Journalof

MusculoskeletalPain
Dan S.
Frances
Heffez Y.-K.
Daniel
Leung G.
Thomas
Malone J.
I. Jon
Romano
David
Russell
Donald G.
Saul
Seibel
Anil Kumar Jain, BSc, MD, Co-Editor, is affiliated with the Ottawa Hospital, Ottawa,
BruceM.Carruthers,MD,CM,FRCP[C],Co-
ON, Canada.
Marjorie I. van de Sande, BEd, Grad Dip Ed, is Consensus Coordinator, Director of Education,
Editor,isSpecialistinInternalMedicine,Saanichton,BC,Canada.
Action Network,
National ME/FM
Canada.

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TheFibromyalgiaSyndrome:
AClinicalCaseDefinition
forPractitioners
TheJournalofMusculoskeletalPain Monographic
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TheFibromyalgiaSyndrome:AClinicalCaseDefinitionforPractitioners, edited by I. Jon Russell, MD, PhD (Vol. 11, No. 4, 2003).
Establishesanexpertconsensustowardaworkingcasedefinitionoffibromyalgiasyndromeandaworkingguidetoits
managementforphysiciansinCanada.

TheClinicalNeurobiologyofFibromyalgiaandMyofascialPain:TherapeuticImplications, edited by Robert M. Bennett, MD

(Vol. 10, No. 1/2, 2002).Coversthelatestdevelopmentsinpainresearch:examinestheresultsofawidescopeofbasicand
appliedresearchonsofttissuepain.

InternationalMYOPAINSocietyMYOPAIN01:Abstractsfromthe5thWorldCongressonMyofascialPainandFibromyalgia,
Portland,Oregon,USA,September9September13,2001(Vol. 9, Suppl. #5, 2001)

MusclePain,MyofascialPain,andFibromyalgia:RecentAdvances, edited by Leonardo Vecchiet, MD, and Maria Adele

Giamberardino, MD (Vol. 7, No. 1/2, 1999).Coversthelatestdevelopmentsinmusculoskeletalpainthatwerepresentedatthe
MYOPAIN98CongressinSilviMarina,Italy.

MYOPAIN98:Abstractsfromthe4thWorldCongressonMyofascialPainandFibromyalgia,SilviMarina[TE],ITALY,August
24August27,1998, edited by Leonardo Vecchiet, MD, and Maria Adele Giamberardino, MD (Vol. 6, Supp. #2,
1998).
TheNeuroscienceandEndocrinologyofFibromyalgia, edited by Stanley R. Pillemer, MD (Vol. 6, No. 3, 1998).Irecommendthis
booktoallhealthcareproviderswhowanttoofferthemostuptodatetherapyfortheirpatientswithfibromyalgia.[David
Borestein,MD,ClinicalProfessorofMedicine,TheGeorgeWashingtonUniversityMedicalCenter,ArthritisandRheumatism]

MusclePainSyndromesandFibromyalgia:PressureAlgometryforQuantificationofDiagnosisandTreatmentOutcome, edited by
Andrew A. Fischer, MD, PhD (Vol. 6, No. 1, 1998).Shouldhelpresearchersindevelopingnewandexpandedstudiesforthe
appropriateroleofpressurealgometry.[MartinGrabois,MD,ProfessorandChairman,PhysicalMedicineandRehabilitation,
BaylorCollegeofMedicine,Houston,Texas]

MusculoskeletalPainEmanatingfromtheHeadandNeck:CurrentConceptsinDiagnosis,Management,andCostContainment,
edited by Murray E. Allen, MD (Vol. 4, No. 4, 1996).Excitingbecauseitcontainsadistillationofrecentresearchthatisofvalue
toallwhotreatandservethosewithwhiplashrelatedinjuries.[NationalAssociationofRehabilitationProfessionalsinthe
PrivateSector]

ClinicalOverviewandPathogenesisoftheFibromyalgiaSyndrome,MyofascialPainSyndrome,andOtherPainSyndromes, edited
by I. Jon Russell, MD, PhD (Vol. 4, No. 1/2, 1996).ThefeaturedspeakersattheMYOPAIN95ThirdWorldCongressarehere
distilledintoananthologythatrepresentsastateoftheartinfibromyalgiasyndromeandmyofascialpainsyndromefromthat
conference.

