ABSTRACT

The patient with pain, fatigue, and loss of motivation may be suffering from a chronic soft tissue rheumatism problem known as fibromyalgia syndrome (FS), formerly known as fibrositis. Primary or idiopathic FS occurs in patients with no definable or demonstrable cause. FS can be diagnosed reliably by a good history and physical examination. Posttraumatic fibromyalgia syndrome patients typically are healthy, productive individuals until their mishap, after which time they develop musculoskeletal pain, problems sleeping, headaches, etc. Pressure over control points such as fingers, metatarsals, or forearm does not cause pain in the patients with FS but may elicit complaints of discomfort or cause withdrawal in the malingerer or patients with psychogenic rheumatism. Patients with polymyalgia rheumatica respond dramatically to relatively low doses of corticosteroid, while patients with FS do not improve. Despite treatment, many patients continue to have active FS with tenderness of specific muscles or muscle insertions and muscle tautness and stiffness.