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Fibromyalgia: A Chronic Widespread Neurologic Pain Condition Disease Overview, Diagnosis, and Management PBP00542 © 2009 Pfizer Inc. All rights reserved. Printed in USA/September 2009 1 What is Fibromyalgia? Pathogenesis of Fibromyalgia Clinical Features and Diagnosis of Fibromyalgia Management of Fibromyalgia 2 FM Is a Chronic Pain Condition and Is Distinct from Other Types of Pain Nociceptive Pain Neuropathic Pain Inflammatory Pain Central Pain Amplification (ie, Burn) (ie, Herpes zoster) (ie, Rheumatoid arthritis) (ie, Fibromyalgia) Painful Stimuli Neuronal Damage Inflammation Acute Pain Adapted from Woolf C. Ann Intern Med. 2004;140:441-451. Abnormal Pain Processing by CNS Chronic Pain 3 Fibromyalgia (FM): A Chronic Widespread Neurologic Pain Condition • • FM is a neurological condition associated with chronic widespread pain (CWP) and tenderness1 American College of Rheumatology (ACR) criteria for the diagnosis of FM2 – Chronic widespread pain • Pain for ≥3 months • Pain above and below the waist • Pain on left and right sides of body and axial skeleton – Pain at ≥11 of 18 tender points when palpated with 4 kg of digital pressure Diagram Showing 18 Tender Points ACR criteria are:2 • Sensitive (88.4%) – measure of correctly diagnosed patients 1Wolfe 2Wolfe F, et al. Arthritis Rheum. 1995;38(1):19-28. F, et al. Arthritis Rheum. 1990;33:160-172. • Specific (81.1%) – statistical probability of an accurate negative diagnosis 4 Epidemiology of FM FM Is One of the Most Common CWP Conditions1 • • Prevalence in United States is estimated to be 2%-5% of the adult population1 FM is highly underdiagnosed2 – Only 1 in 5 is diagnosed – Diagnosis takes an average of 5 years3 • Impacts a wide range of patients2 – Most patients are between 25 and 60 years of age – Women more likely to be diagnosed than men 1Wolfe F, et al. Arthritis Rheum. 1995;38:19-28. PT, et al. J Clin Rheumatol. 2006;12:124-128. 3National Pain Foundation. Available at: http://nationalpainfoundation.org/articles/849/facts-and-statistics. Accessed July 21, 2009. 2Weir 5 Risk Factors for FM • Genetic factors1 – Relatives of FM patients are at higher risk for FM • First-degree relatives are significantly more likely to have FM (Odds ratio=8.5; p=0.0002) • Environmental factors2 – Physical trauma or injury – Infections (Lyme disease, hepatitis C) – Other stressors (e.g., work, family, life-changing events) • Gender3 – Women are diagnosed with FM approximately 7 times more often than men 1Arnold LM, et al. Arthritis Rheum. 2004;50(3):944-952. PJ. J Rheumatol. 2005;32(suppl 75):6-21. 3Arnold LM, et al. Arthritis Rheum. 2004;50(9):2974-2984. 2Mease 6