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Studying the epidemiology of fibromyalgia (FM) is very important to understand the impact of this disorder on persons, families and society. The recent modified 2010 classification criteria of the American College of Rheumatology (ACR), without the need of tender points palpation, allows that larger and nationwide surveys may be done, worldwide. This article reviews the prevalence and incidence studies done in the general population, in several countries/continents, the prevalence of FM in special groups/settings, the association of FM with some sociodemographic characteristics of the population, and the comorbidity of FM with others disorders, especially with headaches.
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Current Pain and Headache Reports
ISSN 1531-3433
Volume 17
Number 8
Curr Pain Headache Rep (2013) 17:1-6
DOI 10.1007/s11916-013-0356-5
Worldwide Epidemiology of Fibromyalgia
Luiz Paulo Queiroz
1 23
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FIBROMYALGIA (M PERES, SECTION EDITOR)
Worldwide Epidemiology of Fibromyalgia
Luiz Paulo Queiroz
#
Springer Science+Business Media New York 2013
Abstract Studying the epidemiology of fibromyalgia (FM) is
very important to understand the impact of this disorder on
persons, families and society. The recent modified 2010 clas-
sification criteria of the American College of Rheumatology
(ACR), without the need of tender points palpation, allows
that larger and nationwide surveys may be done, worldwide.
This article reviews the prevalence and incidence studies done
in the general population, in several countries/continents, the
prevalence of FM in special groups/settings, the association of
FM with some sociodemographic characteristics of the popu-
lation, and the comorbidity of FM with others disorders,
especially with headaches.
Keywords Epidemiology
.
Prevalence
.
Fibromyalgia
.
Chronic widespread pain
.
Chronic pain
.
Headache
Introduction
Chronic pain is one of the most frequent complaints in med-
ical practice. The International Association for the Study of
Pain (IASP) estimates that chronic pain, including musculo-
skeletal and joint pain, neck and back pain, cancer pain,
trauma and post-chirurgical pain, and chronic headache, af-
flicts about 20 % (1055 %) of the adult population, world-
wide [1]. It is considered as a major social and economic
burden to individuals, to families, and to society, with impor-
tant physical and psychological consequences to sufferers [2].
Fibromyalgia (FM) is one of the main causes of chronic
widespread pain (CWP). It represents a situation in which
central nervous sensitization is manifested by CWP, which is
the cardinal symptom of FM, and generalized tender points
(hyperalgesia) [3, 4]. Other associated symptoms may be
present, including fatigue, sleep disturbances, difficulties
with memory and concentration, irritable bowel syndrome,
headache, depression. It is debatable if FM is a distinct
clinical entity or part of spectrum of CWP [5]. There are still
some physicians who deny the validity of this diagnosis,
attributing the pain complaints as a manifestatio n of other
clinical and/or psychiatric disorders.
In 1990, the Ameri can College of Rheumatology (ACR)
published some criteria for the classification of CWP and FM
[6]. The proposed criteria for FM were: CWP in combination
with tenderness at 11 or more of 18 specific tender point
sites. CWP was defined as pain for at least three months, in
the axial skeleton plus pain in the left and the right side of the
body, and pain above and below the waist. Ten years later
(2010), the ACR introduced new preliminary diagnostic
criteria [7], which would also be suitable for use by primary
care physicians, as it did not require tender points examina-
tion, referred by many as difficult to apply and to interpret.
The examination of tender points was also an impediment for
doing large, nationwide epidemiological studies on FM, as
they required all subjects with CWP to be examined by
specialists. In 2011, the same group published a modification
of the 2010 ACR criteria [8••], developing a survey ques-
tionnaire for epidemiological and clinical studies, which
allows easier future larger, nationw ide surveys.
Epidemiological studies are important to better under-
stand the extent of the problem in general populations or
specific settings, in order to calculate the appropriated re-
sources to provide adequate assistance to FM sufferers.
Prevalence of Fibromyalgia
The prevalence of FM has been estimated in many studies in
different settings, areas and countries, and on four continents:
Africa, the Americas, Asia, and Europe. There was only one
This article is part of the Topical Collection on Fibromyalgia
L. P. Queiroz (*)
Department of Neurology, Universidade Federal de Santa Catarina,
Clínica do Cérebro. Rua Presidente Coutinho, 464 - Centro,
88015-231 Florianópolis, SC, Brazil
e-mail: lpqueiroz@floripa.com.br
Curr Pain Headache Rep (2013) 17:356
DOI 10.1007/s11916-013-0356-5
Author's personal copy
study in Africa, in Tunisia [9], and none in Oceania. The
epidemiological studies in adults of the general populations
are depicted in Table 1. The global mean prevalence of FM
was 2.7 %, ranging from 0.4 % in Greece [26]to9.3%in
Tunisia [9]. The mean rate was 3.1 % in the Americas, 2.5 %
in Europe, and 1.7 % in Asia. In women, the mean prevalence
was 4.2 % and in men 1.4 %, with a female-to-male ratio of
3:1. Most of these studies were done in some specific
areas/towns/cities of the country; nationwide prevalence rates
were only estimated in Canada [12], France [21, 22], Finland
[23], Germany [24, 25], Israel [3], Italy[24], Portugal [24],
and Spain [24, 28].
There were three recent studies using the 2010 ACR
criteria for diagnosing FM, in the USA [14], in Germany
[25], and in Thailand (Abstr act) [19]. Although this new
criteria has an increased sensibil ity and decreased specificity
in relation to the 1990 ACR criteria, it seems that it does not
result in higher prevalence rates of FM in epidemiological
surveys [25].
