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Fibromyalgia tender points identified by the American College of Rheumatology in 1990 (at digital palpation with an approximate force of 4 kg). A) Occiput: bilateral, at the suboccipital muscle insertions. B) Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7. C) Trapezius: bilateral, at the midpoint of the upper border. D) Supraspinatus: bilateral, at origins, above the scapula spine near the medial border. E) Second rib: bilateral, at the second costochondral junction, just lateral to the junctions on upper surfaces. F) Lateral epicondyle: bilateral, 2 cm distal to the epicondyles. G) Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle. H) Greater trochanter: bilateral, posterior to the trochanteric prominence. I) Knee: bilateral, at the medial fat pad proximal to the joint line.
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... Pain in 11 of 18 tender sites upon digital pal- pation: there are 18 TPs that doctors assess to con- firm the diagnosis of FM (see Figure 1), and ac- cording to the ACR requirements, a patient must endorse at least 11 as painful upon application of approximately four kg/cm 2 of pressure. As the ACR criteria suggest, a diagnosis of FM re- quires the "hands-on" evaluation of a patient by a skilled medical professional, typically a rheuma- tologist, although other specialists are becoming quite knowledgeable in this area. ...
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... Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain, reflecting a sensitization of the central nervous system (Mease, 2005; Mease et al., 2009; Giacomelli et al., 2011; Ablin and Buskila, 2013). Pain, characterized by hyperalgesia and allodynia, is often associated with fatigue, non-restorative sleep, mood and anxiety disorders, and cognitive impairment (Cazzola et al., 2008). Other common comorbidities are syndromes that may share certain pathophysiological mechanisms, including irritable bowel syndrome, tensiontype headache/migraine, interstitial cystitis or painful bladder syndrome. ...
Objective: Evidence in the literature suggests peculiar personality traits for fibromyalgic (FM) patients, and it has been suggested that personality characteristics may be involved in patients’ different symptomatic events and responses to treatment. The aim of the study is to investigate the personality characteristics of Italian FM patients and to explore the possibility of clustering them considering both personality traits and clinical characteristics.
Design: The study used a cross-sectional methodology and involved a control group. A self-assessment procedure was used for data gathering. The study included 87 female FM patients and 83 healthy females. Patients were approached and interviewed in person during a psychiatric consultation. Healthy people were recruited from general practices with previous telephone contact.
Main Outcome Measures: Participants responded to the Hospital Anxiety and Depression Scale, the Temperament and Character Inventory, the Fibromyalgia Impact Questionnaire and the Short-Form-36 Health Survey.
Results: FM patients scored significantly different from healthy participants on the Harm avoidance (HA), Novelty seeking (NS) and Self-directedness (SD). Two clusters were identified: patients in Cluster1 (n = 37) had higher scores on HA and lower scores on RD, SD, and Cooperativeness and reported more serious fibromyalgia and more severe anxious–depressive symptomatology than did patients in Cluster2 (n = 46).
Conclusion: This study confirms the presence of certain personality traits in the FM population. In particular, high levels of HA and low levels of SD characterize a subgroup of FM patients with more severe anxious–depressive symptomatology. According to these findings, personality assessment could be useful in the diagnostic process to tailor therapeutic interventions to the personality characteristics.
The pain associated with spondyloarthritis (SpA) can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP) that characterises fibromyalgia (FM). The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF) inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs.
The purpose of this clinical review is to clarify and discuss the diagnosis and management of fibromyalgia. This includes typical signs and symptoms, pathophysiology, concomitant disease states, differential diagnoses, and recommended pharmacologic and nonpharmacologic treatment modalities.
The search included Evidence Based Medicine Reviews, Ovid MEDLINE, PubMed, and CINAHL. Search terms used: fibromyalgia diagnosis, fibromyalgia pathophysiology, incidence of fibromyalgia, fibromyalgia comorbidities, etiology of fibromyalgia, fibromyalgia treatment, American College of Rheumatology criteria. Search limited to sources from 1990 to 2010.
Fibromyalgia is a complex muscular rheumatism that is not fully understood and often misdiagnosed. Signs and symptoms may overlap with many other conditions that must be properly ruled out to prevent diagnosis based upon arbitrary clinical judgment. Treatment is most beneficial when tailored to individual patient presentation, and further research is warranted, particularly in the domains of pathophysiology and efficacy of treatment options.
An accurate knowledge of current research will aid the nurse practitioner in effectively prescribing evidence-based clinical interventions. Optimal fibromyalgia management can be achieved through a multifaceted treatment approach and is enhanced with early identification of the disease process.
Fibromyalgia (FM) is a rheumatic disease that is characterised by chronic musculoskeletal pain, stiffness, fatigue, sleep and mood disorder. FM patients demonstrate dysregulation of pain neurotransmitter function and experience a neurohormone-mediated association with sleep irregularities. There are currently no instrumental tests or specific diagnostic markers for FM, and many of the existing indicators are only significant for research purposes. Anti-depressants, non-steroidal anti-inflammatory drugs (NSAIDS), opioids, sedatives, muscle relaxants and antiepileptics have all been used to treat FM with varying results. It has been shown that interdisciplinary treatment programmes lead to greater improvements in subjective pain and function than monotherapies. Physical exercise and multimodal cognitive behavioural therapy are the most widely accepted and beneficial forms of non-pharmacological therapy.
