Posted by BETHIE on 8/12/2007, 11:14 am “Today I’m convinced Fibromyalgia is indeed a ‘broader’ condition with various subsets” - and a Fibromyalgia Spectrum model is helpful in organizing and educating patients, writes Dr. Mark J. Pellegrino, MD, a Fibromyalgia expert specialized in Physical Medicine and Rehabilitation. This article – excerpted with permission from Dr. Pellegrino’s highly praised and reader-friendly book, Fibromyalgia: Up Close and Personal* - explains the spectrum of conditions the doctor has observed in caring for more than 20,000 patients in his clinical practice. Dr. Pellegrino has been a Fibromyalgia patient himself since childhood. As a senior resident at The Ohio State University in 1988, I gave a lecture on Fibromyalgia at the Physical Medicine Grand Rounds. One of my lecture slides was entitled “Fibromyalgia, A Spectrum of Conditions?” I discussed how Fibromyalgia appears to be a “broader” condition with specific subsets. Fibromyalgia was in that area between normal and disease – the “gray” area. Some of the subsets were closer to normal, involving regional pain only, or milder symptoms without numerous associated conditions. ome subsets were closer to abnormal, with some features of connective tissue or rheumatic diseases, but were not quite “there.” I believe this information is helpful in explaining why everyone’s symptoms are different even though they all have Fibromyalgia. This chapter addresses how the Fibromyalgia spectrum is part of the big picture in understanding Fibromyalgia. Dr. Muhammad Yunus, MD, [a professor and FM specialist at the University of Illinois College of Medicine] has developed the concept of Dysregulation Spectrum Syndrome (DSS) to describe how conditions overlap. Ten conditions are in the DSS umbrella: Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, tension headaches, migraine headaches, primary dysmenorrhea, periodic limb movement disorder, restless leg syndrome, temporomandibular pain syndrome, and myofascial pain syndrome. He predicts other entities will be added to this list in the future. 1. Patients with different conditions sharing similar profiles. 2. Common shared symptoms, such as pain, poor sleep, fatigue, and female predominance. 3. Hypersensitivity to pain. I have discussed the Fibromyalgia spectrum with my patients to help them understand the various subsets possible. I do not see Fibromyalgia as a member of a bigger family, but as the main condition. It is the “founding father” and keeps its name. If Fibromyalgia is the founding father, then the various overlapping conditions and subsets become the children. The name Fibromyalgia remains, but different subsets have unique characteristics and together they become the Fibromyalgia spectrum.
The Fibromyalgia Spectrum – Part of the Big Picture in Understanding Fibromyalgia
by Mark J. Pellegrino, MD
Today I’m convinced Fibromyalgia is indeed a “broader” condition with various subsets.
Fibromyalgia Is a Distinct Medical
Entity, and Appropriately So
We have long recognized, however, that many conditions overlap it, and various conditions exist that can lead to secondary Fibromyalgia.
Dr. Yunus describes DSS as representing various associated conditions that share similar clinical characteristics and pathologic mechanisms with Fibromyalgia.
According to Dr. Yunus, Conditions in DSS
Share a Number of Characteristics:
4. No “diagnostic” pathology that can be measured.
5. Shared psychological complaints such as depression and anxiety. ???????
6. Shared common genetic factor likely.
7. Common neurohormonal dysfunctions.
8. Treatments directed at the central nervous system leading to improvement.
9. TMJ [temporomandibular joint] dysfunction.
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