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Fibromyalgia and other unexplained clinical conditions

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Abstract

Several unexplained clinical conditions frequently coexist with fibromyalgia; these include chronic fatigue syndrome, irritable bowel syndrome, temporomandibular disorder, tension and migraine headaches, and others. However, only recently have studies directly compared the physiological parameters of these conditions (eg, fibromyalgia vs irritable bowel syndrome) to elucidate underlying pathogenic mechanisms. This review summarizes data from comparative studies and discusses their implications for future research.

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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. Buchwald D, Garrity D: Comparison of patients with chronic fatigue syndrome, fibromyalgia and multiple chemical sensitivities. Arch Intern Med 1994, 154:2049–2053.

    Article  PubMed  CAS  Google Scholar 

  3. White KP, Speechley M, Harth M, et al.: Co-existence of chronic fatigue syndrome with fibromyalgia syndrome in the general population. A controlled study. Scand J Rheumatol 2000, 29:44–51.

    Article  PubMed  CAS  Google Scholar 

  4. Jason LA, Richman JA, Rademaker AW, et al.: A communitybased study of chronic fatigue syndrome. Arch Intern Med 1999, 159:2129–2137.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  6. Wessely S, Nimnuan C, Sharpe M: Functional somatic syndromes: one or many? Lancet 1999, 354:936–939.

    Article  PubMed  CAS  Google Scholar 

  7. Fukuda K, Straus SE, Hickie I, et al.: The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 1994, 121:953–959.

    PubMed  CAS  Google Scholar 

  8. Clauw DJ, Chrousos GP: Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms. Neuroimmunomodulation 1997, 4:134–153. This article reviews the evidence for pathogenic mechanisms underlying FM, CFS, and other conditions, and proposes a model to account for the development of both systemic and organ-specific disorders (eg, interstitial cystitis) that result from dysregulation of central nervous system functioning.

    PubMed  CAS  Google Scholar 

  9. Yunus MB: Central sensitivity syndromes: a unified concept for fibromyalgia and other similar maladies. J Indian Rheum Assoc 2000, 8:27–33. This article reviews evidence that supports a biopsychosocial model for central sensitivity syndromes, in which "organic," psychiatric, and neuroendocrine processes interact to cause and perpetuate syndromes such as FM.

    Google Scholar 

  10. Hudson JI, Pope HG Jr: Affective spectrum disorder: does antidepressant response identify a family of disorders with a common pathophysiology? Am J Psychiatry 1990, 147:552–564.

    PubMed  CAS  Google Scholar 

  11. Pillemer SR, Bradley LA, Crofford LJ, et al.: The neuroscience and endocrinology of fibromyalgia. Arthritis Rheum 1997, 40:1928–1939. This article summarizes the proceedings of a 1996 NIH interdisciplinary conference regarding the advances in the basic and clinical science of chronic pain, neuroendocrine function and sleep as it relates to the development of FM and other conditions, such as CFS.

    Article  PubMed  CAS  Google Scholar 

  12. Bou-Holaigah I, Calkins H, Flynn JA, et al.: Provocation of hypotension and pain during upright tilt table testing in adults with fibromyalgia. Clin Exp Rheumatol 1997, 15:239–346.

    PubMed  CAS  Google Scholar 

  13. Streeten DH, Thomas D, Bell DS: The roles of orthostatic hypotension, orthostatic tachycardia, and subnormal erythrocyte volume in the pathogenesis of the chronic fatigue syndrome. Am J Med Sci 2000, 320:1–8.

    Article  PubMed  CAS  Google Scholar 

  14. Bendtsen L, Jensen R, Olsen J: Muscle tenderness and pressure pain thresholds in headache: a population study. Pain 1996, 65:259–64.

    Article  PubMed  CAS  Google Scholar 

  15. Crofford LJ, Demitrack MA: Evidence that abnormalities of central neurohormonal systems are key to understanding fibromyalgia and chronic fatigue syndrome. Rheum Dis Clin N Am 1996, 22:267–284.

    Article  CAS  Google Scholar 

  16. Dworkin SF, LeResche L: Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992, 6:301–355.

    PubMed  CAS  Google Scholar 

  17. Barsky A, Borus JF: Functional somatic syndromes. Ann Intern Med 1999, 130:910–921.

    PubMed  CAS  Google Scholar 

  18. Goldenberg DL, Simms RW, Geiger A, et al.: High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Arthritis Rheum 1990, 33:381–387.

