Fibromyalgia Syndrome
Basic Information
Definition
Patients with fibromyalgia experience diffuse pain, have tender points demonstrated on physical examination, and have other symptoms but no inflammatory process or other diseases that can account for the discomfort.
Clinical Presentation
History
At diagnosis, patients typically describe a gradual accumulation of signs and symptoms.
Physical Examination
Table 1-11 1990 Criteria for the Classification of Fibromyalgia
| History of widespread pain* |
| Definition: Pain is considered widespread when all of the following are present: |
| • Pain exists in the left side of the body, pain in the right side of the body, pain above the waist, and pain below the waist. |
| • Axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back) also must be present. |
| • Shoulder and buttock pain is considered as pain for each involved site. |
| • Low back pain is considered lower segment pain. |
| Pain in 11 of 18 tender point sites on digital palpation* |
| Definition: Pain on digital palpation must be present in at least 11 of the following 18 sites: |
| • Occiput: bilateral, at the suboccipital muscle insertions |
| • Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5 to C7 |
| • Trapezius: bilateral, two sets, one above the scapula spine near the medial border the other at the midportion of the spinous process of the scapula (see Figure 1-6) |
| • Second rib: bilateral, at the second costochondral junctions, just lateral to the junctions on the upper surfaces |
| • Lateral epicondyle: bilateral, 1 cm distal to the epicondyles |
| • Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle |
| • Great trochanter: bilateral, posterior to the trochanteric prominence |
| • Knee: bilateral, at the medial fat pad proximal to the joint line |
| Digital palpation should be performed with an approximate force of 4 kg. |
| For a tender point to be considered positive for pain, the subject must state that the palpation was painful. Tender is not considered painful. |
From Wolf F et al: The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 33:160, 1990.
* For classification purposes, patients are said to have fibromyalgia if both criteria are satisfied. Widespread pain must be present for at least 3 months. The presence of a second clinical disorder does not exclude the diagnosis of fibromyalgia.
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