Skip to main content

Advertisement

SpringerLink
Log in

Fibromyalgia: An overview

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

In this article, the authors review current concepts in fibromyalgia. Findings regarding diagnosis, prevalence, comorbidities, and potential pathophysiologic links are discussed. Although fibromyalgia continues to be a complex disorder, there are specific criteria one must meet. Fibromyalgia questionnaires, along with commonalities of age, gender, menopause status, sleep disturbances, and mood symptoms, may aid in the diagnosis. Additionally, the close relationship between fibromyalgia and other chronic disorders should alert the physician to explore for comorbid illness. The relationship between fibromyalgia and irritable bowel syndrome, migraine headaches, and obesity are addressed. The roles of the hypothalamic-pituitary-axis, potential effects of neurotransmitters, and gender-specific hormones all substantiate this diagnosis and provide clues to causality, as well as venues for future treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Wolfe F Smythe HA Yunus MB, et al.: The American College of Rheumatology 1990 Criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 1990, 33:160–172.

    Article  PubMed  CAS  Google Scholar 

  2. Burckhardt CS Clark SR Bennett RM: The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991, 18:728–733.

    PubMed  CAS  Google Scholar 

  3. Offenbaecher M Waltz M Schoeps P: Validation of a German version of the Fibromyalgia Impact Questionnaire (FIQ-G). J Rheumatol 2000, 27:1984–1988.

    PubMed  CAS  Google Scholar 

  4. Kim Ya Lee SS Park K: Validation of a Korean version of the Fibromyalgia Impact Questionnaire. J Korean Med Sci 2002, 17:220–224.

    PubMed  Google Scholar 

  5. Drudi D: A century-long quest for meaningful and accurate occupational injury and illness statistics. Compensation Working Conditions 1997, 1:19–27.

    Google Scholar 

  6. Safety and Health Statistics: Days away from work highest for carpal tunnel syndrome. http://www.bls.gov/opub/ted/2001/ apr/wk1/art01.htm. Accessed July 31, 2002.

  7. Sarmer S Yavuzer G Kucukdeveci A Ergin S: Prevalence of carpal tunnel syndrome in patients with fibromyalgia. Rheumatol Int 2002, 22:68–70.

    Article  PubMed  Google Scholar 

  8. Waylonis GW Ronan PG Gordon C: A profile of fibromyalgia in occupational environments. Am J Phys Med Rehabil 1994, 73:112–115.

    Article  PubMed  CAS  Google Scholar 

  9. Gallinaro AL Feldman D Natour J: An evaluation of the association between fibromyalgia and repetitive strain injuries in metalworkers of an industry in Guarulhos, Brazil. Joint Bone Spine 2001, 68:59–64.

    Article  PubMed  CAS  Google Scholar 

  10. Marder WD Meenan RF Felson DT, et al.:The present and future adequacy of rheumatology manpower: a study of health care needs and physician supply. Arthritis Rheum 1991, 34:1209–1217.

    Article  PubMed  CAS  Google Scholar 

  11. Wolfe F Ross K Anderson J, et al.:The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995, 38:19–28.

    Article  PubMed  CAS  Google Scholar 

  12. Wolfe F: The epidemiology of fibromyalgia. J Musculoskeletal Pain 1994, 1:137–148.

    Article  Google Scholar 

  13. Yunus MB: Gender differences in fibromyalgia and other related syndromes. J Gend Specifi Med 2002, 5:42–47. This article details issues of prevalence and specific gender issues in fibromyalgia.

    Google Scholar 

  14. 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.

    PubMed  CAS  Google Scholar 

  15. Wolfe F Ross K Anderson J Russell IJ: Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms. J Rheumatol 1995, 22:151–156.

    PubMed  CAS  Google Scholar 

  16. Yunus MB Inanici F Aldag JC Mangold RF: Fibromyalgia in men: comparison of clinical features in women. J Rheumatol 2000, 27:485–490.

