Devin J. Starlanyl
Fibromyalgia (FM) is
not homogenous. As I. Jon Russell, MD, PhD, editor of Journal of
Musculoskeletal Pain, said to me, "Fibromyalgia is not an 'it'. It's
a 'they'." Research shows that this is true (1, 2, 3, 4, 5, 6).
I believe that the key to treating FM, like CMPD, is to identify and
control the initiating and perpetuating factors as much as possible.
I also believe that identifying subsets are a key to this process.
Years ago, my friend J. B.
Eisinger, French clinician and researcher, contacted me with an exciting
proposal. He planned to organize a team to define meaningful clinical
subsets of FM. These subsets would be categorized by perpetuating
factors, cause (initiating factors), and symptoms (presenting factors).
Patients would be coded as to age, gender, duration and seriousness of
symptoms. For research purposes, after tabulating the coding, the names could
then be omitted, keeping the patients anonymous.
I was asked to be part of the team.
The result was a medical journal article
that would be especially valuable for FM researchers (7).
The protocol was published in French. Using the translated format
of the protocol for anonymous clinical study for researchers, I have modified
it into a protocol for identification of FM subsets for clinicians, with Dr.
Eisinger's approval. I hope
clinicians will find it helpful. Devin J. Starlanyl
||Walen HR, Cronan TA,
Server ER et al. 2002. Subgroups of fibromyalgia patients:
evidence for heterogeneity and an examination of differential effects
following a community-based intervention. J Musculoskel Pain
||Bennett RM. 2002.
Adult growth hormone deficiency in patients with fibromyalgia. Curr
Rheumatol Rep 4(4):306-12.
||Smith JD, Terpening CM,
Schmidt SO et al. 2001. Relief of fibromyalgia symptoms
following discontinuation of dietary excitotoxins. Ann
||Giesecke T, Williams DA,
Harris RE et al. 2003. Subgrouping of fibromyalgia patients on
the basis of pressure-pain thresholds and psychological factors.
Arthritis Rheum 48 (10):2916-2922.
||Gursoy S. 2002.
Absence of association of the serotonin transporter gene polymorphism
with the mentally healthy subset of fibromyalgia patients. Clin
||Stratz T, Schochat T,
Farber L, Schweiger C, Muller W.
Are there subgroups in fibromyalgia? J Musculoskel
Pain3 (suppl 1) : 15 [Abstract].
||Eisinger, J, D Starlanyl,
F Blotman, L Bueno, E Houvenagle, R Juvin, P Kaminsky, K Lawson, X Le
Loet, J Lowe, P Manesse, K Mechtouof, N Memran, W Muller, M Nicollet,
JC Perragut, A Plantamura, JP Poinsignon, E Reig, R Ruiz Lopez, KL
Schmitt, P Sichere, J Teitelbaum, R Treves, H Zakarian.
2000. [Protocole d'informations anonyme sur les
fibromyalgiques.] Medicine du sud-est Lyon Mediterranee
Medical. 1: 9-11. [French]
for Identification of Fibromyalgia Subsets
||Patient Name _______________________________
form was filled out by: _______________________________________
the patient alone
assisted by a doctor
was made by: ______________________________________
||o another specialist
||Type of pain:
||Number of Tender points
||Age = ______
||Excessive consumption of
caffeine, alcohol, carbohydrates, tobacco?
||Family clustering (members
of family with FMS or FMS-like symptoms)?
1 Hour a Day
2 Hours and Sport
severity (social, professional and on life quality repercussion):
- Less than 5 years
- Moderate (normal activity)
- Life quality = good
- More than 5 years
- Severe (frequent sick leave)
- life quality = moderate
- More than 10
- Very severe (one year sick leave)
- life quality = bad
- More than 15
- life quality = very bad
Perpetuating Factors and Possible Etiologies:
Allergies (asthma, vasomotor rhinitis; urticaria, ocular, chronic sinusitis)
Dysfunction (Raynaud's Syndrome, migraine)
(malnutrition, obesity, insulin resistance, Metabolic Syndrome)
(distinct physical fatigue, mental fatigue/loss of memory and/or focus, CFIDS)
(Premenstrual Syndrome, untreated menopause, vaginismus, vulvar pain)
Treated with T4 (equilibrated/not) or other hormones (equilibrated/not)
(chronic bacterial, fungal, viral, protozoal)
(symptoms appeared at puberty; prepuberty)
(treated/not treated with recent chemotherapy, other treatment)
lupus erythematosis, polyarthritis rheumatica, osteoarthritis
(Possible onset due to beta blockers, other medications, toxins, pollutants)
(carpal tunnel, MS, NMH)
(cataract, glaucoma, Sicca Syndrome)
(depression intrinsic/secondary, anxiety, panic attacks, PTSD, ADHD, OC)
of Pain (spontaneous, moderate, major, hyperalgesia, allodynia)
pain (myofascial trigger points latent/active, local/regional, multiple
regions; chronic myofascial pain/lasting trigger points in at least three
quadrants with spinal involvement, myofascial nerve/lymph/blood vessel
disorders (severe insomnia, sleep apnea central/congestive, narcolepsy, PLMS,
(irritable bladder, voiding dysfunction)
(orthostatic hypotention, tachychardia, palpitations)
treatments and medications linked with FM (analgesics, antidepressants...)
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