The prevalence of FM was also estimated in specific pop-
ulations or settings. In women, the rates were 10.5 % in
Arendal, Norway (20 to 49 years) [31] and 3.6 % in Trabzon,
Turkey (20 to 64 years) [32]. In Mexican school children,
aged 915 years, the prevalence was 1.2 % [33]. In elderly
Table 1 Prevalence of fibromyalgia in the general population
Country Author Case definition N Age range (y) Prevalence (%)
Overall Female Male
Africa
Tunisia Guermazi [9] LFESSQ 1,000 15 9.3 ––
Americas
Brazil Senna [10] COPCORD 3,038 16 2.5 3.9 0.1
Canada White [11] 1990 ACR 3,395 18 3.3 4.9 1.6
Canada McNally [12] Self-reported 131,535 12 1.1 1.8 0.3
USA Wolfe [13] 1990 ACR 3,006 18 2.2 3.4 0.5
USA Vincent [14 ] 2010 ACR 3,410 21 6.4 7.7 4.9
Asia
Bangladesh Haq [15] COPCORD 5,211 15 3.6 6.2 0.9
China Scudds [16] 1990 ACR 1,467 0.8 ––
Israel Ablin [3] LFESSQ + 1990 ACR 1,019 18 2.0 2.8 1.1
Malaysia Veerapen [17] COPCORD 2,594 15 0.9 1.5 0.2
Pakistan Farooqi [18] COPCORD 1,997 15 2.1 ––
Thailand Prateepavanich [19] 2010 ACR 1,000 0.6 ––
Europe
Denmark Prescott [20] 1990 ACR 1,219 1879 0.7 ––
France Bannwarth [21] LFESSQ + 1990 ACR 1,014 15 1.4 2.0 0.7
France Perrot [22] LFESSQ + 1990 ACR 3,081 18 1.6 ––
Finland Mäkelä [23] Yunus criteria 7,217 30 0.75 1.0 0.5
Germany Branco [24] LFESSQ + 1990 ACR 1,002
15 3.2 3.9 2.5
Germany Wolfe [25] 2010 ACR 2,445 14 2.1 2.4 1.8
Greece Andrianakos [26] 1990 ACR 8,740 19 0.4 ––
Italy Salaffi [27] 1990 ACR 2,155 18 2.2 ––
Italy Branco [24] LFESSQ + 1990 ACR 1,000 15 3.7 5.5 1.6
Portugal Branco [24] LFESSQ + 1990 ACR 500 15 3.6 5.2 1.8
Spain Branco [24] LFESSQ + 1990 ACR 1,001 15 2.3 3.3 1.3
Spain Mas [28] 1990 ACR 2,192 20 2.4 4.2 0.2
Sweden Lindell [29] 1990 ACR 2,425 2074 1.3 2.4 0.0
Turkey Turhanoglu [30] 1990 ACR 600 8.8 12.5 5.1
Mean 2.7 4.1 1.4
LFESSQ London Fibromyalgia Epidemiology Study Screening Questionnaire; COPCORD Community Oriented Program for the Control of Rheumatic
Diseases; ACR American College of Rheumatology
356, Page 2 of 6 Curr Pain Headache Rep (2013) 17:356
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subjects, 65 years or older, in São Paulo, Brazil, a rate of 5.5 %
was found [34]. In hospitalized patients of a primary care unit
of Seoul, South Korea, the rate was 1.7 % [35]. Gallinaro et al.
[36] found a 10.4 % prevalence of FM in metalworkers
without repetitive strain injuries, and 58.8 % in those with
this condition. Among textile workers in Denizli, Turkey, the
rate was 7.3 % (9.0 % in females and 0.8 % in males) [37]. In
hospital workers in Japan, the rate was 2.0 % in women and
0.5 % in men [38]. In the Amish community of London,
Ontario, Canada, the rate was 7.3 % (10.4 % in females and
3.7 % in males) [39]. In a low socioeconomic status popula-
tion in Embu, São Paulo, Brazil, assisted by the public primary
health care system, the rate was 4.4 % [40]. In patients of 16
general practices of Marche, Italy, the rate 2.2 % [27], and in
patients of a health insurance company in Germany, the rate
was 0.4 % of women and 0.05 % of men [41].
Incidence of Fibromyalgia
The in cidence of FM has been estima ted in two studies.
Forseth et al. [42] found an incidence in females, aged 20
49 years, living in Arendal, Norway, of 5.83 new cases per
1,000 personyears. Weir et al. [43] reported an incidence
rate of 6.88 new cases per 1,000 personyears for males and
11.28 new cases per 1,000 personyears for females, from a
health insurance claims database.
Association of Fibromyalgia with Some Sociodemographic
Variable s
Many studies have shown that the prevalence of FM is higher
either at the middle age (30 to 50 years) [10, 28, 37]orafter
50 years of age [3, 12, 13, 23, 24, 25, 29, 30, 32]. White et al.
[11] reported a peak prevalence in men in middle age, and in
women the prevalence increasing steadily with age. The study
of Vincent et al. [14] was the only one that contrasted to the
trend of increasing prevalence of FM with older ages; they
described a higher rate in young ages (21 to 39 years).
All papers that studied the association of FM with the
education level of subjects reported higher prevalence rates
of this entity in low educat ed patients [11, 21, 23, 28,
32].
The same pattern was seen with socioeconomic status: the
lower the household income, the higher the FM prevalence
rate [11, 12, 28, 32, 37 ].
Regarding marital status, there was no consensus in the
literature. Topbas et al. [32] found that FM was more fre-
quent in widow ed patients, Cobankara et al. [37] in married
people, and White et al. [11] in divorced ones.
There was also a discrepancy about living in rura l or
urban areas. McNally et al. [12] in Canada, Mas et al. [8••]
in Spain, and Hag et al. [15] in Bangladesh, all reported
higher rates of FM in rural areas, whereas Turhanoglu et al.
