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Although patients with FMS most frequently report diffuse soft tissue pain, the pain is characteristically concentrated in an axial location, such as the neck and lower back; the proximal trapezius muscles are commonly involved. Patients may have more peripheral joint involvement, but be suspicious of the diagnosis if the person has a great deal of hand, wrist, foot, and ankle pain but only minimal proximal shoulder girdle, hip girdle, neck or low back pain. In those instances, inflammatory arthropathies and neuropathic pain syndromes need to be ruled out. (Source: "Fibromyalgia: 20 Clinical Pearls", by Lawrence J. Levanthal, M.D., and Henda Bouali, M.D. Published in the Journal of Musculoskeletal Medicine, Volume 20, Number 2, February 2003.)

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