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Fibromyalgia

About: Fibromyalgia is a research topic. Over the lifetime, 7727 publications have been published within this topic receiving 300873 citations. The topic is also known as: Fibromyalgia Syndrome.


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Journal ArticleDOI
TL;DR: Criteria for the classification of fibromyalgia are widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites, and no exclusions are made for the presence of concomitant radiographic or laboratory abnormalities.
Abstract: To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.

9,289 citations

Journal ArticleDOI
01 Nov 2001-Pain
TL;DR: Using a standard outcome across chronic pain studies would greatly enhance the comparability, validity, and clinical applicability of these studies, and the application of these results to future studies may provide a standard definition of clinically important improvement in clinical trials of chronic pain therapies.
Abstract: Pain intensity is frequently measured on an 11-point pain intensity numerical rating scale (PI-NRS), where 0=no pain and 10=worst possible pain. However, it is difficult to interpret the clinical importance of changes from baseline on this scale (such as a 1- or 2-point change). To date, there are no data driven estimates for clinically important differences in pain intensity scales used for chronic pain studies. We have estimated a clinically important difference on this scale by relating it to global assessments of change in multiple studies of chronic pain. Data on 2724 subjects from 10 recently completed placebo-controlled clinical trials of pregabalin in diabetic neuropathy, postherpetic neuralgia, chronic low back pain, fibromyalgia, and osteoarthritis were used. The studies had similar designs and measurement instruments, including the PI-NRS, collected in a daily diary, and the standard seven-point patient global impression of change (PGIC), collected at the endpoint. The changes in the PI-NRS from baseline to the endpoint were compared to the PGIC for each subject. Categories of "much improved" and "very much improved" were used as determinants of a clinically important difference and the relationship to the PI-NRS was explored using graphs, box plots, and sensitivity/specificity analyses. A consistent relationship between the change in PI-NRS and the PGIC was demonstrated regardless of study, disease type, age, sex, study result, or treatment group. On average, a reduction of approximately two points or a reduction of approximately 30% in the PI-NRS represented a clinically important difference. The relationship between percent change and the PGIC was also consistent regardless of baseline pain, while higher baseline scores required larger raw changes to represent a clinically important difference. The application of these results to future studies may provide a standard definition of clinically important improvement in clinical trials of chronic pain therapies. Use of a standard outcome across chronic pain studies would greatly enhance the comparability, validity, and clinical applicability of these studies.

4,568 citations

Journal ArticleDOI
01 Mar 2011-Pain
TL;DR: Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity.
Abstract: Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and post-surgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk in both developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the first discovery of activity-dependent synaptic plasticity in the spinal cord and the revelation that it occurs and produces pain hypersensitivity in patients. Nevertheless, discovering the genetic and environmental contributors to and objective biomarkers of central sensitization will be highly beneficial, as will additional treatment options to prevent or reduce this prevalent and promiscuous form of pain plasticity.

3,331 citations

Journal ArticleDOI
TL;DR: To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgic symptoms.
Abstract: Objective To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms. Methods We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale. Results Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI > or =7 AND SS > or =5) OR (WPI 3-6 AND SS > or =9). Conclusion This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.

3,192 citations

Journal ArticleDOI
TL;DR: Part 1 Basic aspects: peripheral - peripheral neural mechnaisms of nociception, the course and termination of primary afferent fibres, teh pathophysiology of damaged peripheral nerves, functional chemistry ofPrimary afferent neurons central - the dorsal horn.
Abstract: Introduction. SECTION ONE. . Basic Aspects. Peripheral & Central. . Peripheral Mechanisms of Nociceptors, R.A. Meyer. Inflammatory Pain (Including Cytokines) , J. Levine. Cellular Properties, S. Bevan. Neurotrophins, S.B. Mcmahon. Damaged Peripheral Nerve, M. Devor. Dorsal Horn , C.J. Woolf. Medulla to Thalamus, J. Dostrovsky. Cortex Imaging, M. Ingvar. Fetal -- Neonatal, M. Fitzgerald. Central Pharmacology, T. Yaksh. Dorsal Horn Plasticity, R. Dubner. CNS Modulation, H. Fields. Psychology. Emotions & Psychobiology, K.D. Craig. Cognition, M. Weisenberg. Measurement. Animals, R. Dubner. Children, P.J. Mcgrath. Normal People, R. Gracely. People in Pain, R. Melzack. Other Measures of Pain and Disability, A. De C.Williams, . SECTION TWO: CLINICAL STATES. Soft Tissue, Joints, And Bones. Postoperative Pain, M. Cousins. Osteoarthritis, P.Creamer. Rheumatoid Arthritis, M. Jayson. Muscle and Tendons , D. Newham. Low Back Pain, D.M. Long. Upper Extremity & Neck, A. E. Sola. Fibromyalgia , R. Bennett, . Deep and Visceral Pain. Abdominal, L. Blendis . Heart/Vascular (Including Haemopathies), Procacci. (A), Gynaecology , A.J. Rapkin. (B), Obstetrics, J.S. Mcdonald. Genitourinary, V. Wesselmann. Head. Orofacial, Y. Sharav. Trigeminal, Eye, Ear., J. Zakrzewska. Headache , J. Schoenen. Nerve and Root Damage. Amputation, T.S. Jensen. Peripheral Neuropathies , , J. Scadding. RSD, SMP. Nerve Roots and Arachnoiditis, D. Dubuisson. . Special Cases. (A) , Gender, K. Berkely. (B), Children, C. Berde. Elderly, L. Gagliese. Animals, C.E. Short. Cancer , R.K. Portenoy. (A), Psychiatry and Cancer, W. Breitbart. (B), Pain and Impending Death, C. Saunders. Central Nervous System. Central Pain, J. Boive. Spinal Cord Damage, A. Beric. Pain - Psychological Medicine, H. Merskey. SECTION THREE: THERAPEUTIC ASPECTS. Pharmacology. Methods of Therapeutic Trials, H. Mcquay, . Non-Narcotic Analgesics, K. Brune. Psychotropic Drugs, R.C. Monks. Opioids, R.G. Twycross. Local and Regional Anesthesia, H. Mcquay, . Other Drugs Including Sy

3,121 citations


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Performance
Metrics
No. of papers in the topic in previous years
YearPapers
20241
2023602
20221,075
2021418
2020376
2019358