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Fibromyalgia: HELP
Articles by Daniel J. Clauw
Based on 105 articles published since 2008

Between 2008 and 2019, D. Clauw wrote the following 105 articles about Fibromyalgia.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Editorial What is the meaning of "small fiber neuropathy" in fibromyalgia? 2015

Clauw, Daniel J. ·Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA. ·Pain · Pubmed #26307862.

ABSTRACT: -- No abstract --

2 Editorial The role of stress in rheumatic diseases. 2010

Hassett, Afton L / Clauw, Daniel J. · ·Arthritis Res Ther · Pubmed #20587002.

ABSTRACT: Rheumatology patients frequently note the occurrence of stressful or traumatic life events prior to the onset of their illness and/or a relationship between stress and disease flares. For our patients, identifying causal events could represent an effort to give meaning to a chronic and often disabling disease, while noting a link between stress and flares may proffer a sense of control. Whatever purpose the report of stress as an etiological or maintaining factor may serve, the science exploring a causal relationship between stress and autoimmune disease onset and course is expanding. Moreover, stress can also induce symptoms such as pain via nonimmunological mechanisms.

3 Editorial Fibromyalgia is a controversial disease. 2009

Clauw, Daniel J. · ·Am J Med · Pubmed #19962491.

ABSTRACT: -- No abstract --

4 Editorial Alpha-2-delta ligands in fibromyalgia: is the glass half empty or full? 2009

Clauw, Daniel J. ·Anesthesiology, Medicine (Rheumatology) and Psychiatry, The University of Michigan, Chronic Pain and Fatigue Research Center, 24 Frank Lloyd Wright Dr., P.O. Box 385, Ann Arbor, MI 48106, USA. dclauw@med.umich.edu ·Pain · Pubmed #19560865.

ABSTRACT: -- No abstract --

5 Editorial Commentary on the EULAR recommendations for the management of fibromyalgia. 2008

Clauw, Daniel J. ·Clinical and Translational Research at University of Michigan, Ann Arbor, MI, USA. dclauw@med.umich.edu ·Nat Clin Pract Rheumatol · Pubmed #18560385.

ABSTRACT: -- No abstract --

6 Review Normalizing fibromyalgia as a chronic illness. 2018

Clauw, Daniel J / D'Arcy, Yvonne / Gebke, Kevin / Semel, David / Pauer, Lynne / Jones, Kim D. ·a Department of Anesthesiology , University of Michigan , Ann Arbor , MI , USA. · b Pain Management Nurse Practitioner , Ponte Vedra Beach , FL , USA. · c Department of Family Medicine , Indiana University School of Medicine , Indianapolis , IN , USA. · d Pfizer Inc ., New York , NY , USA. · e Pfizer Inc ., Groton , CT , USA. · f Schools of Nursing & Medicine , Oregon Health & Science University , Portland , OR , USA. ·Postgrad Med · Pubmed #29256764.

ABSTRACT: Fibromyalgia (FM) is a complex chronic disease that affects 3-10% of the general adult population and is principally characterized by widespread pain, and is often associated with disrupted sleep, fatigue, and comorbidities, among other symptoms. There are many gaps in our knowledge of FM, such that, compared with other chronic illnesses including diabetes, rheumatoid arthritis, and asthma, it is far behind in terms of provider understanding and therapeutic approaches. The experience that healthcare professionals (HCPs) historically gained in developing approaches to manage and treat patients with these chronic illnesses may help show how they can address similar problems in patients with FM. In this review, we examine some of the issues around the management and treatment of FM, and discuss how HCPs can implement appropriate strategies for the benefit of patients with FM. These issues include understanding that FM is a legitimate condition, the benefits of prompt diagnosis, use of non-drug and pharmacotherapies, patient and HCP education, watchful waiting, and assessing patients by FM domain so as not to focus exclusively on one symptom to the detriment of others. Developing successful approaches is of particular importance for HCPs in the primary care setting who are in the ideal position to provide long-term care for patients with FM. In this way, FM may be normalized as a chronic illness to the benefit of both patients and HCPs.