    PubMed  CAS  Google Scholar 

  17. Buskila D Neumann L Alhoashle A Abu-Shakra M: Fibromyalgia syndromes in men. Semin Arthritis Rheum 2000, 30:47–51.

    Article  PubMed  CAS  Google Scholar 

  18. Levav I Kohn R Golding JM Weissman MM: Vulnerability of Jews to affective disorders. Am J Psychiatry 1997, 154:941–947.

    PubMed  CAS  Google Scholar 

  19. Wolfe F Hawley DJ: Psychosocial factors and the fibromyalgia syndrome. J Rheumatol 1998, 57:88–91.

    Article  Google Scholar 

  20. Neumann L Buskila D: Ethnocultural and educational differences in Israeli women correlate with pain perception in fibromyalgia. J Rheumatology 1998, 259:1369–1373.

    Google Scholar 

  21. Nishikai M. Fibromyalgia in Japanese. J Rheumatol 1992, 19:110–114.

    PubMed  CAS  Google Scholar 

  22. Choudhury AK Yanus MB Haq SA, et al.:Clinical features on fibromyalgia syndrome in a Bangladeshi population. J Musculoskeletal Pain 2001, 9:25–33.

    Article  Google Scholar 

  23. Carmona L Ballina J Gabriel R Laffon A: The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis 2001, 60:1040–1045.

    Article  PubMed  CAS  Google Scholar 

  24. The Iowa Persian Gulf Study Group: Self-reported illness and health status among Persian Gulf War veterans: a population-based study. JAMA 1997, 277:238–245.

    Article  Google Scholar 

  25. Escalante A Fischbach M: Musculoskeletal manifestations, pain, and quality of life in Persian Gulf War veterans referred for rheumatologic evaluation [see comments.]. J Rheumatol 1998, 25:2228–2235.

    PubMed  CAS  Google Scholar 

  26. Meisler JG: Office of Research on Women’s Health Seminar Series Part II: chronic pain conditions in women. J Womens Health 1999, 8:313–320. Issues of multiple chronic pain syndromes are discussed; the need to explore issues further and problem solving in women’s health are also highlighted.

    Article  PubMed  CAS  Google Scholar 

  27. Buckwalter J Lappin DR: The disproportionate impact of chronic arthralgia and arthritis among women. Clin Orthop 2000, 372:159–168.

    Article  PubMed  Google Scholar 

  28. Waxman J Zatzkis SM: Fibromyalgia and menopause: examination of the relationship. Postgrad Med 1986, 80:165–167.

    PubMed  CAS  Google Scholar 

  29. Fillingim RB Maixner W: Gender differences in the responses to noxious stimuli. Pain Forum 1995, 4:209–221.

    Google Scholar 

  30. Braus P: Marketing Health Care to Women. Ithaca: American Demographic Books; 1997.

    Google Scholar 

  31. Wolfe F Cathey MA Kleinheksel SM, et al.:Psychological status in primary fibrositis and fibrositis associated with rheumatoid arthritis. J Rhemuatol 1984, 1:500–506.

    Google Scholar 

  32. Yunus MB Maas AT Aldag JC: A controlled study of primary fibromyalgia syndrome: clinical features and associations with other functional syndromes. J Rheumatol 1989, 16:62–71.

    Google Scholar 

  33. Fishbain DA: Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997, 13:116–137.

    Article  PubMed  CAS  Google Scholar 

  34. Perez-Stable EJ Miranda J Munoz RF, et al.:Depression in medical outpatients: underrecognition and misdiagnosis. Arch Intern Med 1990, 150:1083.

    Article  PubMed  CAS  Google Scholar 

  35. Pincus T Callahan LF Bradley LA, et al.:Elevated MMPI scores for hypochondriasis, depression and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status. Arthritis Rheum 1986, 29:1456.