MYOPAIN95:Abstractsfromthe3rdWorldCongressonMyofascialPainandFibromyalgia,SanAntonio,Texas,USA,July
30August3,1995, edited by I. Jon Russell, MD, PhD (Vol. 3, Supp. #1, 1995).Anexcellentresourcethatallowsphysicians,
dentists,researchers,andothersworkinginthisfieldtoaccesskeyinformationaspresentedbyspecialistsworldwidewhowork
withandresearchchronicmusclepain.

Fibromyalgia,ChronicFatigueSyndrome,andRepetitiveStrainInjury:CurrentConceptsinDiagnosis,Management,Disability,
andHealthEconomics, edited by Andrew Chalmers, MD, Geoffrey Owen Littlejohn, MD, Irving Salit, MD, and Frederick
MD (Vol. 3, No. 2, 1995).Theinformationandoriginalresearchpresentedisrelevantandusefulforunderstandingsomeofthe
Wolfe,
globalresearchbeingconductedonthesedisorders....Itwouldbemostusefulasanadditiontoascientific/medicallibrary.
[AnnalsofPharmacotherapy]

TheFibromyalgiaSyndrome:CurrentResearchandFutureDirectionsinEpidemiology,Pathogenesis,andTreatment, edited by
Stanley R. Pillemer, MD (Vol. 2, No. 3, 1994).Thishighlyinformativeandwellreferencedtextisrecommendedtobothstudents
andpractitioners.[AnnalsofPharmacotherapy]

MusculoskeletalPain,MyofascialPainSyndrome,andtheFibromyalgiaSyndrome:ProceedingsfromtheSecondWorldCongress
onMyofascialPainandFibromyalgia, edited by Sren Jacobsen, MD, Bente Danneskiold-Samse, MD, PhD, and Birger
MD,
Lund,PhD (Vol. 1, No. 3/4, 1993).Packedwithstateoftheartinformation....Animportantcontributiontoourunderstanding
ofmyofascialpainsyndrome,fibromyalgia,andmusculoskeletalpain,andwillbeusefultobothpatientsandhealthcare
providers.[Lifeline[NationalChronicPainOutreachAssociation]]
TheFibromyalgiaSyndrome:
AClinicalCaseDefinition
forPractitioners

I. Jon Russell, MD,

PhD Edito
r

Journal of Musculoskeletal
Pain Volume 11,
Number 4

The Haworth Medical

An Imprint
Pressof The Haworth Press,
Inc.
EDITOR

I.JONRUSSELL,MD,PhD,TheUniversityofTexasHealthScienceCenter,SanAntonio,TX,USA

FOUNDINGASSISTANTEDITOR[19932002]

BARBARA RUNNELS, MEd,TheUniversityofTexasHealthScienceCenter,SanAntonio,TX,USA

EDITORIALCOMMITTEE

JOHN P. HATCH, PhD,TheUniversityofTexasHealthScienceCenter,SanAntonio,TX,USA

JAMES N. ROGERS, MD,TheUniversityofTexasHealthScienceCenter,SanAntonio,TX,USA
JOHN C. KING, MD,TheUniversityofTexasHealthScienceCenter,SanAntonio,TX,USA

