Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain

Journal: Best Practice and Research, Clinical Rheumatology. 2007 Jun;21(3):481-97

Author and affiliation: Yunus MB. Section of Rheumatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.

PMID: 17602995

Patients with widespread pain or Fibromyalgia syndrome have many symptoms besides musculoskeletal pain: for example, fatigue, sleep difficulties, a swollen feeling in tissues, paresthesia, cognitive dysfunction, dizziness, and symptoms of overlapping conditions such as irritable bowel syndrome, headaches, and restless legs syndrome.

There is evidence for central sensitization in these conditions, but further studies are needed. Anxiety, stress and depression are also present in 30% to 45% of patients. Other factors that may contribute to symptoms include endocrine dysfunction, psychosocial distress, trauma, and disrupted sleep.

Evaluation of a patient presenting with widespread pain includes history and physical examination to diagnose both Fibromyalgia and associated or concomitant conditions. Fibromyalgia should be diagnosed by its own characteristic features. Some patients with otherwise typical symptoms of Fibromyalgia may have as few as four to six tender points in clinical practice.

Patients with rheumatoid arthritis and systemic lupus erythematosus should be evaluated for Fibromyalgia, since 20% to 30% of them have associated Fibromyalgia, requiring a different treatment approach.

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