The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee

University of Kansas, Arthritis Center, Wichita 67214.
Arthritis & Rheumatology (Impact Factor: 7.76). 03/1990; 33(2):160-72.
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To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.

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Available from: Fred Wolfe, Oct 16, 2014
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    • "The valid basic method today of fibromyalgia syndrome diagnosis is to use clinical and physical examination findings. The basis of clinical evaluation is the fibromyalgia classification criteria stipulated by the ACR in 1990 and back in 2010 [28]. FMS can be diagnosed using the ACR Fibromyalgia Diagnostic Criteria. "
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    ABSTRACT: Background: Fibromyalgia syndrome (FMS) is identified by widespread musculoskeletal pain, sleep disturbance, nonrestorative sleep, fatigue, morning stiffness and anxiety. Anxiety is very common in Fibromyalgia and generally leads to a misdiagnosis. Self-rated Beck Anxiety Inventory (BAI) and doctor-rated Hamilton Anxiety Inventory (HAM-A) are frequently used by specialists to determine anxiety that accompanies fibromyalgia. However, these semi-quantitative anxiety tests are still subjective as the tests are scored using doctor-rated or self-rated scales. Method: In this study, we investigated the relationship between heart rate variability (HRV) frequency subbands and anxiety tests. The study was conducted with 56 FMS patients and 34 healthy controls. BAI and HAM-A test scores were determined for each participant. ECG signals were then recruited and 71 HRV subbands were obtained from these ECG signals using Wavelet Packet Transform (WPT). The subbands and anxiety tests scores were analyzed and compared using multilayer perceptron neural networks (MLPNN). Results: The results show that a HRV high frequency (HF) subband in the range of 0.15235Hz to 0.40235Hz, is correlated with BAI scores and another HRV HF subband, frequency range of 0.15235Hz to 0.28907Hz is correlated with HAM-A scores. The overall accuracy is 91.11% for HAM-A and 90% for BAI with MLPNN analysis. Conclusion: Doctor-rated or self-rated anxiety tests should be supported with quantitative and more objective methods. Our results show that the HRV parameters will be able to support the anxiety tests in the clinical evaluation of fibromyalgia. In other words, HRV parameters can potentially be used as an auxiliary diagnostic method in conjunction with anxiety tests.
    Computers in Biology and Medicine 11/2015; 67:126-135. DOI:10.1016/j.compbiomed.2015.10.003 · 1.24 Impact Factor
    • "Eighty-nine women and three men diagnosed with FMS, recruited via the Fibromyalgia Association of Jaén, participated in the study. All patients were examined by a rheumatologist and met the American College of Rheumatology criteria for FMS (Wolfe et al., 1990). Exclusionary criteria comprised cardiovascular diseases of any kind, metabolic abnormalities, inflammatory causes of pain, neurological disorders, and severe somatic (e.g., cancer) or psychiatric (e.g. psychotic or bipolar) diseases. "
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    ABSTRACT: This study evaluates H.J. Eysenck’s three personality dimensions (neuroticism, extraversion, and psychoticism) in patients with fibromyalgia (FMS) compared with healthy controls (HC), and analyzes their association with clinical, emotional and functional variables and pain coping strategies. Ninety-two FMS patients and 65 HC completed the abbreviated EPQR, in addition to instruments measuring clinical pain, fatigue, sleep, anxiety, depression, health related quality of live (HRQL) and pain coping strategies. Results showed: (1) FMS patients exhibited greater levels of neuroticism and psychoticism but not extroversion, in comparison with HC; (2) group differences in all measured variables remained when the three personality dimensions were entered as covariates; (3) while in HC neuroticism was positively associated with pain, anxiety, depression, catastrophizing strategy scores, and lower HRQL, in FMS patients associations were sparse and lower in magnitude; (4) in FMS patients extroversion was associated with lower pain, anxiety, and depression, and higher mental HRQL; and (5) psychoticism was associated with lower anxiety in the FMS group and greater catastrophizing in HC. Data suggest that neuroticism only plays a minor role in clinical manifestations of FMS. However, extraversion appears to exert a protective influence in FMS, as it is associated with better health outcomes in several domains.
    Personality and Individual Differences 10/2015; 85. DOI:10.1016/j.paid.2015.05.017 · 1.95 Impact Factor
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    • "Six of the 18 FM Btender points^ were selected for determination of each subject's mechanical pain sensitivity and tolerance: bilateral second rib, bilateral trapezius muscle, and the bilateral medial fat pads of the knee (Wolfe et al. 1990). A JTech Commander Algometer (JTech Medical, Salt Lake City, UT) with a rubber disc of 1 cm 2 was applied at 90 0 to each of these points. "
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    ABSTRACT: Approximately 30 % of Americans suffer from chronic pain disorders, such as fibromyalgia (FM), which can cause debilitating pain. Many pain-killing drugs prescribed for chronic pain disorders are highly addictive, have limited clinical efficacy, and do not treat the cognitive symptoms reported by many patients. The neurobiological substrates of chronic pain are largely unknown, but evidence points to altered dopaminergic transmission in aberrant pain perception. We sought to characterize the dopamine (DA) system in individuals with FM. Positron emission tomography (PET) with [(18)F]fallypride (FAL) was used to assess changes in DA during a working memory challenge relative to a baseline task, and to test for associations between baseline D2/D3 availability and experimental pain measures. Twelve female subjects with FM and 11 female controls completed study procedures. Subjects received one FAL PET scan while performing a "2-back" task, and one while performing a "0-back" (attentional control, "baseline") task. FM subjects had lower baseline FAL binding potential (BP) in several cortical regions relative to controls, including anterior cingulate cortex. In FM subjects, self-reported spontaneous pain negatively correlated with FAL BP in the left orbitofrontal cortex and parahippocampal gyrus. Baseline BP was significantly negatively correlated with experimental pain sensitivity and tolerance in both FM and CON subjects, although spatial patterns of these associations differed between groups. The data suggest that abnormal DA function may be associated with differential processing of pain perception in FM. Further studies are needed to explore the functional significance of DA in nociception and cognitive processing in chronic pain.
    Brain Imaging and Behavior 10/2015; DOI:10.1007/s11682-015-9459-4 · 4.60 Impact Factor
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