[30], in Turkey, found a higher prevalence in the urban
population.
The association of FM with body weight was only men-
tioned by McNally et al. [12], with higher FM preval ence in
obese wom en.
Fibromyalgia Comorbidity
The EPIFFAC Study [ 44 ], in Spain, reported that 84 % of
patients with FM have one or more comorbid diseases: 67 %
have other musculoskeletal conditions, 35 % psychological
disorders, 27 % gastrointestinal disorders, 23.5 % cardiovas-
cular disorders, and 19 % endocrinological disorders.
Table 2 Prevalence of fibromyalgia in patients with some types of headache
Author N Type of headache Prevalence of fibromyalgia (%) Setting Country
Peres [48] 101 Transformed migraine 35.6 Headache clinic Brazil
Ifergane [49] 92 Episodic migraine 17.4 Headache clinic Israel
de Tommaso [ 50] 217 Primary headaches 36.4 Headache center Italy
Migraine 28.5
TTH 59.0
de Tommaso [ 51] 849 Primary headaches 19.6 Pain clinic Italy
Migraine 17.8
TTH 35.1
Tietjen [52] 1,413 Migraine 6.9 Headache clinics USA
Tietjen [53] 223 Migraine 11.7 Headache clinic USA
Le [54] 8,044 Migraine 1.2 Twins cohort Denmark
Migraine with aura 2.1
Migraine without aura 0.6
Küçüksen [55] 118 Migraine 31.4 Headache clinic Turkey
Curr Pain Headache Rep (2013) 17:356 Page 3 of 6, 356
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In hospitalized patients in the USA, the most common
comorbidities when FM was the primary diagnosis
were: non-specific chest pain, mood disorders, and
spondylosis/intervertebral disc disorders/other back prob-
lems; with FM as a secondary diagnosis, the most common
primary diagnoses were: essential hypertension, disorders of
lipid metabolism, coronary atherosclerosis/other heart dis-
eases, and mental disorders [45].
Wolfe et al. [46], in the USA, reported a significant
association of FM with: hypertension, other cardiovascular
conditions, depression, diabetes, lung diseases, asthma, liver
diseases, neurological diseases, thyroid diseases, gastroin-
testinal disorders, mental illnesses, renal diseases, severe
allergies, genitourinary disorders. FM p atients have stronger
comorbidity with these disorders than patients with rheuma-
toid arthritis.
Weir et al. [43], in a large health insurance database, in the
USA, described that patients with FM were two to seven
times more likely t o have one or more of the following
comorbid conditions: depression, anxiety, headache, irritable
bowel syndro me, chronic fatigue syndrome, systemic lupus
erythematosus, and rheumatoid arthritis. In Germany, in a
statutory health insurance company, 51.9 % of patients with
FM were diagnosed with a comorbid depression as well [41].
There is an overlap in the symptomalogy and also disease
comorbidity among some "functional" condition s, including
FM, chronic headache, chronic fatigue syndrome, low back
pain, irritable bowel syndrome, temporomandibular joint
disorders, major depression, anxiety, panic attack, post-
traumatic stress disorder [47].
The prevalence of FM in p atients with some types of
headache is shown in Table 2. FM is highly prevalent both
in migraineurs, with episodic and chronic forms, as well as in
patients with tension type headache (TTH). Schur et al. [47]
have shown that twins with chronic TTH have 6.6 times more
FM than those without it, and patients with FM have 5.0 times
more chronic TTHa bidirectional association. Aaron et al.
[56] found five patients (22.7 %) with chronic TTH out of 22
with FM. Marcus et al. [57], reported that 76 out of 100
patients with FM had headaches; 32 had migraines, 18 TTH,
16 combined migraine and TTH, 4 post-traumatic headache,
and 6 probable analgesic overuse headache. 84 % of the
patients with FM + headache described important or severe
impact from their head pain. Ravindran et al. [58]statedthat
there is a strong association between FM and chronic fatigue
syndrome + migraine without aura (47.4 %).
Conclusion
The global prevalence of FM, in 26 studies worldwide, is
2.7 %. FM is more prevalent in women, in patients over
50 years of age, in subjects with low education level, with
low socioeconomic status, living in rural areas, and possibly
in obese women.
FM is comorbid with many diseases, usually called "func-
tional" disorders, such as chronic fatigue syndrome, irritable
bowel syndrome, depression, anxiety, panic attacks, and
post-traumatic stress disorder.
The association of FM with headache is signifi cant, in-
cluding episodic and chronic migraine and chronic TTH.
It is desirable and important to have more nationwide
epidemiolog ical studies on FM, e specially outside of Eu-
rope, to have a better view of the prevalence of this disorder
worldwide, and to measure the burden of FM on persons,
families and society.
Compliance with Ethics Guidelines
Conflict of Interest Dr. Luiz Paulo Queiroz reported no potential
conflicts of interest relevant to this article.
Human and Animal Right s and Informed Consent This arti cle
does not contain any studies with human or animal subjects performed
by any of the authors.
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... Fibromyalgia affects between 0.2% and 6.6% of the world's population, thereby making it one of the greatest problems in the general population and the most frequent cause of chronic and diffuse musculoskeletal pain [6]. It is more common in middle-aged adults, with a range of 0.5% to 5% in the general population and up to 17.5% in a clinical setting [7,8]. ...
... Furthermore, the presence of FM implies a reduction in the quality of life in those patients who have it [8,9], and other syndromes such as irritable bowel syndrome or chronic fatigue syndrome can be up to 3 times more prevalent in patients with fibromyalgia than in the rest of the population [3]. Nevertheless, the early detection of FM, not to mention the absence of sleep disturbances in this clinical picture, have been shown to lead to a more favourable outcome in those patients with this condition. ...
