Clinical manifestations and diagnosis of fibromyalgia in adults
- Don L Goldenberg, MD
Don L Goldenberg, MD
- Section Editor — Pain Disorders in Rheumatology
- Emeritus Professor of Medicine, Tufts University School of Medicine
- Affiliate Assistant, Rheumatology Division, Oregon Health Science University
- Affiliate Instructor, School of Nursing Oregon Health Sciences University
Fibromyalgia (FM) is a common cause of chronic widespread musculoskeletal pain, often accompanied by fatigue, cognitive disturbance, psychiatric symptoms, and multiple somatic symptoms. The etiology of the syndrome is unknown, and the pathophysiology is uncertain [1,2]. Despite symptoms of soft tissue pain affecting the muscles, ligaments, and tendons there is no evidence of tissue inflammation.
FM, like other functional somatic syndromes, has been a controversial condition [1,2]. Patients look well, there are no obvious abnormalities on physical examination other than tenderness, and laboratory and radiologic studies are normal. Thus, the role of organic illness had been questioned, and FM was often been considered to be psychogenic or psychosomatic. However, ongoing research suggests that FM is a disorder of pain regulation, often classified as a form of central sensitization . (See "Pathogenesis of fibromyalgia".)
FM is often associated with other conditions that may cause musculoskeletal pain, disruption of sleep, or psychiatric symptoms; features of these conditions may also mimic FM, and the presence of such disorders should be considered in the diagnostic evaluation. (See "Differential diagnosis of fibromyalgia".)
The clinical manifestations and diagnosis of FM will be reviewed here. The differential diagnosis of FM is discussed in detail separately, as are the possible pathogenic mechanisms and treatment of FM in adults, and the clinical manifestations, diagnosis, and treatment of FM in children and adolescents. (See "Differential diagnosis of fibromyalgia" and "Pathogenesis of fibromyalgia" and "Initial treatment of fibromyalgia in adults" and "Treatment of fibromyalgia in adults not responsive to initial therapies" and "Fibromyalgia in children and adolescents: Clinical manifestations and diagnosis" and "Fibromyalgia in children and adolescents: Treatment and prognosis".)
Fibromyalgia (FM) is a common cause of chronic pain and the most common cause of generalized, musculoskeletal pain in women between ages of 20 and 55 years; in the United States and in other countries, the prevalence is approximately 2 to 3 percent and increases with age [4-7]. FM is more common in women than men and occurs in both children and adults [4-8]. It is six times more common in women in reports from specialty clinics, although the female predominance is not as striking in the community and when using survey criteria that do not require a tender point examination . The diagnosis may be underrecognized in clinical practice; prevalence estimates in one US county using surveys with standardized criteria were higher than estimates based upon medical record documentation of the diagnosis (6.4 versus 1.1 percent) . Prevalence studies in adolescents have been very similar to those in adults .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CLINICAL MANIFESTATIONS
- Physical findings
- Laboratory testing and other studies
- Clinical diagnosis
- Diagnostic evaluation
- Additional evaluation
- Classification criteria and proposed diagnostic criteria
- - 1990 ACR classification criteria
- - 2010 ACR preliminary diagnostic criteria
- DIFFERENTIAL DIAGNOSIS
- COEXISTING DISORDERS
- FIBROMYALGIA AND PRIMARY CARE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS