The pain is widespread and of 3 months' duration.
Pain consists of axial pain, on both the right and left sides of the body, and above and below the waist. Pain must be present in at least three segments of the body. There must be at least 11 tender points (of the critical 18) on digital examination (approximate force of 4 kg): Insertion of the suboccipital muscles into the occiput Upper border of the midportion of the trapezius Muscle attachments to the medial scapular border Anterior aspects of the C5 and C7 intertransverse spaces
Second rib space at the costochondral junctions (approximately 3 cm from the sternal border) Muscle insertions 2 cm distal to the lateral epicondyle Upper outer quadrant of the gluteal muscle Muscle attachments posterior to the greater trochanter Medial fat pad proximal to the knee joint
Source. Adapted from Wolfe F, Smythe HA, Yunus MB, et al.: "The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia: Report of the Multicenter Criteria Committee." Arthritis and Rheumatism 33:171, 1990. Copyright 1990 John Wiley & Sons. Used with permission.
required for fibromyalgia leads to a diagnosis of myofascial pain syndrome. Controversy surrounds the diagnosis of fibromyalgia. The American College of Rheumatology (ACR) criteria for the diagnosis of fibromyalgia are listed in Table 8-7 (Wolfe et al. 1990). Some researchers and clinicians consider the diagnostic criteria to be too restrictive, requiring identification of a specific number and location of tender points to establish the diagnosis. Yet many patients experience tender points in other regions of the body that are not included in the "acceptable" locations defined by the ACR. However, some physicians have considered fibromyalgia to be no more than a rheumatologic rubric for somatoform disorders (Hadler 1997).
The prevalence of fibromyalgia varies depending on the populations under study. In general medical clinics, the rate of fibromyalgia is approximately 5%-10%, whereas in rheumatology practices, the rate is approximately 15%. Estimates of fibromyalgia in the general population are approximately 2%. The prevalence appears to increase with age and is higher among women (3%) than men (0.5%).
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