[Steps towards a symptom-based diagnosis of fibromyalgia syndrome. Symptom profiles of patients from different clinical settings].
BACKGROUND
A symptom-based diagnosis of fibromyalgia syndrome (FMS) without tender point examination is helpful for primary medical care. We tested whether a symptom-based diagnosis of FMS can be based on the symptoms of musculoskeletal pain and fatigue.


METHODS
The most frequent and severe symptoms in FMS patients from four different settings (n= 464 from a self-help organization, n=162 from medical expertise, n= 33 from a private rheumatology practice, n=36 from a tertiary-care pain department) were assessed using the Giessen Subjective Complaints List GBB 24. The most frequent and severe symptoms were assessed and compared to those of a representative German population sample. A k-means cluster analysis was performed to identify sub-groups with and without additional vegetative symptoms within the total sample of FMS patients.


RESULTS
The most frequent and severe symptoms in all four sub-samples were low back pain, limb pain and fatigue. The greatest mean differences between FMS patients and the general population were found in the subscales "limb pain" and "fatigue". Cluster analysis identified three sub-groups of patients which were all characterized by severe limb pain and fatigue, as well as varying degrees of vegetative symptoms.


CONCLUSIONS
Following the exclusion of inflammatory rheumatoid, endocrinological and neurological diseases, a symptom-based clinical diagnosis of FMS can be based on of the key symptoms of chronic widespread musculoskeletal pain, as well as chronic fatigue.
Häuser
W
W
Zentrum für Schmerztherapie/Innere Medizin I (Gastroenterologie, Hepatologie, Stoffwechsel- und Infektionskrankheiten, Psychosomatik), Klinikum Saarbrücken gGmbH, Winterberg 1, 66119, Saarbrücken. whaeuser@klinikum-saarbruecken.de
Akritidou
I
I
Felde
E
E
Klauenberg
S
S
Maier
C
C
Hoffmann
A
A
Köllner
V
V
Hinz
A
A
D003937:Diagnosis, Differential; D004185:Disability Evaluation; D005356:Fibromyalgia / Q000175:diagnosis*; D005858:Germany; D006801:Humans; D009209:Myofascial Pain Syndromes / Q000175:diagnosis*; D010147:Pain Measurement; D012720:Severity of Illness Index