7 Review Challenges of implementing fibromyalgia treatment guidelines in current clinical practice. 2017

Arnold, Lesley M / Clauw, Daniel J. ·a Department of Psychiatry and Behavioral Neuroscience, Women's Health Research Program , University of Cincinnati College of Medicine , Cincinnati , OH , USA. · b Departments of Anesthesiology, Medicine (Rheumatology), and Psychiatry, and the Chronic Pain and Fatigue Research Center , The University of Michigan , Ann Arbor , MI , USA. ·Postgrad Med · Pubmed #28562155.

ABSTRACT: The current diagnostic and treatment pathway for patients with fibromyalgia (FM) is lengthy, complex, and characterized by multiple physician visits with an average 2-year wait until diagnosis. It is clear that effective identification and appropriate treatment of FM remain a challenge in current clinical practice. Ideally, FM management involves a multidisciplinary approach with the preferable patient pathway originating in primary care but supported by a range of health care providers, including referral to specialist care when necessary. After the publication of individual clinical studies, high-quality reviews, and meta-analyses, recently published FM treatment guidelines have transitioned from an expert consensus to an evidence-based approach. Evidence-based guidelines provide a framework for ensuring early diagnosis and timely adoption of appropriate treatment. However, for successful outcomes, FM treatments must adopt a more holistic approach, which addresses more than just pain. Impact on the associated symptoms of fatigue and cognitive problems, sleep and mood disturbances, and lowered functional status are also important in judging the success of FM therapy. Recently published guidelines recommend the adoption of a symptom-based approach to guide pharmacologic treatment. Emerging treatment options for FM may be best differentiated on the basis of their effect on comorbid symptoms that are often associated with pain (e.g. sleep disturbance, mood, fatigue). The current review discusses the most recently published Canadian guidelines and the implications of the recent European League Against Rheumatism (EULAR) recommendations, with a focus on the challenges of implementing these guidelines in current clinical practice.

8 Review Treat-to-Target Strategy for Fibromyalgia: Opening the Dialogue. 2017

Häuser, Winfried / Clauw, Daniel J / Fitzcharles, Mary-Ann. ·Klinikum Saarbrücken, Saarbrücken, and Technische Universität München, München, Germany. · University of Michigan Medical Center, Ann Arbor. · McGill University Health Centre, Montreal, Quebec, Canada. ·Arthritis Care Res (Hoboken) · Pubmed #27390268.

ABSTRACT: -- No abstract --

9 Review Neurobiology of fibromyalgia and chronic widespread pain. 2016

Sluka, Kathleen A / Clauw, Daniel J. ·Physical Therapy and Rehabilitation Science, Pain Research Program, University of Iowa, United States. Electronic address: kathleen-sluka@uiowa.edu. · Anesthesiology, Medicine (Rheumatology) and Psychiatry, University of Michigan, United States. ·Neuroscience · Pubmed #27291641.

ABSTRACT: Fibromyalgia is the current term for chronic widespread musculoskeletal pain for which no alternative cause can be identified. The underlying mechanisms, in both human and animal studies, for the continued pain in individuals with fibromyalgia will be explored in this review. There is a substantial amount of support for alterations of central nervous system nociceptive processing in people with fibromyalgia, and that psychological factors such as stress can enhance the pain experience. Emerging evidence has begun exploring other potential mechanisms including a peripheral nervous system component to the generation of pain and the role of systemic inflammation. We will explore the data and neurobiology related to the role of the CNS in nociceptive processing, followed by a short review of studies examining potential peripheral nervous system changes and cytokine involvement. We will not only explore the data from human subjects with fibromyalgia but will relate this to findings from animal models of fibromyalgia. We conclude that fibromyalgia and related disorders are heterogenous conditions with a complicated pathobiology with patients falling along a continuum with one end a purely peripherally driven painful condition and the other end of the continuum is when pain is purely centrally driven.