    Article  PubMed  CAS  Google Scholar 

  36. Roizenblatt S Moldofsky H Benedito-Silva A Tufik S: Alpha sleep characteristic in fibromyalgia. Arthritis Rheum 2001, 44:222–230. The unique findings of specific sleep disturbances in patients with fibromyalgia are discussed. These findings may help with clarification of the diagnosis in the future.

    Article  PubMed  CAS  Google Scholar 

  37. Branco J Atalaia A Paiva T: Sleep cycles and alpha-delta sleep in fibromyalgia syndrome. J Rheumatol 1994, 21:1113–1117.

    PubMed  CAS  Google Scholar 

  38. Schneider-Helmert D Whitehouse I Kumar A, et al.:Insomnia and alpha sleep in chronic non-organic pain a compared to primary insomnia. Neuropsychobiology 2001, 43:54–58.

    Article  PubMed  CAS  Google Scholar 

  39. Campbell JC Lewandowski LA: Mental and physical health effects of intimate partner violence on women and children. Psychiatr Clin North Am 1997, 20:353–374.

    Article  PubMed  CAS  Google Scholar 

  40. Walker EA Keegan D Gardner G, et al.:Psychosocial factors in fibromyalgia and rheumatoid arthritis, II: sexual, physical, and emotional abuse and neglect. Psychosom Med 1997, 59:572–577.

    PubMed  CAS  Google Scholar 

  41. Boisset-Pioro MH Esdaile JM Fitzcharles MA: Sexual and physical abuse in women with fibromyalgia syndrome. Arthritis Rheum 1995, 38:235–241.

    Article  PubMed  CAS  Google Scholar 

  42. Sherman JJ: Prevalence and impact of posttraumatic stress disorder-like symptoms on patients with fibromyalgia syndrome. Clin J Pain 2000, 16:127–134. The role of stress in fibromyalgia is discussed. The article emphasizes that PTSD-like symptoms are prevalent in patients with fibromyalgia and may influence the adaptation to this chronic illness.

    Article  PubMed  CAS  Google Scholar 

  43. Silverstein B: Gender differences in the prevalence of somatic versus pure depression: a replication. Am J Psychiatry 2002, 159:1051–1052.

    Article  PubMed  Google Scholar 

  44. Lipton RB Scher AI Kolodner K, et al.:Migraine in the United States: epidemiology and patterns of health care use. Neurology 2002, 58:885–894.

    PubMed  CAS  Google Scholar 

  45. Okifuji A Turk D Marcus D: Comparison of generalized and local hyperalgesia in patients with recurrent headache and fibromyalgia. Psychosomc Med 1999, 61:771–787.

    CAS  Google Scholar 

  46. Peres M Young W Kaup A, et al.:Fibromyalgia is common in patients with transformed migraine. Neurology 2001, 57:1326–1328.

    PubMed  CAS  Google Scholar 

  47. The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults. Bethesda: National Institutes of Health Publication; 2000.

    Google Scholar 

  48. Mengshoel AM Haugen M: Health status in fibromyalgia: a follow-up study. J Rheumatol 2001, 28:2085–2089.

    PubMed  CAS  Google Scholar 

  49. Yunus M Arslan S Aldag J: Relationship between body mass index and fibromyalgia features. Scand J Rheumatol 2002, 31:27–31.

    Article  PubMed  Google Scholar 

  50. Elert J Kendall SA Larsson B, et al.:Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders. J Rheumatol 2001, 28:1361–1368.

    PubMed  CAS  Google Scholar 

  51. Jones K Clark S Bennett R: Prescribing exercise for people with fibromyalgia. AACN Clin Issues 2002, 13:277–293.

    Article  PubMed  Google Scholar 

  52. Kaartinen K Lammi K Hypen M, et al.:Vegan diet alleviates fibromyalgia symptoms. Scand J Rheumatol 2000, 29:308–313.

    Article  PubMed  CAS  Google Scholar 

  53. Sabo B: How to deal with medically unknown symptoms. West J Med 2000, 172:128–130.

    Article  PubMed  CAS  Google Scholar 

  54. Sperber AD Atzmon Y Neumann L, et al.:Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical indications. Am J Gastroenterol 1999, 94:3541–3546.

