Diagnosis
The symptoms of fibromyalgia are varied, ranging from chronic widespread pain only to chronic widespread pain plus a variety of other symptoms. General or whole body complaints, visceral function abnormalities (or those of internal/vital organs) and regional pain syndromes may all be part of the initial complaint or may overlap or coexist with multiple conditions. It is less important to differentiate the diagnosis of fibromyalgia from these other conditions than it is to obtain a complete picture of how these symptoms affect the patient and what lifestyle factors may be impacting the symptoms.
Because pain and tenderness are defining characteristics of fibromyalgia, it is important to focus on the features of the pain to distinguish it from other disorders. The pain of fibromyalgia may be spread about the body or from multiple point, often comes and goes, and is frequently moving about or migratory in nature. Patients may report discomfort when they are touched or when wearing tight clothing, and may experience dysesthesias (an unpleasant or abnormal sensation whether spontaneous or evoked) or paresthesias (a skin sensation such as burning, prickling, itching or tingling with no apparent physical cause) that accompany the pain. A past or present history of chronic pain in other areas of the body (e.g., the neck or back, noncardiac chest pain, headaches, TMJ, pelvic pain, etc.) makes it more likely that the individual has a condition in this spectrum.
Aside from the pain, a number of seemingly non-related symptoms may develop and persist, such as problems with attention or memory, large, unexplainable weight changes, intolerance to heat or cold, weakness, and the most common complaint, fatigue. Seemingly “allergic” symptoms also are common in fibromyalgia patients. They may show a high degree of adverse reactions or sensitivity to drugs, chemicals and other environmental stimuli such as bright lights or loud noises. These frequent hypersensitivities to various environmental stimuli suggest that in some individuals there is a generalized disturbance in sensory processing, not just of painful stimuli. These patients also are more prone to non-allergic rhinitis (inflammation of the nasal mucous membrane), sinus and nasal congestion, and lower respiratory symptoms, all of which also may be attributable to neural mechanisms or actions of the nervous system.
Distortions in hearing, vision and vestibular (ear canal) symptoms (for example, dizziness) are often reported. Patients with these conditions often experience a reduced threshold to painful noise, low-frequency sensorinueral hearing loss, ocular dysmotility (e.g., difficulty focusing), nystagmus (a rapid, involuntary motion of the eyeball) and sicca symptoms (dry eyes and mouth).
Reference list
Clauw, D. J., Heshmat, Y., Groner, K., Gondy, G., & Barbey, J. T. (1996). Heart rate variability as a measure of autonomic function in patients with FM. Arthritis & Rheumatism, 39, S276.
