Date sent:      	Mon, 26 Aug 2002 


Fibromyalgia Associated Syndromes

J of Musculoskeletal Pain, Vol. 10, No. 1/2, 2002, pp. 201-214

Daniel Clauw, MD

Daniel Clauw, MD, is Scientific Director, Georgetown Chronic
Pain and Fatigue Research Center; Chief, Division of Rheumatology,
Immunology and Allergy, Georgetown University Medical Center, Washington,
DC 20007.


SUMMARY.
Objectives: To describe the syndromes that share overlapping clinical
features with fibromyalgia [FMS].

Findings: There are a number of semantic terms currently used to described
systemic syndromes that share overlapping features with FMS. These include
chronic fatigue syndrome, multiple chemical sensitivity, somatoform
disorders, and Gulf War Illnesses. There are also a number of regional or
"organ-specific" syndromes that overlap with these conditions that have as
their common features regional pain, with and without dysfunction of
internal organs.

Conclusions: In aggregate, chronic multi symptom illnesses such as FMS are
extremely common. Hallmarks of these syndromes include non-nociceptive
pain, fatigue, memory difficulties, and dysfunction of visceral organs.


KEYWORDS. Fibromyalgia, pain, fatigue, syndromes


INTRODUCTION

As defined by the 1990 American College of Rheumatology [ACR] criteria,
fibromyalgia [FMS] is a discrete disorder, characterized by widespread pain
and tenderness on physical examination (1). However, early work by a number
of investigators, including Yunus, Goldenberg, and Hudson, suggested that
individuals who met these or other criteria for FMS typically had a number
of other nondefining clinical features (2-4). A number of terms have been
used to describe these overlapping features.

In this manuscript, the term Chronic Multisymptom Illnesses [CMI] will be
used to describe these overlapping illnesses and clinical features. This
term was coined by Centers for Disease Control and Prevention to describe
individuals in the population with multiple chronic somatic symptoms (5).
In a series of population-based studies using factor analytic techniques,
the "core" symptoms [see Figure 1] that define CMI in the population are
multifocal musculoskeletal pain, fatigue, and memory and/or mood
difficulties (6,7). Many patients with CMI will meet criteria for one or
more systemic conditions such as FMS or chronic fatigue syndrome [CFS],
whereas others will not quite meet the diagnostic criteria required for
these systemic entities, but will have "regional" syndromes such as
irritable bowel syndrome [IBS], migraine, or tension headaches, etc.

© 2002 by The Haworth Press, Inc. All rights reserved.