    Article  PubMed  CAS  Google Scholar 

  55. Veale D Kavanaugh G Fielding JF Fitzgerald O: Primary fibromyalgia and the irritable bowel syndrome: different expressions of a common pathogenic process. Br J Rheumatol 1991, 30:220–222.

    Article  PubMed  CAS  Google Scholar 

  56. Kranzler JD Gendreau JF Srinivas GR: The psychopharmacology of fibromyalgia: a drug development perspective. Psychopharmacol Bull 2002, 36:165–213. This is an excellent article that clarifies the relevance of pain and the role of hormones and neurotransmitters in fibromyalgia.

    PubMed  Google Scholar 

  57. Ernberg M Voog U Alstergren P, et al.:Plasma and serum serotonin levels and their relationship to orofacial pain and anxiety in fibromyalgia. J Orofac Pain 2000, 14:37–46.

    PubMed  CAS  Google Scholar 

  58. Legangneux E Mora JJ Spreux-Varoquaux O, et al.:Cerebrospinal fluid biogenic amine metabolites, plasma-rich platelet serotonin and [3H]imipramine reuptake in the primary fibromyalgia syndrome. Rheumatology 2001, 40:290–296. Levels of neurotransmitters and metabolites are analyzed in the patient with fibromyalgia. This article discusses the potential differences in the patient with fibromyalgia that may lead to a better understanding of the disorder.

    Article  PubMed  CAS  Google Scholar 

  59. Offenbaecher M Bondy B de Jonge S, et al.:Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region. Arthritis Rheuma 1999, 42:2482–2488.

    Article  CAS  Google Scholar 

  60. Catley D Kaell AT Kirschbaum C Stone AA: A naturalistic evaluation of cortisol secretion in persons with fibromyalgia and rheumatoid arthritis. Arthritis Care Res 2000, 13:51–61.

    Article  PubMed  CAS  Google Scholar 

  61. Torpy DJ Papanicolaou DA Lotsikas AJ, et al.:Responses of the sympathetic nervous system and the hypothalamic-pituitaryadrenal axis to interleukin-6: a pilot study in fibromyalgia. Arthritis Rheum 2000, 43:872–880. This article nicely illustrates the interaction between various systems involved in fibromyalgia. It examines the activity of the hypothalamic CRH neuron, which stimulates the HPA axis and the central control nuclei of the sympathetic nervous system. This detailed report suggests that stress may be pathogenic in patients with fibromyalgia.

    Article  PubMed  CAS  Google Scholar 

  62. Griep EN Boersma JW de Kloet ER: Altered reactivity of the hypothalamic-pituitary-adrenal axis in the primary fibromyalgia syndrome. J Rheumatol 1993, 20:469–474.

    PubMed  CAS  Google Scholar 

  63. McCain GA Tilbe KS: Diurnal hormone variation in fibromyalgia syndrome: a comparison with rheumatoid arthritis. J Rheumatol 1980, 16:154–157.

    Google Scholar 

  64. Crofford LJ: Neuroendocrine abnormalities in fibromyalgia and related disorders. Am J Med Sci 1998, 315:359–366.

    Article  PubMed  CAS  Google Scholar 

  65. Wilder RL: Neuroendocrine-immune system interactions and autoimmunity. Annu Rev Immunol 1995, 13:307–338.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Queen’s Medical Center, John A. Burns School of Medicine, 1356 Lusitana Street, Fourth Floor, 96813, Honolulu, HI, USA

    Diane Thompson MD

Authors
  1. Diane Thompson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Louise Lettich MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junji Takeshita MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thompson, D., Lettich, L. & Takeshita, J. Fibromyalgia: An overview. Curr Psychiatry Rep 5, 211–217 (2003). https://doi.org/10.1007/s11920-003-0045-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-003-0045-x

Keywords

Search

Navigation