Current Pain and Headache Reports

, Volume 5, Issue 4, pp 320–329 | Cite as

Classification, epidemiology, and natural history of fibromyalgia

  • Kevin P. White
  • Manfred Harth
Article

Abstract

Fibromyalgia (FM), also known as fibromyalgia syndrome (FMS) and fibrositis, is a common form of nonarticular rheumatism that is associated with chronic generalized musculoskeletal pain, fatigue, and a long list of other complaints. Some have criticized the classification of FM as a distinct medical entity, but existing data suggest that individuals meeting the case definition for FM are clinically somewhat distinct from those with chronic widespread pain who do not meet the full the FM definition.

Clinic studies have found FM to be common in countries worldwide; these include studies in specialty and general clinics. The same is true of general population studies, which show the prevalence of FM to be between 0.5% and 5%. Knowledge about risk factors for FM is limited. Females are at greater risk, and risk appears to increase through middle age, then decline. Although some authors claim that an epidemic of FM has been fueled by an over-generous Western compensation system, there are no data that demonstrate an increasing incidence or prevalence of FM; moreover, existing data refute any association between FM prevalence and compensation. Claims that the FM label itself causes illness behavior and increased dependence on the medical system also are not supported by existing research. This article reviews the classification, epidemiology, and natural history of FM.

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References and Recommended Reading

  1. 1.
    Lawrence RC, Hochberg MC, Kelsey JL, et al.: Estimates of prevalence of selected arthritic and musculoskeletal diseases in the United States. J Rheumatol 1989, 16:427–441.PubMedGoogle Scholar
  2. 2.
    Magni G, Marchetti M, Moreschi C, et al.: Chronic musculoskeletal pain and depressive symptoms in the National Health and Nutrition Examination. I. Epidemiologic follow-up study. Pain 1993, 53:163–168.PubMedCrossRefGoogle Scholar
  3. 3.
    Wolfe F, Ross K, Anderson J, et al.: The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995, 38:19–28.PubMedCrossRefGoogle Scholar
  4. 4.
    Felts W, Yelin E: The economic impact of the rheumatic diseases in the United States. J Rheumatol 1989, 16:867–884.PubMedGoogle Scholar
  5. 5.
    Lee P, Helewa A, Smythe H, et al.: Epidemiology of musculoskeletal disorders (complaints) and related disability in Canada. J Rheumatol 1985, 12:1169–1173.PubMedGoogle Scholar
  6. 6.
    White KP, Speechley M, Harth M, Ostbye T: The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. J Rheumatol 1999, 26:1570–1576. A large community survey identifying a cohort of 100 cases of FM.PubMedGoogle Scholar
  7. 7.
    Reynolds DL, Chambers LW, Badley EM, et al.: Physical disability among Canadians reporting musculoskeletal diseases. J Rheumatol 1992, 19:1020–1030.PubMedGoogle Scholar
  8. 8.
    Andersson HI, Ejlertsson G, Leden I, Rosenberg C: Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain 1993, 9:174–182.PubMedCrossRefGoogle Scholar
  9. 9.
    Hagen JB, Kvien TK, Bjorndal A: Musculoskeletal pain and quality of life in patients with non-inflammatory joint pain compared to rheumatoid arthritis: a population study. J Rheumatol 1997, 24:1703–1709.PubMedGoogle Scholar
  10. 10.
    Croft P, Rigby AS, Boswell R, et al.: The prevalence of chronic widespread pain in the general population. J Rheumatol 1993, 20:710–713.PubMedGoogle Scholar
  11. 11.
    Wood PHN, Badley EM: Rheumatic disorders. In Epidemiology of Diseases. Edited by Miller DL, Farmer RDT. Oxford: Blackwell Scientific Publications; 1982:333–346.Google Scholar
  12. 12.