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Nowadays, there is evidence that relates the amount of physical activity, as well as the impact of psychological factors, to the intensity of symptoms present in patients with fibromyalgia (FM). However, there are no studies which correlate the level of association of physical activity, psychological factors and vegetative symptoms in the FM population. The study has a cross-sectional observational design with 41 participants being recruited from a private clinic and rehabilitation service. The Autonomic Symptom Profile (Compass-31) to assess vegetative symptoms, the GODIN questionnaire to evaluate the level of leisure activity, and the pain catastrophizing scale, Tampa Kinesiophobia Scale and Self-Efficacy Scale to assess psychological factors, were used. A low and significant level of association was found between pain catastrophizing (PCS) and Kinesiophobia (r = 0.398; p < 0.01), as well as with catastrophizing and vegetative symptoms (r = 0.428; p < 0.05). Furthermore, a low and significant level of association was also found between self-efficacy and vegetative symptoms (r = 0.397; p < 0.05). No association was found between the level of daily physical activity (measured by the Godin Leisure questionnaire) and vegetative symptoms, nor with any psychological factor studied. There is an association between vegetative symptoms and psychological factors. Nevertheless, more research which takes other factors into account, such as lifestyle and nutritional, is needed.
... Fibromyalgia is a chronic, centralized pain sensitivity disorder involving the musculoskeletal system with a widespread and fluctuating course of pain episodes accompanied by psychological as well as somatic symptoms [1]. Basically, it increases the processing of pain in the central nervous system [2] with a mean population prevalence of 2.7% worldwide [3]. The most affected population is women in the age group of 30-55 years [4]. ...
... Fibromyalgia (FMS) is a chronic syndrome characterized by complex symptomatology, the core of which is generalized and persistent musculoskeletal pain that also comprises fatigue, sleep disturbances, morning joint stiffness, depression, and anxiety (Bennett, 2009;Schmidt-Wilcke & Diers, 2017). This syndrome is one of the most common causes of widespread chronic pain and is a common condition in the general population (Jones et al., 2015;Queiroz, 2013). The worldwide prevalence of FMS is between 2 and 5%, regardless of the territory, and it mainly affects women (Juuso et al., 2013). ...
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Fibromyalgia (FMS) is a chronic condition that encompasses widespread pain associated with cognitive impairment and significant emotional distress related to functional disability. This study aimed to obtain evidence of the role of pain in the effect of time since FMS diagnosis and cognitive performance using a novel online protocol of neuropsychological evaluation since the COVID-19 pandemic has challenged traditional neuropsychology testing leading to the need for novel procedures transitioning to tele-neuropsychology. A sample of 70 adult women was evaluated (50 with FMS and 19 controls) using online questionnaires that evaluated pain and executive functioning (impulsivity, inhibition control, monitoring, and planning). Afterward, participants were evaluated by trained neuropsychologists in a 30 min online session using virtually adapted cognitive tests: the Hopkins Verbal Learning Test (memory), the Symbol-Digit Modalities Test (attention and speed processing), the F-A-S test (verbal fluency), and Digit Span tests (working memory). We found that the time of FMS diagnosis has an effect on cognitive functioning predominantly mediated by pain. Our results point out the role of pain as a mediator on cognitive performance, specifically in executive functions which are directly affected by the cumulative effect of the time of diagnosis. Furthermore, the importance of considering a broader perspective for assessment and treatment including novel procedures via tele-neuropsychology.
... Fibromyalgia syndrome is a chronic pain disorder, ranked as one of the four most frequent rheumatologic disorders in the world (Cardiel & Rojas-Serrano, 2002;Carmona et al., 2001;Goldenberg et al., 1990;Haq et al., 2005;Häuser et al., 2015). The overall average prevalence of fibromyalgia syndrome is 2.7% (Queiroz, 2013). Although fibromyalgia syndrome is not a highly prevalent condition, patients are large consumers of health services and generate significant costs related to lost productivity (Annemans et al., 2008). ...
Article
Background: The aim of this study was to assess the effectiveness and cost-effectiveness of Pilates versus aerobic exercises in the treatment of patients with fibromyalgia syndrome from a societal perspective. Methods: This two-arm randomized controlled trial with blinded assessor and economic evaluation included 98 patients diagnosed with fibromyalgia syndrome using the American College of Rheumatology 2010 criteria, aged between 20 and 75 years, and pain intensity ≥ 3 points in the Pain Numerical Rating Scale. Patients were randomly allocated into the aerobic or Pilates group. Treatment was performed twice a week for eight weeks. The primary outcome was the impact of fibromyalgia measured eight weeks after randomization. Cost-effectiveness and cost-utility analyses were conducted for the impact of fibromyalgia and quality-adjusted life-years (QALYs), respectively, with a 12-month time horizon. Results: There was not difference between the groups for the impact of fibromyalgia (MD: 6.5 points; 95% CI: -1.8 to 14.9). The incremental cost-effectiveness ratio showed that 1-point increase in the impact of fibromyalgia was on average associated with a societal cost of £56 for the Pilates group compared to the aerobic group. The cost-utility analysis showed that the Pilates group had a 0.71 probability of being cost-effective at a willingness-to-pay of £30,000 per QALY gained. Conclusion: There was no significant difference between groups for the impact of fibromyalgia. Pilates was not cost-effective compared to aerobic exercises for the impact of fibromyalgia. However, Pilates seemed to be the preferred option of treatment considering QALYs, although it depends on the willingness-to-pay threshold.