    Article  PubMed  CAS  Google Scholar 

  19. Buchwald D: Fibromyalgia and chronic fatigue syndrome: similarities and differences. Rheum Dis Clin North Am 1996, 22:219–243.

    Article  PubMed  CAS  Google Scholar 

  20. Plesh O, Wolfe F, Lane N: The relationship between fibromyalgia and temporomandibular disorders: prevalence and symptom severity. J Rheumatol 1996, 23:1948–1952.

    PubMed  CAS  Google Scholar 

  21. Clauw DJ, Schmidt M, Radulovic D, et al.: The relationship between fibromyalgia and interstitial cystitis. J Psychiatr Res 1997, 31:125–131.

    Article  PubMed  CAS  Google Scholar 

  22. Okifuji A, Turk DC, Marcus DA: Comparison of generalized and localized hyperalgesia in patients with recurrent headache and fibromyalgia. Psychosom Med 1999, 61:771–780.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  24. Aaron LA, Burke MM, Buchwald D: Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med 2000, 160:221–227.

    Article  PubMed  CAS  Google Scholar 

  25. Hedenberg-Magnusson B, Ernberg M, Kopp S: Symptoms and signs of temporomandibular disorders in patients with fibromyalgia and local myalgia of the temporomandibular system. A comparative study. Acta Odontol Scand 1997, 55:344–349.

    PubMed  CAS  Google Scholar 

  26. Nicolodi M, Volpe AR, Sicuteri F: Fibromyalgia and headache. Failure of serotonergic analgesia and N-methyl-D-aspartate-mediated neuronal plasticity: their common clues. Cephalalgia 1998, 18(Suppl 21):41–44.

    PubMed  Google Scholar 

  27. Chun A, Desautels S, Slivka A, et al.: Visceral algesia in irritable bowel syndrome, fibromyalgia, and sphincter of oddi dysfunction, type III. Dig Dis Sci 1999, 44:631–636.

    Article  PubMed  CAS  Google Scholar 

  28. Chang L, Mayer EA, Johnson T, et al.: Differences in somatic perception in female patients with irritable bowel syndrome with and without fibromyalgia. Pain 2000, 84:297–307.

    Article  PubMed  CAS  Google Scholar 

  29. Korzun A, Young EA, Engleberg NC, et al.: Follicular phase hypothalamic-pituitary-gonadal axis function in women with fibromyalgia and chronic fatigue syndrome. J Rheumatol 2000, 27:1526–1530.

    Google Scholar 

  30. Raphael KG, Marbach JJ, Klausner J: Myofascial face pain. Clinical characteristics of those with regional vs. widespread pain. J Am Dent Assoc 2000, 131:161–171.

    PubMed  CAS  Google Scholar 

  31. Fischler B, Le Bon O, Hoffmann G, et al.: Sleep anomalies in the chronic fatigue syndrome. a comorbidity study. Neuropsychobiology 1997, 35:115–122.

    PubMed  CAS  Google Scholar 

  32. Buchwald D, Umali J, Stene M: Insulin-like growth factor-I (somatomedin C) levels in chronic fatigue syndrome and fibromyalgia. J Rheumatol 1996, 23:739–742.

    PubMed  CAS  Google Scholar 

  33. Korzun A, Sackett-Lundeen L, Papadopoulos E, et al.: Melatonin levels in women with fibromyalgia and chronic fatigue syndrome. J Rheumatol 1999, 26:2675–2680.

    Google Scholar 

  34. Sperber AD, Weisberg I, Skibin A, et al.: Serum interleukin-1, interleukin-2, interleukin-6, and prolactin levels are not associated with the severity of disease in patients with the irritable bowel syndrome, with or without concomitant fibromyalgia. J Musculoskel Pain 1999, 7:15–27.

    Article  Google Scholar 

  35. Holmes GP, Kaplan JE, Gantz NM, et al.: Chronic fatigue syndrome: a working case definition. Ann Intern Med 1988, 108:387–389.

    PubMed  CAS  Google Scholar 

  36. Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988, 8(Suppl 7):1–96.

    Google Scholar 

  37. Gillenwater JY, Wein AJ: Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, August 28–29, 1987. J Urol 1988, 140:203–206.

    PubMed  CAS  Google Scholar 

  38. Thompson WG, Creed F, Drossman DA: Functional bowel disorders and chronic functional abdominal pain. Gastroenterol Int 1992, 5:75–91.