    Darmawan J, Valkenburg HA, Muirden KD, Wigley RD: Epidemiology of rheumatic diseases in rural and urban populations in Indonesia: a World Health Organization international league against rheumatism COPCORD Study, Stage I, Phase 2. Ann Rheum Dis 1992, 51:525–528.PubMedCrossRefGoogle Scholar
  13. 13.
    Chaiamnuay P, Darmawan J, Muirden KD, Assawatanabodee P: Epidemiology of rheumatic disease in Thailand: a WHOILAR COPCORD study. Community Oriented Programme for the Control of Rheumatic Disease. J Rheumatol 1998, 25:1382–1387.PubMedGoogle Scholar
  14. 14.
    Wolfe F: The clinical syndrome of fibrositis. Am J Med 1986, 81:7–14.PubMedCrossRefGoogle Scholar
  15. 15.
    Alarcon-Segovia D, Ramos-Niembro F, Gonzales-Amaro RF: One thousand private rheumatology patients in Mexico City [letter]. Arthritis Rheum 1983, 26:688–689.PubMedCrossRefGoogle Scholar
  16. 16.
    The Epidemiology of Fibromyalgia: workshop of the Standing Committee on Epidemiology European League Against Rheumatism (EULAR), Bad Sackingen, November 19–21, 1992 [no author mentioned]. Brit J Rheumatol 1994, 33:783-786.Google Scholar
  17. 17.
    Farooqi A, Gibson T: Prevalence of the major rheumatic disorders in the adult population of north Pakistan. Br J Rheumatol 1998, 37:491–495.PubMedCrossRefGoogle Scholar
  18. 18.
    Simons DG: Muscle pain syndrome-part I. Am J Phys Med 1975, 54:289–311.PubMedGoogle Scholar
  19. 19.
    Reynolds MD: The development of the concept of fibrositis. J Hist Med Allied Sci 1983, 38:5–35.PubMedCrossRefGoogle Scholar
  20. 20.
    Smythe HA, Moldofsky H: Two contributions to the understanding of “fibrositis syndrome.” Bull Rheum Dis 1977, 28:928–931.PubMedGoogle Scholar
  21. 21.
    Wolfe F, Smythe HA, Yunus MB, et al.: The American College of Rheumatology criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990, 33:160–172.PubMedCrossRefGoogle Scholar
  22. 22.
    Wolfe F: The fibromyalgia problem. J Rheumatol 1997, 24:1247–1249.PubMedGoogle Scholar
  23. 23.
    Barsky AJ, Borus JF: Functional somatic syndromes. Ann Intern Med 1999, 130:910–921.PubMedGoogle Scholar
  24. 24.
    Hadler NM: Fibromyalgia: la maladie est morte. Vive le malade! J Rheumatol 1997, 24:1250–1251.PubMedGoogle Scholar
  25. 25.
    Carette J: Fibromyalgia 20 years later: what have we really accomplished? J Rheumatol 1995, 22:590–594.PubMedGoogle Scholar
  26. 26.
    Cohen ML: Is fibromyalgia a distinct clinical entity? The disapproving rheumatologist’s evidence. Baillieres J Best Pract Res Clin Rheumatol 1999, 13:421–425.CrossRefGoogle Scholar
  27. 27.
    White KP, Harth M: The occurrence and impact of generalized pain. Baillieres Clin Rheumatol 1999, 13:379–389.CrossRefGoogle Scholar
  28. 28.
    McFarlane GJ, Croft PR, Schollum J, et al.: Widespread pain: is an improved classification possible? J Rheumatol 1996, 23:1628–1632.Google Scholar
  29. 29.
    Croft P, Schollum J, Silman A: Population study of tender point counts and pain as evidence of fibromyalgia. BMJ 1994, 309:696–699.PubMedGoogle Scholar
  30. 30.
    Croft P: Testing for tenderness: what’s the point? J Rheumatol 2000, 27:2531–2533.PubMedGoogle Scholar
  31. 31.
