A Database for Fibromyalgia

Geoffrey O. Littlejohn, MD, MPH, MB, BS (Hons),FRACP,FACRM

Fibromyalgia syndrome (FMS) is a multidimensional disorder characterized by chronic pain, hyperalgesia, fatigue, sleep disturbance, and emotional distress. There recently has been intense investigation into FMS but, like the oft-quoted analogy with the blind men and the elephant, we currently know more about the components of FMS than we know about the "beast" as a whole.

The essential element of FMS is pain. indeed, FMS appears to represent a change in homeostasis of an individual's total integrated pain system. This system has internal characteristics, comprising anatomical, physiologic, and psychologic domains, unique to the individual. External influences, such as cultural, ethnic, and other societal factors, bring further generic inputs into that person's homeostatic mechanisms.

FMS is a complicated reaction of the whole person and reflects powerful and variable physiologic responses linking mind and body. The dimensions of FMS include aberrations at several levels-the nociceptor, the central nervous system, the psyche, and the society with which the individual interacts. All these factors play a role in FMS.

The aim of this article is to examine which of these variables one can collect, measure and use to assess, study, or follow patients with FMS. The different dimensions of FMS are reviewed, and items that may relate to a database are examined. Emphasis is placed on instruments or assessments that have been commonly used or are deemed to be useful in FMS. New instruments to assess aspects of FMS are apparent: all the time, and one needs to remain flexible in choice of assessing instrument.

Only a selection of psychologic instruments, for instance, is provided. It is stressed that each item is only one component of the whole and for any one assessment one selected component may be valid, while for another, a different component may be more appropriate. Pain is the most important and, perhaps, the pivotal component of FMS. Pain has been defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.".9. Pain is thus multidimensional, and measurement of pain might include attention to physiologic, psychologic, cultural, and social dimensions. Measurement of pain reflects the patient's reaction to or report of pain. A number of standard methods have been described

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