EDITORIALBOARD

ROBERT M. BENNETT, MD,OregonHealthandScienceUniversity,Portland,OR,USA

CAROL S. BURCKHARDT, PhD,OregonHealthandScienceUniversity,Portland,OR,USA
RENE CAILLIET, MD,UniversityofSouthernCalifornia[retired],LosAngeles,CA,USA
DANIEL J. CLAUW, MD,UniversityofMichigan,AnnArbor,MI,USA
LESLIE J. CROFFORD, MD,UniversityofMichigan,AnnArbor,MI,USA
RICHARD A. DEYO, MD,UniversityofWashington,Seattle,WA,USA
PERRY G. FINE, MD,UniversityofUtah,SaltLakeCity,UT,USA
JAMES R. FRICTON, DDS,UniversityofMinnesota,Minneapolis,MN,USA
ROBERT D. GERWIN, MD,JohnsHopkinsUniversity,Baltimore,MD,USA
KARL G. HENRIKSSON, MD, PhD,LinkpingUniversity,Linkping,Sweden
CHANG-ZERN HONG, MD,NationalChengKungUniversity,Tainan,Taiwan
STEPHEN A. JOHNSTON, PhD,TheUniversityofTexasSouthwestern,Dallas,TX,USA
STEVEN F. LEWIS, PhD,BostonUniversity,Boston,MA,USA
GEOFFREY LITTLEJOHN, MD,MonashUniversityMedicalCenter,Clayton,Australia
JOHN D. LOESER, MD,UniversityofWashington,Seattle,WA,USA
GLENN A. McCAIN, MD,RheumatologyPrivatePractice,Charlotte,NC,USA
ORLANDO MAYORAL DEL MORAL, PT,HospitalProvincialdeToledo,Toledo,Spain
SIEGFRIED MENSE, Dr Med,HeidelbergUniversity,Heidelberg,Germany
HAROLD MERSKEY, DM,WesternOntarioUniversity,London,Ontario,CA
HARVEY MOLDOFSKY, MD,ResearchDirector,SleepPhysiology,Toronto,Ontario,Canada
FRED NYBERG, PhD,UniversityofUppsala,Uppsala,Sweden
THOMAS J. ROMANO, MD, PhD,RheumatologyPrivatePractice,MartinsFerry,Ohio,USA
DAVID SIMONS, MD,EmoryUniversity,Atlanta,GA,USA
HENNING VAEROY, Dr. Med Sci,Fjellhamar,Norway
DANIEL J. WALLACE, MD,UniversityofCalifornia,LosAngeles,CA,USA
MUHAMMAD B. YUNUS, MD,UniversityofIllinoisCollegeofMedicine,Peoria,IL,USA
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 Indexing,Abstracting&
Website/InternetCoverage
JournalofMusculoskeletalPain

