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The diagnosis of generalized pain - fibromyalgia related research

  [ 53 votes ]   [ Discuss This Article ] • September 10, 1999

Patients whose symptoms include widespread, diffuse
musculoskeletal pain are commonly referred for rheumatological
evaluation, even when the underlying cause may lie out with
the remit of rheumatology. A diagnosis of fibromyalgia may
seem highly probable even from the referral letter, or after a
few leading questions during the consultation. However, the
lack of specificity of the many symptoms associated with
widespread pain means that other diagnoses have to be
considered. The history and examination must bear in mind
alternative and concomitant musculoskeletal disorders, such as
mild systemic lupus erythematosus, polyarticular
osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica,
hypermobility syndromes and even osteomalacia.

Non-rheumatological diseases may also have symptomatic
similarities to fibromyalgia, including neoplastic and
neurological diseases, hypothyroidism and other endocrine
disorders, chronic infections, as well as a variety of
psychiatric conditions. A rational approach to investigation
will usually allow other diagnostic possibilities to be
excluded without reinforcing the abnormal illness behaviour so
common in chronic pain states.

Reilly PA

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