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Fibromyalgia (FM) is common in a postpoliomyelitis clinic

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OBJECTIVE: To determine prospectively the occurrence and clinical
characteristics of fibromyalgia in patients serially
presenting to a postpolio clinic. Fibromyalgia may mimic some
of the symptoms of postpoliomyelitis syndrome, a disorder
characterized by new weakness, fatigue, and pain decades after
paralytic poliomyelitis.

DESIGN: Case series.

SETTING: A
university-affiliated hospital clinic.

PATIENTS: One hundred
five patients were evaluated with a standardized history and
physical examination during an 18-month period. Ten patients
were excluded because of the absence of past paralytic
poliomyelitis.

INTERVENTIONS: Patients with fibromyalgia were
treated with low-dose, nighttime amitriptyline hydrochloride
or other conservative measures.

MAIN OUTCOME MEASURES:
Patients with fibromyalgia had diffuse pain and 11 or more of
18 specific tender points on examination (American College of
Rheumatology criteria, 1990). Patients with borderline
fibromyalgia had muscle pain and five to 10 tender points on
physical examination.

RESULTS: Ten (10.5%) of 95 postpolio
patients met the criteria for fibromyalgia, and another 10
patients had borderline fibromyalgia. All patients with
fibromyalgia complained of new weakness, fatigue, and pain.
Patients with fibromyalgia were more likely than patients
without fibromyalgia to be female (80% vs 40%, P < .04) and to
complain of generalized fatigue (100% vs 71%, P = .057), but
were not distinguishable in terms of age at presentation to
clinic, age at polio, length of time since polio, physical
activity, weakness at polio, motor strength scores on
examination, and the presence of new weakness, muscle fatigue,
or joint pain. Approximately 50% of patients in both the
fibromyalgia and borderline fibromyalgia groups responded to
low-dose, nighttime amitriptyline therapy.

CONCLUSIONS: (1)
Fibromyalgia occurs frequently in a postpolio clinic. (2)
Fibromyalgia can mimic some symptoms of postpoliomyelitis
syndrome. (3) Fibromyalgia in postpolio patients can respond
to specific treatment.

Trojan DA, Cashman NR

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