This section provides you with a list of major indexing &

vices. That is to
abstracting say, each service began covering this
ser-
year notedduring
periodical in the the
right column. Most Websites which are listed
indicated
below have that they will either post, disseminate, compile,
alert their
archive, own
cite, orWebsite users with research-based content
[This
from this work.current as the copyright date of this
list is as
publication.]
Abstracting, Website/Indexing Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Year When
Coverage Began
AnalgesiaFile,DannemillerMemorialEducationalFoundation,Texas
<http://www.pain.com>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.2003
BehavioralMedicineAbstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1994
BiologyDigest[inprint&online]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2000
CambridgeScientificAbstracts[Calcium&CalcifiedTissueAbstracts/Health&Safety
ScienceAbstracts]<http://www.csa.com> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1993
CentreRegionalDExplorationdesMyalgies<http://www.infomyalgie.com> . . . . . . . . . . .1996
CFS
NEWS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CINAHL[CumulativeIndextoNursing&AlliedHealthLiterature],inprint,EBSCO,
andSilverPlatter,DataStar,andPaperChase.[SupportmaterialsincludeSubject
HeadingList,DatabaseSearchGuide,andinstructionalvideo]
<http://www.cinahl.com> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.1995
CNPIECReferenceGuide:ChineseNationalDirectoryofForeignPeriodicals . . . . . . . . . .1995
CurrentContents/ClinicalMedicine<http://www.isinet.com> . . . . . . . . . . . . . . . . . . . . . . . .1997
EMBASE/ExcerptaMedicaSecondaryPublishingDivision<http://www.elsevier.nl>. . . . . . .1993
epsyche,LLC<http://www.epsyche.net> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2001
EnvironmentalSciencesandPollutionManagement[CambridgeScientificAbstracts
InternetDatabaseService]<http://www.csa.com> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*
Ergonomics
Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1993
ExcerptaMedica...SeeEMBASE/ExcerptaMedica. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1993
FMForumBritishColumbiaFibromyalgiaSociety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1996
Health&PsychosocialInstruments[HaPI]Database[availablethroughonline
andasaCDROMfromOvidTechnologies]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2002
IndustrialHygieneDigest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1996
ISIWebofScience<http://www.isinet.com> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2003
[continue
d]
MANTIS[Manual,AlternativeandNaturalTherapy]<http://www.healthindex.com> . . . .1999
NationalLibraryofMedicineAbstractsSection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1999
PainWatch<http://www.neuromuscularinfo.com/pain_watch.htm>. . . . . . . . . . . . . . . . . . .2003
PediatricPainLetter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.1998
PharmacistsLetterAbstractsSection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1993
PhysicalTherapyAbstractsSection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1993
PhysiotherapyEvidenceDatabase[PEDro]<http://www.pedro.fhs.usyd.edu.au>. . . . . . . . .1999
PsychologicalAbstracts[PsycINFO]<http://www.apa.org>. . . . . . . . . . . . . . . . . . . . . . . . . .1998
ReferativnyiZhurnal[AbstractsJournaloftheAllRussianInstituteofScientific
andTechnicalInformationinRussian] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1993
REHABDATA,NationalRehabilitationInformationCenter
<http://www.naric.com/naric> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1997
RESEARCHALERT/ISIAlertingServices
<http://www.isinet.com>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.1997
ScienceCitationIndexExpanded<http://www.isinet.com> . . . . . . . . . . . . . . . . . . . . . . . . . .1997
SciSearch[alsoknownasScienceCitationIndexexpanded]<http://www.isinet.com> . . . .1997
SocialWorkAbstracts<http://www.silverplatter.com/catalog/swab.htm> . . . . . . . . . . . . . . .2003
Swetsnet<http://www.swetsnet.com> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2001
*Exactstartdatetocome.

SpecialBibliographicNotesrelatedtospecialjournalissues
[separates]andindexing/abstracting:
indexing/abstracting services in this list will also cover material in any separate that
multaneously
is co-publishedwith si- Haworths special thematic journal issue or DocuSerial.
covers material at theusually
Indexing/abstracting
monographic co-editions
article/chapter level. are intended for either non-subscribers or libraries which
secondto
intend copy for their
purchase a circulating
monographic
collections. co-editions are reported to all jobbers/wholesalers/approval plans. The
listed as
source the series
journal is to assist the prevention of duplicate purchasing in the same
books-in-
manner utilized for
to facilitate user/access services all indexing/abstracting services are encouraged to
series.
ing entry
utilize thenote indicated at the bottom of the first page of each
co-index-
this is intended to assist a library user of any reference tool [whether print, electronic,
article/chapter/contribution.
CD-ROM]
online, or to locate the monographic version if the library has purchased this version
tion to the
but not source
a subscrip-
individual
journal. articles/chapters in any Haworth publication are also available through the
ment Delivery
Haworth Docu-Service
[HDDS].
 TheFibromyalgiaSyndrome:
AClinicalCaseDefinition
forPractitioners
Journal of Musculoskeletal
Pain Volume 11,
Number 4

CONTENTS

Preface: Back to the xii

I.JonRussell
Future i
Introduction: Canadian Consensus Document on 1
AnilKumarJain
Fibromyalgia Syndrome
BruceM.Carruthers
MarjorieI.vandeSande