10 Review Rethinking chronic pain in a primary care setting. 2016

Stanos, Steven / Brodsky, Marina / Argoff, Charles / Clauw, Daniel J / D'Arcy, Yvonne / Donevan, Sean / Gebke, Kevin B / Jensen, Mark P / Lewis Clark, Evelyn / McCarberg, Bill / Park, Peter W / Turk, Dennis C / Watt, Stephen. ·a Swedish Pain Services , Swedish Health System , Seattle , WA , USA. · b Global Medical Affairs , Pfizer Inc ., New York , NY , USA. · c Department of Neurology , Albany Medical Center , Albany , NY , USA. · d Department of Anesthesiology , The University of Michigan , Ann Arbor , MI , USA. · e Suburban Hospital , Bethesda , MD , USA. · f Department of Family Medicine , Indiana University School of Medicine , Indianapolis , IN , USA. · g Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA. · h Warrior Centric Health, LLC , Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA. · i University of California San Diego , San Diego , CA , USA. · j Department of Anesthesiology and Pain Medicine , University of Washington , Seattle , WA , USA. ·Postgrad Med · Pubmed #27166559.

ABSTRACT: Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings.

11 Review Opioid Use in Fibromyalgia: A Cautionary Tale. 2016

Goldenberg, Don L / Clauw, Daniel J / Palmer, Roy E / Clair, Andrew G. ·Department of Medicine, Tufts University School of Medicine, Boston, MA. Electronic address: dongoldenberg44@gmail.com. · Department of Anesthesiology, University of Michigan, Ann Arbor. · Pfizer Inc, New York, NY. ·Mayo Clin Proc · Pubmed #26975749.

ABSTRACT: Multiple pharmacotherapies are available for the treatment of fibromyalgia (FM), including opioid analgesics. We postulate that the mechanism of action of traditional opioids predicts their lack of efficacy in FM. Literature searches of the MEDLINE and Cochrane Library databases were conducted using the search term opioid AND fibromyalgia to identify relevant articles, with no date limitations set. Citation lists in returned articles and personal archives of references were also examined for additional relevant items, and articles were selected based on the expert opinions of the authors. We found no evidence from clinical trials that opioids are effective for the treatment of FM. Observational studies have found that patients with FM receiving opioids have poorer outcomes than patients receiving nonopioids, and FM guidelines recommend against the use of opioid analgesics. Despite this, and despite the availability of alternative Food and Drug Administration-approved pharmacotherapies and the efficacy of nonpharmacologic therapies, opioids are commonly used in the treatment of FM. Factors associated with opioid use include female sex; geographic variation; psychological factors; a history of opioid use, misuse, or abuse; and patient or physician preference. The long-term use of opioid analgesics is of particular concern in the United States given the ongoing public health emergency relating to excess prescription opioid consumption. The continued use of opioids to treat FM despite a proven lack of efficacy, lack of support from treatment guidelines, and the availability of approved pharmacotherapy options provides a cautionary tale for their use in other chronic pain conditions.

12 Review Premature Aging in Fibromyalgia. 2015

Hassett, Afton L / Clauw, Daniel J / Williams, David A. ·Department of Anesthesiology, University of Michigan Medical School, Chronic Pain & Fatigue Research Center, Domino's Farms, Lobby M, P.O Box 385, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA. afton@med.umich.edu. ·Curr Aging Sci · Pubmed #26212052.

ABSTRACT: Chronic pain is highly prevalent in older adults, and until recently, was considered to be common but relatively "benign." Mounting evidence, however, suggests that some of the 116 million US adults who suffer from chronic pain are also at an increased risk for developing age-related diseases prematurely, suffering earlier cognitive and physical decline, and experiencing earlier mortality. Given the aging US population and the prevalence of chronic pain along with related healthcare consequences, there is a critical need to better understand the relationship between aging and chronic pain. Herein, we focus on one chronic pain state, fibromyalgia, and provide an overview of the evidence suggesting that individuals with this chronic pain condition show signs of premature aging.

