Sick and Tired: Understanding and Managing Sleep Difficulties in ...

and are less able to inhibit the pain response (Mease, 2005). Genetic factors, depression
and the experience of stressful life events (such as surgery, childbirth or traffic
accidents) have been linked to an increased risk of developing FMS, although the
evidence is often inconsistent (Al-Allaf et al., 2002; Arnold et al., 2004; Forseth, Husby,
Gran, & Forre, 1999; Kato, Sullivan, Evengard, & Pedersen, 2006; McBeth, 2005).
No physiological marker for FMS has been identified and diagnosis is usually made
after the exclusion of other possible causes of pain (such as rheumatoid arthritis,
systemic lupus erythematosus and polymyalgia rheumatica) (Marcus, 2009). Although
no specific risk factors have been identified, smoking (Yunus, Arslan, & Aldag, 2002b),
high Body Mass Index (Yunus, Arslan, & Aldag, 2002a), lower levels of education and
unemployment (White, Speechley, Harth, & Ostbye, 1999b) have all been associated
with increased severity of symptoms.
FMS was first described by clinicians, in the 1800s, as muscular rheumatism. At the
beginning of the following century the condition became known as „fibrositis‟
(suggesting inflammation of the fibrous tissue); until the term was changed to
„Fibromyalgia Syndrome (FMS)‟ in 1976, to reflect the lack of evidence of
inflammation within the condition. It was not until 1987 that the condition was
recognised by the American Medical Association. The term FMS continues to suggest
that FMS is a rheumatological condition and patients are most commonly diagnosed and
treated by rheumatologists, however, as indicated above, the latest evidence points to
the fact that symptoms of FMS have a neurological, rather than a rheumatological basis
(Moldofsky, 2009).
Diagnosis
The most commonly applied diagnostic criteria is the American College of
Rheumatology (ACR) criteria (Wolfe et al., 1990), which defines FMS as persistent
widespread pain (across four quadrants of the body) for >3 months and pain in ≥11 out
of 18 tender points on digital palpitation, using the amount of pressure sufficient to
blanch a finger nail or approximately 4kg pressure (see Figure 1, p. 7) (Wolfe et al.,
1990). High tender point scores have been be found to correlate with higher levels of
disability (Lundberg & Gerdle, 2002) and the criteria have been found to have 88%
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