ARTICLE

Fibromyalgia Syndrome: Canadian Clinical Working Case Definition,

and Treatment ProtocolsA Consensus
Diagnostic 3
AnilKumarJain
Document
BruceM.Carruthers
MarjorieI.vandeSande
StephenR.Barron
C.C.StuartDonaldson
JamesV.Dunne
EmersonGingrich
DanS.Heffez
FrancesY.K.Leung
DanielG.Malone
ThomasJ.Romano
I.JonRussell
DavidSaul
DonaldG.Seibel

RESEARCH IDEAS

Proposed Study to Develop and Validate a Clinical Case

for the Fibromyalgia Syndrome Applicable to the Clinical
Definition 10
I.JonRussell
Practice Setting 9
Proposed Methods for Validation of a Clinical Case
of the Fibromyalgia
Definition 11
KarenG.Raphael
Syndrome 3
Developing and Validating a Clinical Case Definition for the
Syndrome for Use in Clinical
Fibromyalgia 11
KevinP.White
Practice 7
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ERRATUM
In theJournalofMusculoskeletalPain, volume 11, issue 3, an error occurred in the article
paring Patients
entitled Com-with Fibromyalgia Chronic Low Back Pain Participating in an Outpatient
ioral Treatment Program by Carol Wells-Federman, Paul Arnstein, and Margaret Caudill-
Cognitive-Behav-
affiliation The
Slosberg. of Carol Wells-Federman should be read as: Carol Wells-Federman, MEd, APRN,
Senior Lecturer, Simmons College, Boston, MA
BC, is Adjunct
The Haworth Press sincerely regrets this error and any inconvenience it
02115.
may have caused.
 instructions for authors
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Int Med 115: 437-442,
1991.
JournalSupplements
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pp. 1983,
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 ABOUTTHEEDITOR

I.JonRussell,MD,PhD, is Associate Professor of Medicine at The University of

Science
Texas HealthCenter in San Antonio, where he is also Director of the University
Center. He is the founding Editor of theJournalofMusculoskeletalPain and has
Clinical Research
progress
guided itssince 1993. He was Founding President of the International MYOPAIN
currentlyand
Society serves as a Board Member of that organization. He is a member of
ofPainWatch.
the Dr. Russell is an internationally recognized researcher and
Editorial Board
caring
clinical practitionerwith a wide variety of musculoskeletal pain disorders but
for patients
the
withfibromyalgia
emphasis onsyndrome. He serves on expert panels for fibromyalgia
ganizations
syndrome supportin the United
or- States, Canada,
Dr. Russell
and France. has twice been the National Chairman for the American College
atologys
of Rheum- Nonarticular Rheumatism Study Group and has been a Counselor
Region
for of the American College of Rheumatology. He has served on the
the Central
mittee forGrants
Research the Arthritis
Com- Foundation and on the Research and Development
the Audie
Grants Murphy Veterans
Committee of Administration
Dr. Russell has been honored by listings inTheBestDoctorsinAmerica,TheBest
Hospital.
America:CentralRegion,TheBestDoctorsintheSouthandSouthwest,
Doctorsin andTheBest2000
DoctorsinAmerica. His service to the South Texas community was
Humanitarian
acknowledgedof thethe
with Year Award [1994] by the South Central Texas Chapter of
Foundatio
the Arthritis
n. Dr. Russell is the author of over 85 original publications and over 30
books. He isinco-author
chapters ofTheFibromyalgiaHelpBook, and producer of the video
medical text-
Fibromyalgia and You, two educational resources for people with
documentary
extensively, speaking
fibromyalgia. He travels to medical and lay audiences about musculoskeletal
ucation
pain and medical ed- doctorate in biochemistry and nutrition, a medical
issues. With a
ternal
degree, medicine,
residency subspecialty
in in- in rheumatology, 25 years of pain research, and
world view,
an experienced Dr. Russell brings to this journal an interdisciplinary perspective
to emerging
and background issues in both research and
clinical practice.
 Announcem
ent
THEINTERNATIONALMYOPAINSOCIETY[IMS]
and
TheUniversityofTexasHealthScienceCenteratSanAntonio
ContinuingMedicalEducationDepartment