... Fibromyalgia (FM) has a prevalence of 1-4% in the population and has a higher prevalence in women. [1][2][3] It is characterized by generalized widespread pain and hyperalgesia/allodynia. 4 Symptoms and comorbidities such as fatigue, psychological distress, irritable bowel syndrome, and insomnia are frequent. FM diagnosis is either based on anamnestic reports and semi-objective examination of hyperalgesia and/or anamnestic reports. ...
Article
Background: Obesity is a risk factor for the development of fibromyalgia (FM) and generally most studies report increased Body Mass Index (BMI) in FM. Obesity in FM is associated with a worse clinical presentation. FM patients have low physical conditioning and obesity further exacerbates these aspects. Hitherto studies of FM have focused upon a surrogate for overall measure of fat content, ie, BMI. This study is motivated by that ectopic fat and adipose tissues are rarely investigated in FM including their relationships to physical capacity variables. Moreover, their relationships to clinical variables including are not known. Aims were to 1) compare body composition between FM and healthy controls and 2) investigate if significant associations exist between body composition and physical capacity aspects and important clinical variables. Methods: FM patients (n = 32) and healthy controls (CON; n = 30) underwent a clinical examination that included pressure pain thresholds and physical tests. They completed a health questionnaire and participated in whole-body magnetic resonance imaging (MRI) to determine body composition aspects. Results: Abdominal adipose tissues, muscle fat, and BMI were significantly higher in FM, whereas muscle volumes of quadriceps were smaller. Physical capacity variables correlated negatively with body composition variables in FM. Both body composition and physical capacity variables were significant regressors of group belonging; the physical capacity variables alone showed stronger relationships with group membership. A mix of body composition variables and physical capacity variables were significant regressors of pain intensity and impact in FM. Body composition variables were the strongest regressors of blood pressures, which were increased in FM. Conclusion: Obesity has a negative influence on FM symptomatology and increases the risk for other serious conditions. Hence, obesity, dietary habits, and physical activity should be considered when developing clinical management plans for patients with FM.
... 1,2 Its prevalence in the general population is 2-8%, and it is the third most common musculoskeletal-related disorder after lumbar pain and osteoarthritis. [3][4][5][6] Although the American College of Rheumatology (ACR) issued the first diagnostic criteria for fibromyalgia in 1990, 7 the clinical diagnosis and treatment of fibromyalgia still face enormous challenges. For example, fibromyalgia is mainly diagnosed based on clinical symptoms, with no specific laboratory indicators and imaging examinations, and prior to revision of the diagnostic criteria for fibromyalgia by the ACR in 2016, 8 fibromyalgia was mostly considered to be an exclusive diagnosis. ...
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Background: Fibromyalgia is a rheumatic disease with no specific laboratory markers and is insensitive to hormonal drugs and nonsteroidal anti-inflammatory drugs commonly used to treat rheumatism. Guidelines recommend that non-pharmacological therapy should be the first-line treatment for fibromyalgia. Since the publication of the first diagnostic criteria for fibromyalgia in 1990, studies on acupuncture for fibromyalgia have been reported periodically. This study aims to explore the intellectual landscape of acupuncture for fibromyalgia since 1990, and to identify research trends and fronts in this field. Methods: The Web of Science Core Collection Database was searched for publications on acupuncture for fibromyalgia from 1990 to 2022. VOSviewer and CiteSpace were used to analyze the annual publication, countries, institutions, authors and cited authors, journals and cited journals, references and keywords. Results: A total of 280 publications were retrieved, and the number of publications showed an overall upward trend. The United States was the most productive country. China Medical University was the institution with the most publications. Lin Yi-wen was the most prolific author, while Wolfe was the most cited author. Evidence-Based Complementary and Alternative Medicine was the journal in which most of the research was published, while Pain was the most cited journal. An article by Wolfe (1990) had the most citations, but an article by Crofford (2001) had the highest centrality. The four most frequently used keywords in the included articles were mechanism, spinal cord, activation and sensitivity. Conclusion: Acupuncture can effectively relieve pain in patients with fibromyalgia and improve accompanying symptoms such as anxiety and depression. However, the design of clinical trials still needs to be optimized to better verify the efficacy of acupuncture on various clinical symptoms of fibromyalgia. Exploring the central analgesic mechanism of acupuncture on fibromyalgia is also the focus research direction now and future.
... El diagnóstico de fibromialgia se ha transformado en un problema de salud relevante en el mundo. Tal como lo han constatado investigadores en diversos países, se trata de un síndrome con crecientes índices de prevalencia en población general, que tiende a afectar en mayor proporción a mujeres que a hombres [1][2] . Surgido como un síndrome cuyos primeros criterios diagnósticos fueron publicados por el Colegio Reumatológico Americano en 1990, según la última definición propuesta el año 2010, la fibromialgia se caracteriza por la presencia de dolor en distintas áreas del cuerpo (principalmente cuello, espalda, brazos o piernas) que habitualmente se acompaña de fatiga, sueño no reparador, dificultades en la memoria y la concentración, cuya duración es de al menos tres meses, y que no presenta una causa claramente identificable ni en la evaluación clínica ni en exámenes de laboratorio 3 . ...
