Controllling Pain: New thinking about fibromyalgia pain
Yvonne D'Arcy MS, CRNP, CNS

February 2011 
Volume 41  Number 2
Pages 63 - 64
  PDF Version Available!

STEPHANIE PETERS*, 48, has been seeing her primary care provider off and on for several years with the same types of complaints: generalized, severe bilateral musculoskeletal pain at various anatomic sites, including her hips and shoulders. She has difficulty falling asleep and staying asleep, and says she's fatigued and irritable at times. She also has some difficulty remembering things but just feels it's a part of her busy lifestyle. Yesterday, a friend hugged her, causing Ms. Peters to scream in pain. You suspect she has fibromyalgia.This patient's pain has all the hallmarks of fibromyalgia pain-it's chronic, widespread, and occurs above and below the waist and on both sides of her body. She also has a sleep disturbance and fatigue. With these three criteria, this patient would fulfill the American College of Rheumatologists' (ACR) newly expanded criteria for a diagnosis of fibromyalgia syndrome (FMS).1,2 This article describes the expanded criteria.FMS is now being considered a neuropathic pain syndrome with a central amplification (or exaggerated response) of pain that produces allodynia (pain from a stimulus that's not normally painful) and hyperalgesia (an exaggerated pain response to a mildly painful stimulus).3 FMS isn't a musculoskeletal syndrome-the severe intensity of pain is the result of changes in pain transmission, high levels of substance P (a pain-facilitating substance) in the cerebrospinal fluid, and elevated nerve growth factor that alters sensory processing.4-7Because FMS can include several different comorbid conditions (see A fibromyalgia primer), patients can be difficult to diagnose. According to the National Fibromyalgia Association ( ), the average FMS patient sees four to six healthcare providers over 5 to 6 years before obtaining a definitive diagnosis.The current diagnostic criteria for FMS are: * chronic, widespread axial pain above and below the waist, affecting the right and left sides of the body, for more than

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