ANNOUNCE

MYOPAIN04
SIXTHWORLDCONGRESSONMYOFASCIALPAINANDFIBROMYALGIA
MUNICH,GERMANY
JULY1822,2004

InternationalMYOPAINSociety[IMS]OfficersandBoard:
President: Robert M. Bennett, MD,
VicePresident: Dieter Pongratz, Prof Dr med,
USA
Secretary/Treasurer: Robert D. Gerwin, MD,
Germany
BoardChair: Leonardo Vecchiet, MD,
USA
BoardMembers: Bente
Italy Danneskiold-Samse, MD, PhD,
James R. Fricton, DDS, MS,
Denmark
I. Jon Russell, MD, PhD,
USA
Jack
USA H. Scott, BS,
Administrator: Barbara Runnels, MEd,
USA
USA
CongressProgramCommittee
ProgramChair: Dieter Pongratz, Prof Dr med,
CongressCoChair: Siegfried Mense, Prof Dr med,
Germany
LocalArrangements: Michael
GermanySpaeth, MD,
Members: Robert Bennett, MD,
Germany
Leslie J. Crofford, MD,
USA
Salvatore
USA DiMauro, MD,
Chang-Zern Hong, MD,
USA
Frederick W. Miller, MD, PhD,
Taiwan
I.
USAJon Russell, MD, PhD,
David G. Simons, MD,
USA
USA
TORECEIVECONGRESSINFORMATION:Gototheweb,www.myopain.orgAlternatively,request
informationbymail.Providecompletemailingaddressto:InternationalMYOPAINSociety,P.O.Box
690402,SanAntonio,TX,USA78249

ABSTRACTDEADLINE: FEBRUARY25,2004.
SUBMITELECTRONICALLY:www.myopain.org
 Announcem
ent
THEJANETG.TRAVELL,MD
SEMINARSERIESSM

FoundationsofTriggerPoint
ExaminationandTreatment
Sept. 5-7, 2003
Nov. 7-9, 2003
[completed]
June 4-6,
[completed]
Head,Face,Neck,andShoulderPain
2004
Dec. 5-7, 2003
ExercisePrescription
[completed]
ForPatientswithChronicPain
Jan. 23-24,
LowBack,PelvicPain
2004
Feb. 6-7,
ExtremityPain
2004
March 12-14,
TriggerPointNeedling
2004
April 16-18,
PelvicPain/HeadNeckPain[Advanced]
2004
May 14-15,
2004
Facultyincludes: Robert Gerwin,
Jan
MD;Dommerholt, PT, MPS; Tamer
Adrienne McAuley, PT,
Issa, PT;
and Steven Shannon,
OCS;
MD
Information available online at
Workshops held in
www.painpoints.com
[aBethesda,
suburb ofMD Washington, DC,
USA]
Forinformationaboutthecourses
Ortosponsoracourseinyourtown
ContactMyopainSeminars
7830OldGeorgetownRoad,SuiteC15
Bethesda,MD208142432
At301.656.0220[phone],301.654.0333[fax]
admin@painpoints.com[email]
 Prefac
Backe:to the
Future