    White KP, Speechley M, Harth M, et al.: Comparing self-reported function and work disability in 100 random community cases of fibromyalgia versus control in London, Ontario: the London Fibromyalgia Epidemiology Study. Arthritis Rheum 1999, 42:76–83.PubMedCrossRefGoogle Scholar
  32. 32.
    White KP, Speechley M, Harth M, et al.: The London Fibromyalgia Epidemiology Study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls. J Rheumatol 1999, 26:1577–1585.PubMedGoogle Scholar
  33. 33.
    White KP, Harth M, Speechley M, et al.: A general population study of fibromyalgia tender points in non-institutionalized adults with chronic widespread pain. J Rheumatol 2000, 27:2677–2682.PubMedGoogle Scholar
  34. 34.
    Russell IJ: Is fibromyalgia a distinct clinical entity? The clinical investigator’s evidence. Ballieres Best Pract Res Clin Rheumatol 1999, 13:445–454. An excellent review of the current understanding regarding disease mechanisms in FM.CrossRefGoogle Scholar
  35. 35.
    Arnett FL, Edworthy SM, Bloch DA, et al.: American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988, 31:315–324.PubMedCrossRefGoogle Scholar
  36. 36.
    Hadler NM: The changes of the diagnostic process. In Occupational Musculoskeletal Disorders. Edited by Hadler NM. New York, NY: Raven Press; 1993:16–33.Google Scholar
  37. 37.
    Coderre TJ, Katz J, Valccarino AL, et al.: Contributions of central neuroplasticity to pathological pain; review of clinical and experimental evidence. Pain 1993, 52:259–285.PubMedCrossRefGoogle Scholar
  38. 38.
    Kwiatek R, Barnden L, Tedman R, et al.: Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography incidence of reduction in the pontine tegmentum and thalami. Arthritis Rheum 2000, 43:2822–2833.CrossRefGoogle Scholar
  39. 39.
    Gagliese L, Katz J: Medically unexplained pain is not caused by psychopathology. Pain Res Manage 2000, 5:251–257.Google Scholar
  40. 40.
    Epstein WV, Henke CJ: The nature of U.S. rheumatology practice. Arthritis Rheum 1981, 24:1177–1187.PubMedCrossRefGoogle Scholar
  41. 41.
    The American Rheumatism Association Committee on Rheumatologic Practice. A description of rheumatology practice [no authors mentioned]. Arthritis Rheum 1997, 20:1278-1281.Google Scholar
  42. 42.
    Bohan A: The private practice of rheumatology. The first 1,000 patients. Arthritis Rheum 1981, 24:1304–1307.PubMedCrossRefGoogle Scholar
  43. 43.
    Mazanec DJ: First year of a rheumatologist in private practice. Arthritis Rheum 1982, 25:718–719.CrossRefGoogle Scholar
  44. 44.
    Yunus M, Masi AT, Calabro J, et al.: Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum 1981, 11:151–171.PubMedCrossRefGoogle Scholar
  45. 45.
    Campbell SM, Clark S, Tindall EA, et al.: Clinical characteristics of fibrositis. I. A ``blinded’’ controlled study of symptoms and tender points. Arthritis Rheum 1983, 26:817–824.PubMedCrossRefGoogle Scholar
  46. 46.
    Wolfe F, Cathey MA: Prevalence of primary and secondary fibrositis. J Rheumatol 1983, 10:965–968.PubMedGoogle Scholar
  47. 47.
    Marder WD, Meenan RF, Felson DT: The present and future adequacy of rheumatology manpower. Arthritis Rheum 1991, 34:1204–1217.CrossRefGoogle Scholar
  48. 48.
    Calabozo-Raluy, Llamazares-Gonzalez AI, Munoz-Gallo MT, Alonso-Ruiz A: Sindrome de fibromyalgia (fibrositis): tan frequente como desconcido. Med Clin (Barc) 1990, 94:173–175.Google Scholar
  49. 49.