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RESUMEN Introducción: El presente artículo propone una revisión del proceso de recepción y construcción del diagnóstico de fibromialgia al interior del discurso médico chileno. Se plantea que, derivado de las discusiones que previamente se instalan en torno al fenómeno del dolor crónico, la amplia penetración de la fibromialgia entre los profesionales de la salud chilenos puede ser entendida en función de su estrecha ligazón a la noción de calidad de vida. Material y métodos: Se revisó ochenta y un artículos editados en Chile en revistas especializa-das del ámbito médico desde 1953 a 2018, tres libros y una guía clínica cuyo tema principal es el dolor crónico y la fibromialgia. Se realizó un análisis de contenidos utilizando una codificación abierta en tres etapas mediante el programa Atlas.ti Resultados: La información obtenida permite desprender tres discusiones principales: factores biológicos involucrados en el dolor crónico y la fibromialgia, los aspectos subjetivos de quienes los padecen, y el ámbito interpersonal que se ve concernido en torno a dichos diagnósticos. Discusión: Se constata que, al ser un diagnóstico que no presenta una clara etiología alojada en la biología de quien lo padece, la fibromialgia se transforma en el indicador de quienes no se adecúan a los comportamientos esperables según una adecuada calidad de vida. Aquello habilita al profesional tratante a intervenir buscando la modificación de comportamientos en diversos ámbitos de la vida del paciente, bajo el supuesto que aquello conducirá a una reduc-ción del dolor.
Article
Purpose: To investigate the prevalence of fibromyalgia(FM) and to show its relations with symptoms, polio-related impairments (PRI), and quality of life (QoL) in persons with prior paralytic poliomyelitis (PsPP) with and without post-polio syndrome (PPS). Materials and methods: The study included 74 PsPP under 60 years of age, 60 of whom met the criteria for PPS. Presence and severity of FM were assessed by the American College of Rheumatology (ACR) 1990, 2010, and 2016 criteria, and Fibromyalgia Severity Score. PPS symptoms, PRI, and QoL were evaluated using the Self-Reported Impairments in Persons with Late Effects of Polio Rating Scale, Fatigue Severity Scale, and Nottingham Health Profile. Frequency, comparison, and correlation analyses were performed. Results: While 15% of PsPP with PPS met the criteria of ACR 1990, 32% of ACR 2010, and 35% of ACR 2016, none of those without PPS met any of the criteria for FM. Severity of PPS symptoms and PRI were significantly higher, and QoL was significantly lower in those with co-existing FM. FM severity was found to be significantly associated with severity of PPS symptoms, PRI and reduced QoL. Conclusions: FM frequently coexists in PsPP with PPS and may increase the burden of PPS.Implications for RehabilitationFibromyalgia (FM) is commonly seen in patients with post-polio syndrome (PPS).Co-existing FM may increase the burden of PPS, as it is associated with more severe symptoms, more polio-related impairments, and worse quality of life.Recognition, appropriate referral, and successful management of co-existing FM may allow for reduced symptoms or symptom severity and improved quality of life in persons with PPS.
Chapter
Fibromyalgia (FM) is a rheumatologic disorder marked by chronic, widespread pain and associated comorbid conditions. In 2010 new diagnostic criteria were put forth by the American College of Rheumatology that called for a broader focus on symptomology (Wolfe et al. J Rheumatol. 38:1113–1122, 2011). In recent years there has been a growing body of evidence to suggest that FM is a disorder of central pain processing (Sluka and Clauw. Neuroscience 338:114–129, 2016; Trouvin and Perrot. Best Pract Res Clin Rheumatol. 33:101415, 2019). Fibromyalgia has been diagnosed in 5–20% of patients with rheumatoid arthritis, spondyloarthritis, Sjögren’s syndrome, and psoriatic arthritis (Dougados and Perrot. Joint Bone Spine. 84:511–513, 2017). Fibromyalgia syndrome (FMS) is the term to include other frequently co-occurring diagnosis associated with FM, including migraine, sleep dysregulation, irritable bowel, pelvic pain, and depression (Häuser et al., Clin Exp Rheumatol. 37:90–97, 2019). When addressing treatment of FM during pregnancy, one must also consider management of comorbid presenting symptoms and worsening of co-presenting diagnosis. This chapter will address the incidence and prevalence during pregnancy, as well as pharmacological and non-pharmacological management strategies.KeywordsPain managementPregnancyFibromyalgiaChronic painFibromyalgia syndromeBody pain
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Objective: Peripheral nerve blockage treatments reduce central sensitization and are effective in patients with migraine. We wanted to evaluate the efficacy of peripheral nerve blockage in patients with fibromyalgia and migraine whose etiology may be responsible for central sensitization, and their associations are common. Methods: The files of patients with chronic migraine who had peripheral nerve blockage treatment in our clinic and had fibromyalgia were scanned. The patients underwent bilateral great occipital nerve, lesser occipital nerve, and supraorbital nerve blockage at baseline and in the second week. The revised Fibromyalgia Impact Questionnaire, Migraine Disability Assessment Scale, Visual Analog Scale scores, the number of days in pain, and the number of analgesics taken in the last month were recorded. Results: In the third month, Fibromyalgia Impact Questionnaire, Migraine Disability Assessment Scale, and Visual Analog Scale scores were significantly lower from baseline. While Fibromyalgia Impact Questionnaire scores in the third month were significantly lower than in the first month, no significant difference was observed between Visual Analog Scale scores. In the third month, the number of days in pain and the number of analgesics taken in the last month was significantly lower than the baseline but higher than the first month. Conclusion: Peripheral nerve blockage has been found to be an effective treatment for the symptoms of both diseases in patients with migraine and fibromyalgia coexistence.