13 Review Fibromyalgia and related conditions. 2015

Clauw, Daniel J. ·University of Michigan, Ann Arbor, MI. Electronic address: dclauw@med.umich.edu. ·Mayo Clin Proc · Pubmed #25939940.

ABSTRACT: Fibromyalgia is the currently preferred term for widespread musculoskeletal pain, typically accompanied by other symptoms such as fatigue, memory problems, and sleep and mood disturbances, for which no alternative cause can be identified. Earlier there was some doubt about whether there was an "organic basis" for these related conditions, but today there is irrefutable evidence from brain imaging and other techniques that this condition has strong biological underpinnings, even though psychological, social, and behavioral factors clearly play prominent roles in some patients. The pathophysiological hallmark is a sensitized or hyperactive central nervous system that leads to an increased volume control or gain on pain and sensory processing. This condition can occur in isolation, but more often it co-occurs with other conditions now being shown to have a similar underlying pathophysiology (eg, irritable bowel syndrome, interstitial cystitis, and tension headache) or as a comorbidity in individuals with diseases characterized by ongoing peripheral damage or inflammation (eg, autoimmune disorders and osteoarthritis). In the latter instance, the term centralized pain connotes the fact that in addition to the pain that might be caused by peripheral factors, there is superimposed pain augmentation occurring in the central nervous system. It is important to recognize this phenomenon (regardless of what term is used to describe it) because individuals with centralized pain do not respond nearly as well to treatments that work well for peripheral pain (surgery and opioids) and preferentially respond to centrally acting analgesics and nonpharmacological therapies.

14 Review Fibromyalgia: a clinical review. 2014

Clauw, Daniel J. ·Professor of Anesthesiology, Medicine (Rheumatology), and Psychiatry and Director, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor. ·JAMA · Pubmed #24737367.

ABSTRACT: IMPORTANCE: Fibromyalgia is present in as much as 2% to 8% of the population, is characterized by widespread pain, and is often accompanied by fatigue, memory problems, and sleep disturbances. OBJECTIVE: To review the epidemiology, pathophysiology, diagnosis, and treatment of fibromyalgia. EVIDENCE REVIEW: The medical literature on fibromyalgia was reviewed from 1955 to March 2014 via MEDLINE and the Cochrane Central Registry of Controlled Trials, with an emphasis on meta-analyses and contemporary evidence-based treatment guidelines. Treatment recommendations are based on the most recent evidence-based guidelines from the Canadian Pain Society and graded from 1 to 5 based on the level of available evidence. FINDINGS: Numerous treatments are available for managing fibromyalgia that are supported by high-quality evidence. These include nonpharmacological therapies (education, exercise, cognitive behavioral therapy) and pharmacological therapies (tricyclics, serotonin norepinephrine reuptake inhibitors, and gabapentinoids). CONCLUSIONS AND RELEVANCE: Fibromyalgia and other "centralized" pain states are much better understood now than ever before. Fibromyalgia may be considered as a discrete diagnosis or as a constellation of symptoms characterized by central nervous system pain amplification with concomitant fatigue, memory problems, and sleep and mood disturbances. Effective treatment for fibromyalgia is now possible.

15 Review A framework for fibromyalgia management for primary care providers. 2012

Arnold, Lesley M / Clauw, Daniel J / Dunegan, L Jean / Turk, Dennis C / Anonymous2430725. ·Department of Psychiatry and Behavioral Neuroscience and the Women's Health Research Program, University of Cincinnati College of Medicine, OH 45219, USA. Lesley.Arnold@uc.edu ·Mayo Clin Proc · Pubmed #22560527.

ABSTRACT: Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary care providers through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting.