    Reilly PA, Littlejohn GO: Peripheral arthralgic presentation of fibrositis/fibromyalgia syndrome. J Rheumatol 1992, 19:281–283.PubMedGoogle Scholar
  50. 50.
    White KP, Harth M, Speechley M, Ostbye T: Fibromyalgia in rheumatology practice. A survey of Canadian rheumatologists. J Rheumatol 1995, 22:722–726.PubMedGoogle Scholar
  51. 51.
    Hartz A, Kirchdoerfer E: Undetected fibrositis in primary care practice. J Fam Pract 1987, 25:365–369.PubMedGoogle Scholar
  52. 52.
    Muller W: The fibrositis syndrome: diagnosis, differential diagnosis and pathogenesis. Scand J Rheumatol Suppl 1987, 65:40–53.PubMedGoogle Scholar
  53. 53.
    Wolfe F: Fibromyalgia. Rheum Dis Clin North Am 1990, 16:681–698.PubMedGoogle Scholar
  54. 54.
    Briscoe ME: Why do people go to the doctor? Sex differences in the correlates of GP consultation. Soc Sci Med 1987, 25:507–513.PubMedCrossRefGoogle Scholar
  55. 55.
    Waldron I: Sex differences in illness incidence, prognosis and mortality: issues and evidence. Soc Sci Med 1983, 17:1107–1123.PubMedCrossRefGoogle Scholar
  56. 56.
    Chien A, Schneiderman LJ: A comparison of health care utilization by husbands and wives. J Community Health 1975, 1:118–126.PubMedCrossRefGoogle Scholar
  57. 57.
    Wolfe F: Fibromyalgia: the clinical syndrome. Rheum Dis Clin North Am 1989, 15:1–18.PubMedGoogle Scholar
  58. 58.
    Ontario Health Survey 1990 Highlights. Ontario Ministry of Health, September 1992.Google Scholar
  59. 59.
    Lewis CE, Raczynski JM, Oberman A, Cutter GR: Risk factors and the natural history of coronary heart. disease in blacks. Cardiovasc Clin 1991, 21:29–45.PubMedGoogle Scholar
  60. 60.
    Zuckerman MJ, Guerra LG, Drossman DA, et al.: Health care seeking behaviors related to bowel complaints. Hispanics versus non-Hispanic whites. Dig Dis Sci 1996, 41:77–82.PubMedCrossRefGoogle Scholar
  61. 61.
    Forseth KO, Gran JT, Husby G: A population study of the incidence of fibromyalgia among females aged 26–55 years. Arthritis Rheum 1997, 40(suppl 9):S44.Google Scholar
  62. 62.
    Jacobsson L, Lindgarde F, Manthorpe R: The commonest rheumatic complaints of over 6 weeks’ duration in a twelve month period in a defined Swedish population. Scand J Rheumatol 1989, 18:361–368.Google Scholar
  63. 63.
    Makela M, Heliovaara M: Prevalence of primary fibromyalgia in the Finnish population. BMJ 1991, 303:216–219.PubMedCrossRefGoogle Scholar
  64. 64.
    Raspe H, Baumgartner CH: The epidemiology of fibromyalgia syndrome (FMS) in a German town. Scand J Rheumatol 1992, 21(suppl 94):8.Google Scholar
  65. 65.
    Lyddell C, Meyers OL: The prevalence of fibromyalgia in a South African community. Scand J Rheumatol 1992, 21(suppl 94):8.Google Scholar
  66. 66.
    Lindell L, Bergman S, Petersson IF, et al.: Prevalence of fibromyalgia and chronic widespread pain. Scand J Prim Health Care 2000, 18:149–153.PubMedCrossRefGoogle Scholar
  67. 67.
    Prescott E, Kjoller M, Jacobsen S, et al.: Fibromyalgia in the adult Danish population: I. A prevalence study. Scand J Rheumatol 1993, 22:233–237.PubMedGoogle Scholar
  68. 68.