Article
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To estimate the prevalence of fibromyalgia (FM) and to compare some descriptive epidemiological and quality of life data between persons with and without FM criteria in a representative sample of the general Spanish population. Cross sectional study of 2,192 Spaniards aged 20 or above, selected by cluster sampling. Subjects were invited to a structured interview carried out by trained rheumatologists to ascertain various musculoskeletal disorders. The visit included screening and examination, validated instruments for measuring function (HAQ) and quality of life (SF-12) and questions about socio-demographic characteristics and musculoskeletal, mental, and other general symptoms. FM was suspected in subjects with widespread pain for more than three months. FM was defined by theAmerican College of Rheumatology classification criteria. All estimates are adjusted to sampling scheme. The prevalence of FM in Spain is 2.4% (95% CI: 1.5-3.2). FM is significantly more frequent in women (4.2%) than in men (0.2%), with an OR for women of 22.5 (95%CI: 7.2- 69.9), mainly in the 40-49 years age interval. It is more frequent in rural (4.1%) than in urban settings (1.7%), with an OR for rural settings of 2.5 (95%CI: 1.03-5.9). FM is associated with a low educational level, to a low social class, and to self-reported depression. The scores in the HAQ and in the SF-12 were significantly lower in FM subjects, despite adjustment by covariates. FM has a high prevalence in the general population. FM is associated to female gender, comorbidities, age between 40 and 59 years, and a rural setting. Persons fulfilling FM criteria show impaired functioning and quality of life.
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Objective: The objectives of this study were to determine the prevalence of the fibromyalgia syndrome [FMS] in Diyarbakır, a city located in the southeastern region of Turkey, and to evaluate associated demographic variables. Methods: This study was conducted in the beginning of 2003. A total of 600 people, randomly selected by stratified cluster sampling, were interviewed in person using a questionnaire consisting of demographic features and history of chronic widespread pain. Individuals with chronic widespread pain were examined by a specialist in physical medicine and rehabilitation in order to confirm or exclude FMS based on the American College of Rheumatology classification criteria. The statistical analysis was performed by using a package program called Epi Info 2000. Results: Fifty-three people were diagnosed with FMS. Based on the study results, the prevalence of FMS was 8.8 percent in our regional study group. The prevalence was higher in women [12.5 percent] than in men [5.1 percent; P = 0.002, OR = 3.038, 95% CI = 1.5–6.1], and subjects in urban areas [11.4 percent] had a higher FMS rate than subjects in rural areas [5.2 percent; P = 0.011, OR = 2.388, 95% CI = 1.2–4.6]. The FMS was most common in the 50- to 59-year-old age group. No difference was observed in terms of education, occupation, and marital status. Conclusion: To the best of our knowledge, this cross-sectional study is the first report on the prevalence of FMS in Diyarbakır. The FMS prevalence was 8.8 percent in our region. The FMS was found 2.45 times more common in women than in men and found 2.3 times higher in urban areas than in rural areas.
Article
Objective. To estimate the prevalence of rheumatic diseases in residents of Montes Claros, Brazil, of both sexes, aged above 16 years, using the COPCORD questionnaire. Methods. This was a cross-sectional study of 3038 people; the sample was probabilistic, by conglomerates, multiple stages, within homogeneous strata, the sampling unit being the domicile. The COPCORD questionnaire was used for all subjects, and a rheumatologist evaluated those patients who presented pain and/or functional disability. Laboratory tests and radiographs of small and large joints were done in some patients to confirm the diagnosis. Subjects were identified by socioeconomic level in quintiles A, B, C, D, and E, A being the highest. Results. Two hundred nineteen patients were identified with rheumatic diseases, mean age 37 (SD 27) years, with female predominance. Seventy-seven (35.2%) were unemployed and socioeconomic level D was the most prevalent. Of all patients with rheumatic disease, osteoarthritis (OA) was observed in 126 (57.5%) patients, fibromyalgia (FM) in 76 (34.7%), rheumatoid arthritis (RA) in 14 (6.4%), and lupus in 3 (1.4%). Women were predominant in all diseases except OA. The mean (SD) age was 56 (12.7) years for OA, 43.2 (9.1) for FM, 53.4 (13.9) for RA, and 40 (14) for lupus. Conclusion. The prevalence of rheumatic diseases evaluated by the COPCORD questionnaire was 4.14% for OA, 2.5% for FM, 0.46% for RA, and 0.098% for lupus.
Article
Forseth KØ, Gran JT. The prevalence of fibromyalgia among women aged 20–49 years in Arendal, Norway. Scand J Rheumatol 1992; 21: 74–8. In an epidemiological survey of females aged 20–49 years in Arendal, Norway, a prevalence of fibromyalgia according to the ACR criteria of 1990 of 10.5% was found. Thirty-four out of 40 women with fibromyalgia (85.0%) had, prior to the present population study, consulted a physician because of widespread pain and/or stiffness. Of these 34 women, 14 cases (41.2%) had been given a diagnosis of fibromyalgia. It is concluded that fibromyalgia represents one of the major causes of pain in the loco motor system, and unfortunately, the condition often remains undiagnosed for long periods.
Article
Objectives: The community prevalence of fibromyalgia syndrome [FMS] indifferent countries has been reported to vary between 0.64 percent in South Africa to 10.5 percent in Norway. However, no study has yet reported on the prevalence of FMS in a Chinese population. The primary purpose of this study was, therefore, to estimate the prevalence of FMS in the Chinese community in Hong Kong. Methods: The study consisted of three parts: a. translation of the screening instrument (6) into Chinese, b. a standardized telephone survey of Hong Kong Chinese adults for the presence of chronic widespread pain [CWP], c. a detailed physical examination of those willing people who were identified as having CWP in the previous three months. The examination included determining the presence of FMS tender points. Results: Of 2,458 eligible respondents, 1,467 adults agreed to be interviewed [60 percent response rate]. Sixty-four of these reported CWP and 37 attended a clinical examination. Seven of these subjects [four male: three female] were classified as having FMS. The prevalence of FMS in Hong Kong was estimated to be 0.82 percent [95 percent CI: 0.35 percent, 1.29 percent]. Conclusions: The prevalence of FMS in the Chinese population of Hong Kong is low but is similar to that of some other Western countries.
