Commentary: Differential Diagnosis of Fibromyalgia Syndrome

COMMENTARY: DIFFERENTIAL DIAGNOSIS OFFIBROMYALGIA SYNDROME: PROPOSAL OF A MODEL AND ALGORITHM FOR PATIENTS PRESENTING WITH THEPRIMARY SYMPTOM OF CHRONIC WIDESPREAD PAIN

By: Michael J. Schneider, DC, PhD,a David M. Brady, ND, DC,b and Stephen M. Perle, DC, MSc


Fibromyalgia syndrome (FMS) remains an elusive condition of unknown etiology, in which patients report chronic widespread pain (allodynia or hyperalgesia) and a variety of other complaints including fatigue, sleep disorders, cognitive deficit, irritable bowel and bladder syndrome, headache, Raynaud’s syndrome, bruxism, atypical patterns of sensory dysethesia, and other symptoms. Despite the name of the condition, fibromyoalgia, there are no data to support the hypothesis that FMS is a distinct pathologic disorder of the soft tissues. More recent data tend to support the notion that FMS is a disorder of the central nervous system pain processing pathways and not some type of primary auto-immune disorder of the peripheral tissues. It is quite possible that the term FMS is a poor choice of words, for it implies that patients with a variable symptom complex all have the same singular disease or disorder. The diagnosis of FMS has been burdened by a controversial and problematic history since its inception in 1990, with a disturbing trend toward overdiagnosis in recent years. A recent study provided some evidence of the seriousness of improper FMS diagnosis, when a cohort of patients referred to a specialty rheumatology clinic with a tentative diagnosis of FMS were prospectively followed and the FMS diagnosis could only be confirmed in 34% of these patients.1

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