Fibromyalgia
Fibromyalgia is a chronic medical condition that is characterised by widespread pain, fatigue, waking unrefreshed and cognitive disorders. In the field of musculoskeletal medicine in New Zealand, the highly subjective nature of the diagnostic criteria has meant that it is a controversial diagnosis in this specialty. Recent work has found that 40-50% of patients have small fibre neuropathy.[1]
Epidemiology
Fibromyalgia is present across the world, and has a prevalence ranging between 2% to 4%.
Diagnosis
The current criteria for fibromyalgia were established in 2010 by the American College of Rheumatology (ACR). There is no requirement for a tender point examination like in the ACR 1990 classification. Three criteria must be met for the diagnosis
- Widespread Pain Index (WPI) ≥ 7/19 and Symptom Severity Scale (SSS) Score ≥ 5/12 or WPI between 3–6/19 and SSS ≥ 9/12
- Symptoms being present at a similar level for at least 3 months
- The patient does not have another disorder that would otherwise sufficiently explain the pain.
Conditions 1 and 2 are assessed by the Fibromyalgia Survey Questionnaire.
Small Fibre Neuropathy and Widespread Pain Syndromes
Oaklander et al found that in 41 patients with unexplained widespread pain that started before the age of 21, 59% of children at definite small fibre neuropathy (SFN), 17% had probable SFN, and 22% had possible SFN.[2] They then found that in a group of 27 fibromyalgia patients and 30 matched controls, 41% of fibromyalgia patients had definite SFN, compared to 3% in the control group.[3] Following this research in the early 2010s, there has been numerous further research in this area, which has reinforced that a proportion of fibromyalgia patients actually have SFN - a neuropathic pain syndrome. Overall it appears that around 40-50% of fibromyalgia patients have SFN.
See Also
References
- ↑ Maslinska et al. Small fibre neuropathy as a part of fibromyalgia or a separate diagnosis? Int. J. Clin. Rheumatol. (2018) 13(6), 353-359. Full Text
- ↑ Oaklander & Klein. Evidence of small-fiber polyneuropathy in unexplained, juvenile-onset, widespread pain syndromes. Pediatrics 2013. 131:e1091-100. PMID: 23478869. DOI. Full Text.
- ↑ Oaklander & Klein. Evidence of small-fiber polyneuropathy in unexplained, juvenile-onset, widespread pain syndromes. Pediatrics 2013. 131:e1091-100. PMID: 23478869. DOI. Full Text.
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