Article
The objective of this study was to assess the prevalence of fibromyalgia (FM) in patients with episodic migraine and to evaluate the relationship between migraine characteristics and FM. One hundred and eighteen consecutive patients (mean age = 38 years, 75 % women) fulfilling the International Classification of Headache Disorders-II criteria for migraine with (n = 22) and without (n = 96) aura from an outpatient headache clinic of a university hospital were evaluated. The diagnosis of FM was made based on the 1990 American College of Rheumatology classification criteria. Participants completed some self-administered questionnaires ascertaining sociodemographics, headache severity, frequency and duration, headache-related disability (Headache Impact Test [HIT-6]) and Migraine Disability Assessment Scale, widespread musculoskeletal pain (visual analog scale), depression (Beck depression inventory), anxiety (Beck anxiety inventory), sleep quality (Pittsburgh Sleep Quality Index), fatigue (Multidimensional Assessment of Fatigue), and quality of life (Short Form-36 Health Survey [SF-36]). In patients with FM, the tender point count and the Fibromyalgia Impact Questionnaire were employed. FM was diagnosed in 37 (31.4 %) of the patients. FM comorbidity was equally distributed across patients with and without aura. Severity of migraine headache, HIT-6, and anxiety were especially associated with FM comorbidity. Patients suffering from migraine plus FM reported lower scores on all items of the SF-36. This study indicates that the assessment and management of coexisting FM should be taken into account in the assessment and management of migraine, particularly when headache is severe or patients suffer from widespread musculoskeletal pain.
Article
Objective To evaluate fibromyalgia in the general population with emphasis on prevalence, dimensionality, and somatic symptom severity.Methods We studied 2,445 subjects randomly selected from the German general population in 2012 using the American College of Rheumatology 2010 preliminary diagnostic criteria for fibromyalgia, as modified for survey research, and the polysymptomatic distress scale (PSD). Anxiety, depression, and somatic symptom severity were assessed with the Patient Health Questionnaire (PHQ) series, and measures of symptoms and quality of life were assessed with the European Organization for Research and Treatment of Cancer questionnaire.ResultsThe prevalence of fibromyalgia was 2.1% (95% confidence interval [95% CI] 1.6, 2.7), with 2.4% (95% CI 1.5, 3.2) in women and 1.8% (95% CI 1.1, 2.6) in men, but the difference was not statistically significant. Prevalence rose with age. Fibromyalgia subjects had markedly abnormal scores for all covariates. We found smooth, nondisordered relationships between PSD and all predictors, providing additional evidence against the hypothesis that fibromyalgia is a discrete disorder and in support of a dimensional or spectrum disorder. There was a strong correlation (r = 0.790) between the PSD and the PHQ somatic symptom severity scale; 38.5% of persons with fibromyalgia satisfied the proposed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for a physical symptom disorder.Conclusion The modified 2010 diagnostic criteria do not result in high levels of fibromyalgia. PSD and fibromyalgia are strongly related to somatic symptom severity. There is evidence in support of fibromyalgia as a dimensional or continuum disorder. This has important ramifications for neurobiologic and epidemiology research, and for clinical diagnosis, treatment, and ascertainment of disability.
Article
Objective To estimate and compare the prevalence of fibromyalgia by 2 different methods in Olmsted County, Minnesota.Methods The first method was a retrospective review of medical records of potential cases of fibromyalgia in Olmsted County using the Rochester Epidemiology Project (from January 1, 2005, to December 31, 2009) to estimate the prevalence of diagnosed fibromyalgia in clinical practice. The second method was a random survey of adults in Olmsted County using the fibromyalgia research survey criteria to estimate the percentage of responders who met the fibromyalgia research survey criteria.ResultsOf the 3,410 potential patients identified by the first method, 1,115 had a fibromyalgia diagnosis documented in the medical record by a health care provider. The age- and sex-adjusted prevalence of diagnosed fibromyalgia by this method was 1.1%. By the second method, of the 2,994 people who received the survey by mail, 830 (27.6%) responded and 44 (5.3%) met the fibromyalgia research survey criteria. The age- and sex-adjusted prevalence of fibromyalgia in the general population of Olmsted County by this method was estimated at 6.4%.Conclusion To the best of our knowledge, this is the first report of the rate at which fibromyalgia is being diagnosed in a community. This is also the first report of prevalence as assessed by the fibromyalgia research survey criteria. Our results suggest that patients, particularly men, who meet the fibromyalgia research survey criteria are unlikely to have been given a diagnosis of fibromyalgia.
Article
Unlabelled: Fibromyalgia represents the tip of the iceberg of chronic pain in the general population. We have attempted to estimate the prevalence of fibromyalgia in the Israeli population, using the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFESSQ), an instrument previously utilised in several European countries. Methods: The LFESSQ-4 screens for widespread pain, and the LFESSQ-6 for widespread pain and chronic fatigue. The LFESSQ was administered via telephone to a sample of 1019 individuals. To estimate the positive predictive value (PPV) of LFESSQ-4 and LFESSQ-6, this questionnaire was submitted to a sample of rheumatology outpatients (n=76), who were examined to confirm or exclude fibromyalgia according to the 1990 criteria. The prevalence of fibromyalgia in the general population was estimated by applying the PPV to community subjects. Results: In the community survey, 5.1% and 3.9% of individuals screened positive for the LFESSQ-4 and LFESSQ-6, respectively. The point prevalence of FMS in the Israeli general population was 2.6% (95%CI 1.7-3.4) when using LFESSQ-4 and 2.0% (95%CI 1.3-2.7) when using the LFESSQ-6 criteria. Conclusions: The prevalence of the fibromyalgia syndrome in the Israeli population is considerable and constitutes a significant health care issue. The prevalence is similar to that observed in other western populations. Based on this tool, over 25% of fibromyalgia cases appear to be among males, a proportion higher than generally appreciated.