oregon.


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