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Fibromyalgia or Nerve Symptoms? How To Tell

How can doctors tell if arm pain in patients with fibromyalgia syndrome (FMS) is from the fibromyalgia or something else? FMS describes a condition of painful tender points in the muscles. To be diagnosed with FMS, the patient must have 11 positive tender points out of 18 possible points. The tender points must be present in all four arms and legs as well as the trunk. Other symptoms such as fatigue, headache, and sleep problems must also be present. Injury or damage to the nerves (neuropathy) in the arms and legs can also cause painful symptoms.

A careful exam is needed to sort these problems out when the patient who has FMS also develops symptoms of neuropathy. This is the conclusion of hand surgeons at Johns Hopkins University. They say the tests for nerve damage are still valid in patients with FMS. The tender points of FMS and the painful points with neuropathy are close together, but not the same.

The pain is also described differently. Pain with FMS is widespread and usually on both sides. Patients say it's "deep" and "aching." Pressure on the nerves to the arm usually causes numbness, tingling, or weakness more than pain. When it's present, nerve pain is described as "hot," "sharp or stabbing," or "burning."

The authors conclude that using standard tests for positive nerve damage is still useful in patients with FMS and arm pain.

References: A. Lee Dellon, MD, et al. Diagnosis of Compressive Neuropathies in Patients with Fibromyalgia. In The Journal of Hand Surgery. November 2003. Vol. 28A. No. 6. Pp. 894-897.

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