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Fibromyalgia syndrome (FMS) is one of the most frequent causes of widespread musculoskeletal pain and disability. It is a painful condition predominantly involving muscles and soft tissue rather than joints.1 Patient’s with FMS are commonly seen by rheumatologists and are often referred to pain centers. A multidisciplinary approach to treatment appears to be most beneficial, and may include pharmacologic management, injection therapy, transcutaneous electrical nerve stimulation (TENS), psychological counseling, and behavior modification.

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Etiology and Prevalence

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The debate continues as to whether fibromyalgia is a distinct syndrome or a composite of various pain syndromes with overlapping features. FMS has been used interchangeably in the past with other painful muscular conditions such as myofascial pain syndrome. Myofascial pain syndrome (MPS) can best be described as a regional muscle pain disorder accompanied by trigger points.2 A trigger point, as defined by the International Association for the Study of Pain, is characterized as a discrete point of tenderness, palpable in a taut band of muscle.3 Palpation of a trigger point usually produces a twitch or “jump sign” as well as a regional referred pain pattern. Myofascial trigger points can also be found in ligaments and tendons and are associated with other chronic pain syndromes including fibromyalgia.

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Fibromyalgia syndrome encompasses a broader spectrum of clinical features including sleep disturbance, memory loss, migraine headache, irritable bowel, diffuse pain, and morning stiffness.4 Women are generally affected more often than men, with the prevalence rate of 3.4% for women, 0.5% for men, and 2.0% for both genders overall. Patients between the ages of 20 and 60 years are most often affected by FMS.5

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Data on myofascial pain suggest that it is a commonly encountered entity. In a study of 172 patients presenting to a university primary care clinic, 54 patients complained of pain, 30% of whom received a diagnosis of myofascial pain. In another study, myofascial pain was the primary diagnosis in 85% of admissions to a chronic pain center.6 The incidence of trigger points also appears to be higher in women. Myofascial pain has been shown to increase during the second week of the menstrual cycle, suggesting a hormonal influence. Other studies have shown myofascial pain to be less common in sedentary workers, indicating a possible protective effect of daily activity. In terms of anatomic distribution of pain, the neck, shoulder area, and lower back appear to account for most trigger point activity.7

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Signs and Symptoms

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Correctly diagnosing fibromyalgia can be difficult because of the various symptoms previously mentioned, including widespread musculoskeletal pain, muscle stiffness, and weakness. Timely diagnosis is important to ensure patients obtain both psychological support and relief from pain. It is important to distinguish that fibromyalgia is characterized as generalized diffuse musculoskeletal pain involving multiple tender points in the absence of an underlying condition, such as rheumatoid arthritis or hypothyroidism.8 Well-defined diagnostic criteria ...

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