    Google Scholar 

  39. International Association for the Study of Pain: Classification of chronic pain. Pain 1986, 3(Suppl):59S-60S.

    Google Scholar 

  40. Goldenberg DL: Fibromyalgia syndrome a decade later. What have we learned? Arch Intern Med 1999, 159:777–785. This is a thoughtful review of the progress and advancements in knowledge regarding fibromyalgia since the establishment of FM classification criteria in 1990 by the American College of Rheumatology.

    Article  PubMed  CAS  Google Scholar 

  41. Iverson GL, McCracken LM: ‘Postconcussive’ symptoms in persons with chronic pain. Brain Inj 1997, 11:783–790.

    Article  PubMed  CAS  Google Scholar 

  42. Simms RW, Roy SH, Hrovat M, et al.: Lack of association between fibromyalgia syndrome and abnormalities in muscle energy metabolism. Arthritis Rheum 1994, 37:794–800.

    Article  PubMed  CAS  Google Scholar 

  43. Bradley LA, McKendree-Smith NL, Alarcon GS: Pain complaints in patients with fibromyalgia versus chronic fatigue syndrome. Curr Rev Pain 2000, 4:148–157. This article provides a succinct overview of common and unique physiological and psychological features reported in association with FM and CFS. It includes a unifying model, based on the available research findings, to account for the development of these conditions.

    PubMed  CAS  Google Scholar 

  44. Bendtsen L: Central sensitization in tension-type headache-possible pathophysiological mechanisms. Cephalagia 2000, 20:486–508.

    Article  CAS  Google Scholar 

  45. Bennett RM, Jacobsen S. Muscle function and origin of pain in fibromyalgia. Baillieres Clin Rheumatol 1994, 8:721–746.

    Article  PubMed  CAS  Google Scholar 

  46. Korszun A, Papadopoulos E, Demitrack M, et al.: The relationship between temporomandibular disorders and stressassociated syndromes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998, 86:416–420.

    Article  PubMed  CAS  Google Scholar 

  47. Russell IJ, Orr MD, Littman B, et al.: Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum 1994, 37:1593–1601.

    Article  PubMed  CAS  Google Scholar 

  48. Vaeroy H, Helle R, Forre O, et al.: Elevated CSF levels of substance P and high incidence of Raynaud’s phenomenon in patients with fibromyalgia: new features for diagnosis. Pain 1988, 32:21–26.

    Article  PubMed  CAS  Google Scholar 

  49. Evengard B, Nilsson CG, Lindh G, et al.: Chronic fatigue syndrome differs from fibromyalgia. No evidence for elevated substance P levels in cerebrospinal fluid of patients with chronic fatigue syndrome. Pain 1998, 78:153–155.

    Article  PubMed  CAS  Google Scholar 

  50. Ichise M, Salit IE, Abbey SE, et al.: Assessment of regional cerebral perfusion by 99Tcm-HMPAO SPECT in chronic fatigue syndrome. Nucl Med Commun 1992, 13:767–772.

    PubMed  CAS  Google Scholar 

  51. Johansson G, Risberg J, Rosenhall U, et al.: Cerebral dysfunction in fibromyalgia: evidence from regional cerebral blood flow measurements, otoneurological tests and cerebrospinal fluid analysis. Acta Psychiatr Scand 1995, 91:86–94.

    PubMed  CAS  Google Scholar 

  52. Naliboff B, Munikata J, Kodner A, et al.: IBS non-patients do not differ from healthy controls on visceral sensitivity. Gastroenterology 1996, 110:A723.

    Google Scholar 

  53. Silverman DH, Munakata JA, Ennes H, et al.: Regional cerebral activity in normal and pathological perception of visceral pain. Gastroenterology 1997, 112:64–72.

    Article  PubMed  CAS  Google Scholar 

  54. Aaron LA, Bradley LA, Alarcon GS, et al.: Perceived physical and emotional trauma as precipitating events in fibromyalgia. Associations with health care seeking and disability status but not pain severity. Arthritis Rheum 1997, 40:453–460.

    Article  PubMed  CAS  Google Scholar 

  55. Buchwald D, Goldenberg DL, Sullivan JL, Komaroff AL: The "chronic, active Epstein-Barr virus infection" syndrome and primary fibromyalgia. Arthritis Rheum 1987, 30:1132–1136.

    Article  PubMed  CAS  Google Scholar 

  56. Massoth DL, Dworkin SF, Whitney CW, et al.: Patient explanatory models for temporomandibular disorders. In Proceedings of the 7th World Congress on Pain, Progress in Pain Research and Management, Vol. 2. Edited by GF Gebhart, DL Hammond, TS Jensen. Seattle: IASP Press; 1994:187–200.

