An Army Sergeant With Mysterious Pain: Crack the Case

Christopher L. Tracy, MD


November 10, 2014

Chronic Multifocal Pain Without Apparent Cause

In clinical practice, fibromyalgia syndrome (FMS) should be suspected in patients with chronic multifocal pain without objective injury or inflammation.[1]

After osteoarthritis, fibromyalgia is the second most common "rheumatic disorder," affecting an estimated 2%-8% of the US population. This patient meets the 1990 American College of Rheumatology diagnostic criteria for fibromyalgia with pain (lasting > 3 months) above and below the waist and on both sides of the body, and tenderness in at least 11 of 18 designated tender points.

More recently, the American College of Rheumatology has proposed alternative diagnostic criteria for FMS that are based on data from a multicenter study.[2] The newer criteria place less emphasis on the designated tender point evaluation and include a patient self-report survey asking about the locations of pain, the presence and severity of fatigue, sleep disturbances, memory difficulties, and somatic complaints.


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