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SANGITA CHAKRABARTY, MD, MSPH, Meharry Medical College, Nashville, Tennessee ROGER ZOOROB, MD, MPH, Meharry Medical College and Vanderbilt University, Nashville, Tennessee

Fibromyalgia is an idiopathic, chronic, nonarticular pain syndrome with generalized tender points. It is a multisystem disease characterized by sleep disturbance, fatigue, headache, morning stiffness,paresthesias, and anxiety. Nearly 2 percent of the general population in the United States suffers from fibromyalgia, with females of middle age being at increased risk. The diagnosis is primarily based on the presence of widespread pain for a period of at least three months and the presence of 11 tender points among 18 specific anatomic sites. There are certain comorbid conditions that overlap with, andalso may be confused with, fibromyalgia. Recently there has been improved recognition and understanding of fibromyalgia. Although there are no guidelines for treatment, there is evidence that a multidimensional approach with patient education, cognitive behavior therapy, exercise, physical therapy, and pharmacologic therapy can be effective. (Am Fam Physician 2007;76:247-54. Copyright © 2007American Academy of Family Physicians.)
This article exemplifies the AAFP 2007 Annual Clinical Focus on management of chronic illness. See editorial on page 290. Patient information: Handouts on fibromyalgia are available at http:// familydoctor.org/070.xml and http://familydoctor. org/061.xml. The online version of this article includes supplemental content at http:// www.aafp.org/afp. ▲ ▲

Fibromyalgia is an idiopathic, chronic, nonarticular pain syndrome defined by widespread musculoskeletal pain and generalized tender points (Table 1). Other common symptoms include sleep disturbances, fatigue, headache, morning stiffness, paresthesias, and anxiety. Initially called fibrositis, the name was changed to fibromyalgia when it became evident that inflammation was not a part of thiscondition.1 The American College of Rheumatology (ACR) 1990 criteria for the classification of fibromyalgia was the product of the first well-designed, multicenter study on fibromyalgia and remains a cornerstone for the diagnosis.2 Epidemiology Fibromyalgia is a common rheumatologic disorder that is underdiagnosed. Using the 1990 ACR classification criteria, the prevalence of fibromyalgia in the generalpopulation of the United States is reported to be 3.4 percent in women and 0.5 percent in men.3 Prevalence increases steadily through 80 years of age, and then declines. This condition affects women 10 times more often than men.3 Fibromyalgia is usually considered a disorder of women 20 to 50 years of age; however, it also has been observed in males, children, adolescents, and older persons.Fibromyalgia is more common in relatives of patients with fibromyalgia, sug

gesting the contribution of both genetic and environmental factors.4 Demographic and social characteristics associated with the presence of fibromyalgia are female sex, being divorced, failing to complete high school, and low income. Psychological factors associated with this syndrome include somatization disorder, anxiety,and personal or family history of depression.5 Pathophysiology The pathophysiology of fibromyalgia is unclear. Fibromyalgia clusters in families, suggesting a genetic predisposition. Environmental and psychological factors, which

Table 1. Characteristics and  Associated Features of Fibromyalgia
Characteristic features Chronic widespread pain for at least three months Tender points in 11 of 18specific anatomic locations Associated features Anxiety Cognitive difficulties Fatigue Headache Paresthesias Sleep disturbance

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