16 Review Central pain mechanisms in chronic pain states--maybe it is all in their head. 2011

Phillips, Kristine / Clauw, Daniel J. ·University of Michigan, Ann Arbor, MI, United States. kphill@med.umich.edu ·Best Pract Res Clin Rheumatol · Pubmed #22094191.

ABSTRACT: Mechanisms underlying chronic pain differ from those underlying acute pain. In chronic pain states, central nervous system (CNS) factors appear to play particularly prominent roles. In the absence of anatomical causes of persistent pain, medical sub-specialities have historically applied wide-ranging labels (e.g., fibromyalgia (FM), irritable bowel syndrome, interstitial cystitis and somatisation) for what now is emerging as a single common set of CNS processes. The hallmark of these 'centrally driven' pain conditions is a diffuse hyperalgesic state identifiable using experimental sensory testing, and corroborated by functional neuroimaging. The characteristic symptoms of these central pain conditions include multifocal pain, fatigue, insomnia, memory difficulties and a higher rate of co-morbid mood disorders. In contrast to acute and peripheral pain states that are responsive to non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, central pain conditions respond best to CNS neuromodulating agents, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and anticonvulsants.

17 Review Does psychological stress cause chronic pain? 2011

Hassett, Afton L / Clauw, Daniel J. ·Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI 48106, USA. afton@med.umich.edu ·Psychiatr Clin North Am · Pubmed #21889680.

ABSTRACT: -- No abstract --

18 Review Fibromyalgia: a primer for the anesthesia community. 2011

Brummett, Chad M / Clauw, Daniel J. ·Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, USA. cbrummet@umich.edu ·Curr Opin Anaesthesiol · Pubmed #21799404.

ABSTRACT: PURPOSE OF REVIEW: The present review is intended to give an overview of fibromyalgia for the anesthesiologist. While the basics of the treatment of fibromyalgia are included, the intent is to provide context to discuss the potential implications in perioperative management. RECENT FINDINGS: Research continues to demonstrate that fibromyalgia patients have neurophysiologic abnormalities that alter sensory perception, including lower levels of central neurotransmitters associated with the inhibition of pain and higher levels those that facilitate pain. While comorbid mood disorders are more common in fibromyalgia patients, studies have shown that fibromyalgia symptoms are not explained by depression alone. In the last year, the American College of Rheumatology established a new self-report questionnaire for the diagnosis of fibromyalgia in lieu of the previously required tender point examination plus self-report questionnaire. This questionnaire allows for the study of the severity of sensitivity and symptomatology on a continuum, which is termed 'fibromyalgianess'. Some new concepts in the treatment have been proposed, including sodium oxybate, transcranial magnetic stimulation, and web-based cognitive behavioral therapy. SUMMARY: The impact of fibromyalgia on anesthesia care is not known. Years of quality research have clearly demonstrated multiple pathophysiologic changes that could impact anesthesia care and future study is needed.

19 Review Fibromyalgia: from pathophysiology to therapy. 2011

Schmidt-Wilcke, Tobias / Clauw, Daniel J. ·Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, 48106, USA. tobiass@ med.umich.edu ·Nat Rev Rheumatol · Pubmed #21769128.

ABSTRACT: Individuals with fibromyalgia generally experience chronic widespread pain, which can be accompanied by further symptoms including fatigue, sleep disturbances, cognitive dysfunction, anxiety and depressive episodes. As the recognition and diagnosis of fibromyalgia has improved, the availability of therapeutic options for patients has increased. Furthermore, research into the neurobiological mechanisms that contribute to the chronic pain and concomitant symptoms experienced by patients with fibromyalgia has advanced our understanding of this debilitating disorder. In this Review, we aim to provide an overview of existing pathophysiological concepts. The roles of biological and psychological stress, genetic factors, and pain and sensory processing in the pathophysiology of fibromyalgia and related conditions are discussed. In addition, pharmacological treatments, including monoamine modulators, calcium channel modulators and γ-aminobutyric acid modulators, as well as nonpharmacological treatment options are considered.

