New thinking about fibromyalgia pain.

STEPHANIE PETERS*, 48, has been seeing her primary care provider off and on for several years with the same types of complaints: generalized, severe bilateral musculoskeletal pain at various anatomic sites, including her hips and shoulders. She has difficulty falling asleep and staying asleep, and says she’s fatigued and irritable at times. She also has some difficulty remembering things but just feels it’s a part of her busy lifestyle. Yesterday, a friend hugged her, causing Ms. Peters to scream in pain. You suspect she has fibromyalgia. This patient’s pain has all the hallmarks of fibromyalgia pain—it’s chronic, widespread, and occurs above and below the waist and on both sides of her body. She also has a sleep disturbance and fatigue. With these three criteria, this patient would fulfill the American College of Rheumatologists’ (ACR) newly expanded criteria for a diagnosis of fibromyalgia syndrome (FMS).1,2 This article describes the expanded criteria.