title: Fibromyalgia syndrome in an Amish community: a controlled study to determine disease and symptom prevalence.
abstract: OBJECTIVE
  To estimate the point prevalence of fibromyalgia syndrome (FM) in Amish adults and to compare the prevalence of chronic pain, chronic widespread pain, FM, chronic fatigue, and debilitating fatigue in the Amish versus non-Amish rural and urban controls. The a priori assumption was that, if litigation and/or compensation availability have major effects on FM prevalence, then FM prevalence in the Amish should approach zero.
  
  
  METHODS
  We surveyed 242 Amish adults in a small rural community southeast of London, Ontario, Canada. Individuals were screened using a validated screening instrument. Those reporting chronic, widespread pain were examined for FM using published classification criteria. Amish results were compared to results collected in a random telephone survey of 492 non-Amish adults living in rural Southwestern Ontario and 3395 non-Amish adults previously surveyed in London.
  
  
  RESULTS
  Pain lasting at least one week in the preceding 3 months was reported by 34.3% of the Amish; pain in the upper extremities by 25.4%, in the lower extremities by 22.5%, and in the trunk by 28.1%. Twenty-six (15 women, 11 men) reported chronic, widespread pain. Eleven FM cases were confirmed among women (age adjusted point prevalence, p = 10.4%) and 2 among men (p = 3.7%) for an overall age and sex adjusted prevalence of 7.3% (95% CI 5.3, 9.7); this was both statistically greater than zero (p < 0.0001) and greater than in either control population (both p < 0.05).
  
  
  CONCLUSIONS
  FM is relatively common among the Amish.
authors.affiliation: Department of Medicine, University of Western Ontario, London, Ontario, Canada.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: White
authors.forename: John
authors.initials: J
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D005221:Fatigue / Q000208:ethnology*; D005260:Female; D005356:Fibromyalgia / Q000208:ethnology*; D006801:Humans; D016365:Liability, Legal; D008131:London; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010146:Pain / Q000208:ethnology*; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D017678:Sex Distribution; D014505:Urban Population / Q000706:statistics & numerical data; D014942:Workers' Compensation