20 Review The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia. 2011

Lee, Yvonne C / Nassikas, Nicholas J / Clauw, Daniel J. ·Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA. ylee9@partners.org ·Arthritis Res Ther · Pubmed #21542893.

ABSTRACT: Pain is a key component of most rheumatologic diseases. In fibromyalgia, the importance of central nervous system pain mechanisms (for example, loss of descending analgesic activity and central sensitization) is well documented. A few studies have also noted alterations in central pain processing in osteoarthritis, and some data, including the observation of widespread pain sensitivity, suggest that central pain-processing defects may alter the pain response in rheumatoid arthritis patients. When central pain is identified, different classes of analgesics (for example, serotonin-norepinephrine reuptake inhibitors, α2δ ligands) may be more effective than drugs that treat peripheral or nociceptive pain (for example, nonsteroidal anti-inflammatory drugs and opioids).

21 Review Improving the recognition and diagnosis of fibromyalgia. 2011

Arnold, Lesley M / Clauw, Daniel J / McCarberg, Bill H / Anonymous1720693. ·Department of Psychiatry and Behavioral Neuroscience and the Women's Health Research Program, University of Cincinnati College of Medicine, Cincinnati, OH, USA. lesley.arnold@uc.edu ·Mayo Clin Proc · Pubmed #21531887.

ABSTRACT: Fibromyalgia (FM) is a chronic widespread pain disorder often seen in primary care practices. Advances in the understanding of FM pathophysiology and clinical presentation have improved the recognition and diagnosis of FM in clinical practice. Fibromyalgia is a clinical diagnosis based on signs and symptoms and is appropriate for primary care practitioners to make. The hallmark symptoms used to identify FM are chronic widespread pain, fatigue, and sleep disturbances. Awareness of common mimics of FM and comorbid disorders will increase confidence in establishing a diagnosis of FM.

22 Review Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome. 2011

Smith, Howard S / Harris, Richard / Clauw, Daniel. ·Albany Medical College, Department of Anesthesiology, Albany, NY 12208, USA. smithh@mail.amc.edu ·Pain Physician · Pubmed #21412381.

ABSTRACT: Fibromyalgia is a condition which appears to involve disordered central afferent processing. The major symptoms of fibromyalgia include multifocal pain, fatigue, sleep disturbances, and cognitive or memory problems. Other symptoms may include psychological distress, impaired functioning, and sexual dysfunction. The pathophysiology of fibromyalgia remains uncertain but is believed to be largely central in nature. In 1990 the American College of Rheumatology (ACR) published diagnostic research criteria for fibromyalgia. The criteria included a history of chronic and widespread pain and the presence of 11 or more out of 18 tender points. Pain was considered chronic widespread when all of the following are present: pain in the left side of the body; pain in the right side of the body; pain above the waist; pain below the waist. In addition, axial skeletal pain must be present and the duration of pain must be more than 3 months. A tender point is considered positive when pain can be elicited by pressures of 4 kg/cm2 or less. For tender points to be considered positive, the patient must perceive the palpation as painful; tenderness to palpation is not sufficient. However, over the next 20 years it became increasingly appreciated that the focus on tender points was not justified. In 2010 a similar group of investigators performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop new preliminary ACR diagnostic criteria, and to construct a symptom severity (SS) scale. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, un-refreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. The investigators combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI > or = 7 AND SS > or = 5). Although there is no known cure for fibromyalgia, multidisciplinary team efforts using combined treatment approaches, including patient education, aerobic exercise, cognitive behavioral therapy, and pharmacologic therapies (serotonin norepinephrine reuptake inhibitors [e.g., duloxetine, milnacipran] and alpha 2-delta receptor ligands [e.g., pregabalin]) might improve symptoms as well as function in patients with fibromyalgia.

23 Review Perspectives on fatigue from the study of chronic fatigue syndrome and related conditions. 2010

Clauw, Daniel J. ·Chronic Pain and Fatigue Research Center, The University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA. dclauw@umich.edu ·PM R · Pubmed #20656623.

