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Abstract
Fibromyalgia is a perplexing, controversial syndrome with many unanswered questions regarding both etiology and manifestations and impairment and disability issues. This article reviews controversies attending this diagnosis, examines the debates concern etiology, explains why this diagnosis is unratable by the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, and explore issues of disability. Health care professionals debate whether the diagnostic criteria actually define a distinct clinical disorder, but the American College of Rheumatology published, for research purposes, classification criteria for Fibromyalgia Syndrome (FMS) that since have been widely used: FMS has been defined as a complex, chronic condition characterized by widespread noninflammatory musculoskeletal pain, severe fatigue, and sleep disturbances. Many health care professionals maintain that FMS is best understood from a biopyschosocial perspective because of the absence of visible clinical signs and inability to confirm the condition by laboratory tests. FMS may affect between 3 and 6 million people in the United States, with a 10:1 predominance in women, most between 35 and 60 years of age. Section 18.3b, When This Chapter Should Not Be Used to Rate Pain-Related Impairment, advises that “the pain of individuals with ambiguous or controversial pain syndromes is considered unratable” and provides three discriminatory questions.
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McBeth J, Macfarlane GJ, Benjamin S, et al.. The association between tender points, psychological distress, and adverse childhood experiences. Arthritis Rheumatology. 1996;42:1397–1404.
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Barsky AJ, Borus JF. Functional somatic syndromes. Ann Intern Med. 1999;130: 910–921.
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Makela MO. Is fibromyalgia a distinct clinical entity? The epidemiologist's evidence. Baillieres Best Pract Res Clin Rheumatol. 1999;13:415–419.
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Wolfe F, Ross L, Anderson J, Russel IJ, and Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis and Rheumatism. 1995;38:19–28.
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Bennet RM. A Contemporary overview of fibromyalgia. Presentation to the National Fibromyalgia Research Association; 1999; Portland, Ore.
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Aaron LA, Bradley LA, Alarcon GS, et al.. Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behavior rather than to illness. Arthritis and Rheumatism. 1996;39:436–445.
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