    Prescott E, Kjoller M, Jacobsen S, et al.: Fibromyalgia in the adult Danish population: II. A study of clinical features. Scand J Rheumatol 1993, 22:238–242.PubMedGoogle Scholar
  69. 69.
    Forseth KO, Gran JT: The prevalence of fibromyalgia among women aged 20–49 years in Arendal, Norway. Scand J Rheumatol 1992, 21:74–78.PubMedGoogle Scholar
  70. 70.
    Buskila D, Neumann L, Hazanov I, Carmi R: Familial aggregation in the fibromyalgia syndrome. Semin Arthritis Rheum 1996, 26:605–611.PubMedCrossRefGoogle Scholar
  71. 71.
    Buskila D, Neumann L: Fibromyalgia syndrome (FM) and nonarticular tenderness in relatives of patients with FM. J Rheumatol 1997, 24:941–944.PubMedGoogle Scholar
  72. 72.
    Romano TJ: Coexixtence of fibromyalgia syndrome (FS) and systemic lupus erythematosis (SLE). Scand J Rheumatol 1992, 21(suppl 94):12.Google Scholar
  73. 73.
    Romano TJ: Incidence of fibromyalgia syndrome (FS) in rheumatoid arthritis (RA) patients in a general rheumatology practice. Scand J Rheumatol 1992, 21(suppl 94):11.Google Scholar
  74. 74.
    Romano TJ: Presence of fibromyalgia syndrome (FS) in osteosrthritis (OA) patients. Scand J Rheumatol 1992, 21(suppl 94):11.Google Scholar
  75. 75.
    Bengtsson A, Ernerudh J, Vrethem M, Skogh T: Absence of autoantibodies in primary fibromyalgia. J Rheumatol 1990, 17:1682–1683.PubMedGoogle Scholar
  76. 76.
    Simms RW, Zerbini CAF, Ferrante N, et al.: Fibromyalgia syndrome in patients infected with Human Immunodeficiency Virus. Amer J Med 1992, 92:368–374.PubMedCrossRefGoogle Scholar
  77. 77.
    Buskila D, Fefer P, Harman-Boehm I, et al.: Assessment of nonarticular tenderness and prevalence of fibromyalgia in hyperprolactinemic women. J Rheumatol 1993, 20:2112–2115.PubMedGoogle Scholar
  78. 78.
    Jurell KC, Zanetos MA, Orsinelli A, et al.: Fibromyalgia: a study of thyroid function and symptoms. J Musculoskel Pain 1996, 4:49–60.CrossRefGoogle Scholar
  79. 79.
    May KP, West SG, Baker MR, Everett DW: Sleep apnea in male patients with the fibromyalgia syndrome. Amer J Med 1993, 94:505–508.PubMedCrossRefGoogle Scholar
  80. 80.
    Fiona D, Esdaile JM, Kimoff JR, Fitzcharles M: Musculoskeletal complaints and fibromyalgia in patients attending a respiratory sleep disorders clinic. J Rheumatol 1996, 23:1612–1616.Google Scholar
  81. 81.
    Bennett RM: Disabling fibromyalgia: appearance versus reality. J Rheumatol 1993, 20:1821–1824.PubMedGoogle Scholar
  82. 82.
    Greenfield S, Fitzcharles M, Esdaile JM: Reactive fibromyalgia syndrome. Arthritis Rheum 1992, 35:678–681.PubMedCrossRefGoogle Scholar
  83. 83.
    Romano T: Clinical experiences with post-traumatic fibromyalgia syndrome. W V Med J 1990, 86:198–202.PubMedGoogle Scholar
  84. 84.
    Waylonis GW, Perkins RW: Post-traumatic fibromyalgia. A long-term follow-up. Am J Phys Med Rehabil 1994, 73:403–412.PubMedCrossRefGoogle Scholar
  85. 85.
    Bohr TW: Fibromyalgia syndrome and myofascial pain syndrome. Do they exist? Neurol Clin 1995, 13:365–384.PubMedGoogle Scholar
  86. 86.