ABSTRACT: Fatigue is a symptom whose causes are protean and whose phenotype includes physical, mood, and behavioral components. Chronic fatigue syndrome (CFS) is an illness that has strong biological underpinnings and no definite etiology. Diagnostic criteria established by the Centers for Disease Control and Prevention have helped classify CFS as an overlap of mood, behavioral, and biological components. These include the presence of fatigue for more than 6 months associated with a diminution of functional activity and somatic symptoms, and pain not attributable to a specific diagnosis or disease. Four of the following criteria need to be present: sore throat, impaired memory or cognition, unrefreshing sleep, postexertional fatigue, tender glands, aching stiff muscles, joint pain, and headaches. Many researchers have observed that CFS shares features in common with other somatic syndromes, including irritable bowel syndrome, fibromyalgia, and temporomandibular joint dysfunction. Correlations between inflammation and infection, augmented sensory processing, abnormalities of neurotransmitters, nerve growth factors, low levels of serotonin and norepinephrine, abnormalities of homeostasis of the stress system, and autonomic dysfunction may be hallmarks of CFS. The relative contributions of each of these abnormalities to the profound fatigue associated with CFS need to be explored further to better evaluate and treat the syndrome.

24 Review Pharmacotherapy in fibromyalgia (FM)--implications for the underlying pathophysiology. 2010

Schmidt-Wilcke, T / Clauw, D J. ·Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA. tobiass@med.umich.edu ·Pharmacol Ther · Pubmed #20388527.

ABSTRACT: Although chronic pain states are highly prevalent, the underlying neurobiological mechanisms involved in causing pain are incompletely understood. This is especially true for the so-called chronic functional pain syndromes and pain syndromes of unknown origin, such as fibromyalgia (FM), in which no structural correlates of pain experience, in terms of a nociceptive source, can clearly be defined. In addition to limited therapeutic options and often unsatisfactory treatment, such patients often struggle with socio-medical acceptance of their pain condition. As FM has become more widely recognized, options available for treatment have grown along with our understanding of the neurobiological mechanisms underlying chronic pain experience and concomitant symptoms. The current review aims to provide an overview of existing pharmacotherapies for FM, and their implication for the underlying pathophysiology. Further we discuss some of the potential targets that have been recently identified that may hold promise for the development of novel treatments.

25 Review Fibromyalgia: an overview. 2009

Clauw, Daniel J. ·Chronic Pain & Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan 48106, USA. dclauw@med.umich.edu ·Am J Med · Pubmed #19962494.

ABSTRACT: Fibromyalgia is the diagnosis given to individuals with chronic widespread musculoskeletal pain for which no alternative cause, such as tissue inflammation or damage, can be identified. Fibromyalgia is now believed to be, at least in part, a disorder of central pain processing that produces heightened responses to painful stimuli (hyperalgesia) and painful responses to nonpainful stimuli (allodynia). Aberrations in central pain processing may also be partly responsible for symptoms experienced in several chronic pain disorders that coaggregate with fibromyalgia, which is itself a product of genetic and environmental factors. Thus, aberrational central pain processing is implicated in irritable bowel syndrome, temporomandibular disorder, chronic low back pain, and certain other chronic pain disorders. Fibromyalgia and related disorders appear to reflect deficiencies in serotonergic and noradrenergic, but not opioidergic, transmission in the central nervous system. The heightened state of pain transmission may also be owing to increases in pronociceptive neurotransmitters such as glutamate and substance P. In some cases, psychological and behavioral factors are also in play. Although the overlapping symptomatology between fibromyalgia and related disorders may present diagnostic challenges, proper examination and observation can help clinicians make an accurate diagnosis. In recent years, the vastly improved understanding of the mechanism underlying fibromyalgia and the related spectrum of diseases has fostered rapid advances in the therapy of these chronic pain disorders by both pharmacologic and nonpharmacologic interventions.