The diagnosis of generalized pain – fibromyalgia related research

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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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