Prefaceentire special issue of the selection of FMS patients for entry

MusculoskeletalPain [JMP] is devoted to
Journalof search
into re- studies. The ACR Criteria have
sentation
pre- of what will likely to be possible
made it for a reader of FMS research
Canadian
called the Consensus Document on confidence
to have that studies done
algia
Fibromy- Syndrome [FMS] (1). The ita, Peoria, in
separately Boston,
Wich- Portland, and San
compasses
document en- a very broad scope, were evaluating comparable patients.
Antonio
clinical
involving a definition, diagnosis, and
case applies
The same to studies performed in
agement
man- of FMS. In addition, the Asia that
Europe have espoused the ACR
and
of
importance findings within the FMS
research the otherOn
Criteria. hand, there has been no
has prompted the inclusion of a
construct the 1990 that
certainty ACR Criteria would properly
ing what
section regard-is known about the tify all of the affected individuals in a
iden-
FMS. The
pathogenesis history
of of the development nity clinic while properly excluding
commu-
document,
of this which was supported by shouldwho
those not be given this
Canada,
Health is outlined in a companion diagnosis. ACR Criteria utilized
The 1990
(2) by
editorial its physician editors and the analysis to establish a somewhat
statistical
coordinator
lay group of the in
arbitrary cut [at least 11 affected of
the number
The clinical case definition
project. tomically-named]
18 ana- of body sites,
Expert
proposedConsensus
by the Panel (1) chosen points [TePs],
called tender that were unusually
Canada
by Health is based on the reasonable deep digital
sensitive to palpation pressure and
Panel members
judgment of who have quired
were re- for a patient to enter a FMS
ence with FMS
considerable experi- in academic and study.
research That was a reasonable
environments.
community In the same way that dardizing
approach enrollment
to stan- in pivotal
of the
the Delphi1990 ACR Criteria study were a Delphi-defined
research about disorder. On the
entrusted
properly to know the disorder based some (4)
other hand, have argued that it is
extensive
on their clinical experience, so the the 1990 ACR
improper to use criteria for diagnosis in
bers,
Panel in their composite wisdom,
mem- munity
com- medical practice. Of course,
to perceive
were considered what was likely to prove cians
physi-in clinical practice have applied
ful in the
to be use- ACR criteria diagnostically because
the 1990
This undertaking can be viewed as
community. is such
body pain a major clinical problem and
step
a thein anext
long-term plan. Since the nothing
there is more precise than the 1990
of the American
development College of teria for identifying patients with
ACR Cri-
[ACR] 1990
Rheumatology Classification Criteria for ing comparable
FMS. Noth- has been created and
bromyalgia
the Fi- Syndrome (3), it has been dated
or vali- for use in community medicine.
that
clear eventually it would be necessary the only
Frankly, reason anyone really cares
mine
to deter-what to include in a clinical sicians
what phy- diagnose in the confines of
tion
casefor use in community medicine.
defini- tices is
their prac-that the diagnosis of FMS can
Criteria
The ACRwere developed to guide the on legal
then take [compensation] implications
uniform for which
[Haworth co-indexing entry note]: Preface: BacktotheFuture. Russell, I.Jon.Co-published simultaneously inJournal
[The Haworth Medical Press, an imprint of The Haworth Press, Inc.] Vol. 11, No. 4, 2003, pp. xiii-xv; and:The
PainofMusculoskeletal
ClinicalCaseDefinitionforPractitioners[ed:I.JonRussell]TheHaworthMedicalPress,animprintofTheHaworthPress,Inc.,2003,pp.xi-xiii.
FibromyalgiaSyndrome:A
SingleormultiplecopiesofthisarticleareavailableforafeefromTheHaworthDocumentDeliveryService[1-800-
p.m. [EST]. E-mail address:
HAWORTH,9:00a.m.-5:00
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2003b/JMP
by The Haworth Press, Inc. All rights xii
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xi THEFIBROMYALGIASYNDROME:ACLINICALCASEDEFINITIONFORPRACTITIONERS
v