    Google Scholar 

  57. Bennett RM, Cook DM, Clark SR, et al.: Hypothalmic-pituitaryinsulin-like growth factor-I-axis dysfunction in patients with fibromyalgia. J Rheumatol 1997, 24:1384–1389.

    PubMed  CAS  Google Scholar 

  58. Rosner I, Rozenbaum M, Naschitz JE, et al.: Cardiovascular response to upright tilt differs in fibromyalgia from chronic fatigue syndrome. Arthritis Rheum 2000, 43(Suppl 9):S209.

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

  60. Schmaling K, DiClementi JD: Interpersonal stressors in chronic fatigue syndrome: a pilot study. J Chronic Fatigue Syndrome 1995, 1:153–158.

    Article  Google Scholar 

  61. Drossman DA, Leserman J, Nachman G, et al.: Sexual and physical abuse in women with functional organic gastrointestinal disorders. Ann Intern Med 1990, 113:828–833.

    PubMed  CAS  Google Scholar 

  62. Aaron LA, Bradley LA, Alarcon GS, et al.: Psychiatric diagnoses in patients with fibromyalgia are related to health careseeking behavior rather than to illness. Arthritis Rheum 1996, 39:436–445.

    Article  PubMed  CAS  Google Scholar 

  63. Russell IJ, Michalek JE, Vipraio GA, et al.: Platelet 3H-imipramine uptake receptor density and serum serotonin levels in patients with fibromyalgia/fibrositis syndrome. J Rheumatol 1992, 19:104–109.

    PubMed  CAS  Google Scholar 

  64. Bonaccorso S, Lin AH, Verkerk R, et al.: Immune markers in fibromyalgia: comparison with major depressed patients and normal volunteers. J Affect Disord 1998, 48:75–82.

    Article  PubMed  CAS  Google Scholar 

  65. Fischler B, D’Haenen H, Cluydts R, et al.: Comparison of 99mTc HMPAO SPECT scan between chronic fatigue syndrome, major depression and healthy controls: an exploratory study of clinical correlates of regional cerebral blood flow. Neuropsychobiol 1996, 34:175–183.

    CAS  Google Scholar 

  66. Lishman WA: Physiogenesis and psychogenesis in the ‘postconcussional syndrome’. Br J Psychiatry 1988, 153:460–469.

    Article  PubMed  CAS  Google Scholar 

  67. Azpiroz F, Dapoigny M, Pace F, et al.: Nongastrointesinal disorders in the irritable bowel syndrome. Digestion 2000, 62:66–72. This article reviews clinical symptoms overlapping IBS and other disorders. The authors suggest that patients with IBS may receive different diagnostic labels, depending upon the type of medical specialty clinic to which they initially present and, in turn, may be subjected to unnecessary diagnostic and treatment procedures.

    Article  PubMed  CAS  Google Scholar 

  68. Bombardier CH, Buchwald D: Chronic fatigue, chronic fatigue syndrome, and fibromyalgia. Disability and health-care use. Med Care 1996, 34:924–930.

    Article  PubMed  CAS  Google Scholar 

  69. Wolfe F, Anderson J, Harkness D, et al.: A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia. Arthritis Rheum 1997, 40:1560–1570.

    Article  PubMed  CAS  Google Scholar 

  70. Thompson WG, Longstreth GF, Drossman DA, et al.: Functional bowel disorders and functional abdominal pain. Gut 1999, 45(Suppl II):1143–1147.

    Google Scholar 

  71. Bartha L, Baumzweiger W, Buscher DS, et al.: Multiple chemical sensitivity: a 1999 consensus. Arch Environ Health 1999, 54:147–149.

    Article  Google Scholar 

  72. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association; 1994.

  73. Watson D, Pennebaker JW: Situational, Dispositional, and Genetic Bases of Symptom Reporting. In Mental Representation in Health and Illness. Edited by JA Skelton, RT Croyle. New York: Springer-Verlag; 1991: 60–84.

    Google Scholar 

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  1. Department of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359780, 98104, Seattle, WA, USA

    Leslie A. Aaron PhD, MPH & Dedra Buchwald MD

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  2. Dedra Buchwald MD
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Aaron, L.A., Buchwald, D. Fibromyalgia and other unexplained clinical conditions. Curr Rheumatol Rep 3, 116–122 (2001). https://doi.org/10.1007/s11926-001-0006-5

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