    Rush PJ, Ameis A: Trauma and fibromyalgia: does the punishment fit the crime? [letter] J Rheumatol 1995, 22:372.PubMedGoogle Scholar
  87. 87.
    Wolfe F and the Vancouver fibromyalgia consensus group: The fibromyalgia syndrome: a consensus report on fibromyalgia and disability. J Rheumatol 1996, 23:534–539.PubMedGoogle Scholar
  88. 88.
    Buskila D, Neumann L, Vaisberg G, et al.: Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury. Arthritis Rheum 1997, 40:446–452.PubMedCrossRefGoogle Scholar
  89. 89.
    White KP, Carette S, Harth M, Teasell RW: Trauma and fibromyalgia: is there an association and what does it mean? Semin Arthritis Rheum 2000, 29:200–216. A detailed review of the current understanding and controversies regarding the causative role of trauma in FM.PubMedCrossRefGoogle Scholar
  90. 90.
    White KP, Ostbye T, Harth M, et al.: Perspectives on posttraumatic fibromyalgia: a random survey of Canadian general practitioners, orthopaedists, physiatrists, and rheumatologists. J Rheumatol 2000, 27:790–796.PubMedGoogle Scholar
  91. 91.
    Kennedy M, Felson DT: A prospective long-term study of fibromyalgia syndrome. Arthritis Rheum 1996, 39:682–685.PubMedCrossRefGoogle Scholar
  92. 92.
    Bengtsson A, Backman E: Long-term follow up of fibromyalgia patients. Scand J Rheumatol 1992, 21(suppl 94):98.Google Scholar
  93. 93.
    Ledingham J, Doherty S, Doherty M: Primary fibromyalgia syndrome-an outcome study. Br J Rheumatol 1993, 32:139–142.PubMedCrossRefGoogle Scholar
  94. 94.
    Granges G, Zilko P, Littlejohn GO: Fibromyalgia syndrome: assessment of the severity of the condition two years after diagnosis. J Rheumatol 1994, 21:523–529.PubMedGoogle Scholar
  95. 95.
    Felson DT, Goldenberg DL: The natural history of fibromyalgia. Arthritis Rheum 1986, 29:1522–1526.PubMedCrossRefGoogle Scholar
  96. 96.
    Buskila D, Neumann L, Hershman E, et al.: Fibromyalgia syndrome in children-an outcome study. J Rheumatol 1995, 22:525–528.PubMedGoogle Scholar
  97. 97.
    Papageorgiou AC, Croft PR, Ferry S, et al.: Estimating the prevalence of low back pain in the general population. Evidence from the South Manchester Back Pain Survey. Spine 1995, 20:1889–1894.PubMedCrossRefGoogle Scholar
  98. 98.
    Brena SR, Chapman SL: The “learned pain syndrome”: decoding a patient’s pain signals. Postgrad Med 1981, 69:53–64.PubMedGoogle Scholar
  99. 99.
    Chapman SL, Brena SR: Learned helplessness and responses to nerve blocks in chronic low back patients. Pain 1982, 14:355–364.PubMedCrossRefGoogle Scholar
  100. 100.
    Hadler NM: Social security. The process of pensioning the invalid. In Occupational Musculoskeletal Disorders. Edited by Hadler NM. New York, NY: Raven Press; 1993:227–248.Google Scholar
  101. 101.
    Robbins JM, Kirmayer LS: Illness, worry and disability in fibromyalgia syndrome. Int J Psychiatry Med 1990, 20:49–63.PubMedCrossRefGoogle Scholar
  102. 102.
    White KP, Nielson WR, Harth M, et al.: Does the label ‘fibromyalgia’ alter health status and function? A prospective, within-group comparison. Arthritis Rheum 2000, 43(suppl 9):S212.Google Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Kevin P. White
    • 1
  • Manfred Harth
    • 1
  1. 1.Department of MedicineUniversity of Western OntarioLondonCanada

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