Clinical evaluation of fibromyalgia

Objectives. - Fibromyalgia is characterized by diffuse, persistent and unexplained muscle pain associated with tenderness (mechanical allodynia) and unspecific symptoms. Diagnosis criteria as well as pathophysiological mechanisms are still unclear, justifying appropriate questionnaires and clinical investigations. Actual topics. - Several questionnaires including visual analogic scales with respect to pain, fatigue, sleep or mood disorders have been used in fibromyalgia such as Fibromyalgia Impact Questionnaire (30 items) and the European List for Fibromyalgia Evaluation (53 items). Similarly several methods have been proposed to evaluate tenderness in fibromyalgia patients: The study of tender points involves their number (normal value < 4/18), or their pain mean intensity score and the sum of their sensitivities defining the tender point index (normal value < 11/72) -. The average pain threshold (normal value > 4 kg/cm(2)) is more precise, requiring sophisticated devices (mechanical algometers) and physician training; Less complex than pain threshold measurement, more reliable than the tender points number or index, the tensiometer induced myalgia (normal value > 210 mmHg) is probably a promising new alternative way to screen for fibromyalgia. Prospects. - Even if further studies are needed, diagnosis approach of fibromyalgia could be improved by new tools such as the European List for Fibromyalgia Evaluation and algotensiometry. (C) 2003 Editions scientifiques et medicales Elsevier SAS. All rights reserved.