1. Fibromyalgia: A Chronic Widespread Neurologic Pain Condition
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Fibromyalgia: A Chronic Widespread Neurologic Pain Condition
Disease Overview, Diagnosis, and Management
PBP00542 © 2009 Pfizer Inc. All rights reserved. Printed in USA/September 2009

2. Pathogenesis of Fibromyalgia
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11/14/2018
What is Fibromyalgia?
Pathogenesis of Fibromyalgia
Clinical Features and Diagnosis of Fibromyalgia
Management of Fibromyalgia 2 2

3. Central Pain Amplification Abnormal Pain Processing by CNS
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FM Is a Chronic Pain Condition and Is Distinct from Other Types of Pain
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Woolf C
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Figure 1
Nociceptive
Pain
Neuropathic
Pain
Inflammatory
Pain
Central Pain Amplification
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Figure 1
(ie, Burn)
FM is a chronic pain condition and is distinct from other types of pain
Nociceptive pain is a response to a painful stimulus, such as fire. This is typically short in duration and involves acute pain1
Neuropathic pain, such as herpes zoster or diabetic peripheral neuropathy, is typically a result of damage to the nerves. Patients commonly develop a lesion or underlying condition causing the symptom1
Inflammatory pain can present with redness and swelling. Conditions such as Rheumatoid Arthritis present with inflammatory pain1
In the spectrum of clinical pain syndromes, fibromyalgia lies in the realm of central pain amplification. This is when abnormal pain processing occurs in the Central Nervous System (CNS). Often, no obvious cause can be identified.1 Fibromyalgia pain is chronic in nature
Reference:
Woolf CJ. Pain: Moving from Symptom Control toward Mechanism-Specific Pharmacologic Management. Ann Intern Med. 2004;140:
(ie, Herpes zoster)
(ie, Rheumatoid arthritis)
(ie, Fibromyalgia)
Painful
Stimuli
Neuronal
Damage
Inflammation
Abnormal Pain Processing by CNS
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Figure 1
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Acute Pain
Chronic Pain
Adapted from Woolf C. Ann Intern Med. 2004;140: 3

4. Fibromyalgia (FM): A Chronic Widespread Neurologic Pain Condition
11/14/2018
Fibromyalgia (FM): A Chronic Widespread Neurologic Pain Condition
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Wolfe et al
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FM is a neurological condition associated with chronic widespread pain (CWP) and tenderness1
American College of Rheumatology (ACR) criteria for the diagnosis of FM2
Chronic widespread pain
Pain for ≥3 months
Pain above and below the waist
Pain on left and right sides of body and axial skeleton
Pain at ≥11 of 18 tender points when palpated with 4 kg of digital pressure
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Fibromyalgia (FM) is a chronic widespread neurologic pain condition1
To diagnose FM using the ACR Diagnostic criteria:
The patient must have chronic, widespread pain for ≥3 months2
The pain is located in all 4 quadrants of the body – that is both above and below the waist and on left and right sides of the body2
The pain includes the axial skeleton2
The patient has pain in at least 11 of the 18 tender points when palpated with 4 kg of digital pressure2
The American College of Rheumatology (ACR) guidelines provide a sensitive (88.4%) and specific (81.1%) tool that can be used to differentiate FM from other rheumatologic conditions. Sensitivity, or the true positive rate, is the proportion of FM patients positive for the criterion. Specificity, or the true negative rate, is the proportion of controls negative for the criterion2
References:
1. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38:19-28.
2. 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 Rheum. 1990;33:
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Wolfe et al
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Diagram Showing 18 Tender Points
ACR criteria are:2
Sensitive (88.4%) – measure of correctly diagnosed patients
Specific (81.1%) – statistical probability of an accurate negative diagnosis
Ref 2.a
Wolfe et al
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Ref 2.b
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1Wolfe F, et al. Arthritis Rheum. 1995;38(1):19-28.
2Wolfe F, et al. Arthritis Rheum. 1990;33:
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Table 6

5. Epidemiology of FM FM Is One of the Most Common CWP Conditions1
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Epidemiology of FM
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FM Is One of the Most Common CWP Conditions1
Prevalence in United States is estimated to be 2%-5% of the adult population1
FM is highly underdiagnosed2
Only 1 in 5 is diagnosed
Diagnosis takes an average of 5 years3
Impacts a wide range of patients2
Most patients are between 25 and 60 years of age
Women more likely to be diagnosed than men
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Weir et al
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NPF Website
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Weir et al
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Table 2
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FM affects 2%-5% of the US adult population.1
Only 1 in every 5 patients suffering from FM is diagnosed and it takes an average of 5 years for the diagnosis to be made2,3
FM impacts a wide range of patients2
Most patients are between 25 and 60 years of age
Women are more likely to be diagnosed with FM than men
References:
Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38(1):19-28.
Weir PT, Harlan GA, Nkoy FL, et al. The incidence of fibromyalgia and its associated comorbidities: a population-based retrospective cohort study based on International Classification of Diseases, 9th Revision codes. J Clin Rheumatol. 2006;12(3):
National Pain Foundation. Available at: Accessed July 21, 2009.
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NPF Website
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Weir et al
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Table 2
1Wolfe F, et al. Arthritis Rheum. 1995;38:19-28.
2Weir PT, et al. J Clin Rheumatol. 2006;12:
3National Pain Foundation. Available at: Accessed July 21, 2009.

6. Risk Factors for FM Genetic factors1 Environmental factors2 Gender3
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Risk Factors for FM
Genetic factors1
Relatives of FM patients are at higher risk for FM
First-degree relatives are significantly more likely to have FM (Odds ratio=8.5; p=0.0002)
Environmental factors2
Physical trauma or injury
Infections (Lyme disease, hepatitis C)
Other stressors (e.g., work, family, life-changing events)
Gender3
Women are diagnosed with FM approximately 7 times more often than men
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Arnold et al
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While the cause of fibromyalgia is not known, evidence suggests that genetic,
environmental, and other factors may predispose individuals to developing FM.1
Arnold et al demonstrated that FM and reduced pain pressure thresholds may aggregate in families1
First-degree relatives are significantly more likely to have FM2
This was adjusted for the relative’s age, sex, relationship to proband, interview status, and correlation of observations within families2
Environmental factors such as physical trauma, infections (Lyme disease, hepatitis C, parvovirus, Epstein-Barr virus), and other stressors such as work, family, or life-changing events may trigger the onset of FM2
Gender is also a factor as women are diagnosed with FM approximately 7 times more often than men3
References:
1. Arnold LM, Hudson JI, Hess EV, et al. Family study of fibromyalgia. Arthritis Rheum. 2004;50(3):
2. Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol. 2005;32(suppl 75):6-21.
3. Arnold LM, Lu Y, Crofford LJ, et al. A Double-Blind, Multicenter Trial Comparing Duloxetine With Placebo in the Treatment of Fibromyalgia Patients With or Without Major Depressive Disorder. Arthritis Rheum. 2004;50(9):
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1Arnold LM, et al. Arthritis Rheum. 2004;50(3):
2Mease PJ. J Rheumatol. 2005;32(suppl 75):6-21.
3Arnold LM, et al. Arthritis Rheum. 2004;50(9):