someone has to pay. Another view, is a summary of the challenge given

lar
withimplications,
simi- holds that epidemiologists.
to the That is followed by
egies [often
management strat- expensive ones] found to from each
outlines of the experts (7,8)
FMS should
work for be made available to needs
indicating what and how it could be
to be done
patients
community with ten or less TePs, plished
accom- using the Canadian
they have if
especially typical FMS associated ment (1) asDocu-
Consensus a resource. These efforts
such as
symptoms, chronic insomnia, prolonged to resolve
will help conceptual, legal, and
stiffness,
morning or irritable bowel that have
other disputesarisen from the clinical
The
syndrome. development of the Canadian of the 1990
application ACR Criteria Research
Case Definition
Clinical for FMS can be for
Definition
first concerted
viewed as the effort to correct this The panel had no illusion that
FMS.
hoped that
deficit. It is the process of validation the field would
everyone in be completely
tually benefit both the practitioners
will even- the
satisfied with as it now stands. The
document
patien
and their Canadian
proposed Clinical Case Definition
ts.The clinical case definition submitted
must be to further research
Canadian
proposed Consensus
in the Document (1) relevant
scrutiny in settings.
the The definitive study
elements
contains very similar to those expensive.
will be It must be carefully
Yunus and
proposed by coworkers in 1989 (5), those with
planned by much experience in this
of the Preface,
hence the title Back to the Future. will require
process. It international cooperation
new,
While this approach to the diagnosis interested
between parties from a variety of
agement
and man- of FMS uses what has been and holding different views. The main
disciplines
about
learned FMS since 1990 and addresses ments
require-for professional participation in
ously
previ- expressed concerns. Thus, posed
the pro- study should be a willingness
recognized
clinicians have that patients who met the tribute
to con- selflessly to the effort and a
ACR
1990 Criteria for Classification of FMS to accept the scientific outcome.
commitment
also
can exhibit a variety of clinical cacy
Strong will be needed to develop an
advo-
other
manifestations pain and tenderness,
than body tocol and
airtight pro-to secure adequate funding
insomnia,
such as cognitive complaints, job
to do the is expected that there will
right. It
morning
headaches, stiffness, and affective est disagreements that must be
be hon-
Those
symptoms. concerns have also been the tiated,
amicably butnego-
cynical detractors and
many
basis forof the pharmaceutical based naysayers
bodacious must be ignored. The
volving
studies in-FMS patients. The main JMP are
readers of invited to voice opinions in
the Canadian
objective of Consensus Document of Letters
the form to the
enhance
(1) is to the ability of Canadian Editor.
physicians I.JonRussell,MD,PhD
community recognize and treat FMS
to
practices TheEditor
in their and to be more aware of its
clinical
many manifestations, including
yond.
pain, andThebe- extent to which its REFERENCE
tends
influence ex- Canada is yet to
beyond S
1.JainAK,CarruthersBM,vandeSandeMI,Barr
beThis
seen.document addresses previous
SR,on Donaldson CCS, Dunne JV, Gingrich E,
andconcerns a clinical case definition
presents Leung
Heffez FY-K,
DS, Malone DJ, Romano TJ, Russell IJ,
international
that the scientific community D, Seibel DG: Fibromyalgia syndrome:
Saul
as needed
can refine and then should attempt cal working
Canadian case definition, diagnostic and
clini-
To facilitate
to validate. that process, theJMP protocolsa
treatment consensus document. J
staff have
editorial contacted two well- 11(4):3-107,Pain
Musculoske
demiologists, with established track 2. Jain AK, Carruthers BM, van de Sande
2003.
respected epi-
studying FMS. Each was asked to duction: Canadian Consensus Document on
MI: Intro-
records in algia Syndrome. J Musculoske Pain 11(4):1-
lished epidemiological and statistical Fibromy-
apply estab- 3. Wolfe F, Smythe HA, Yunus MB, Bennett
2, 2003.
in the design of a study to validate a
methods Bombardier C, Goldenberg DL, Tugwell P,
RM,
case definition for use in community
clinical SM, Abeles M, Clark P, Fam AG, Farber SJ,
Campbell
The Research
medicine. Ideas section of this JJ, Franklin CM, Gatter RA, Hamaty D, Lessard
Fiechtner
provides
volume three short manuscripts. Lichtbroun AS, Masi AT, McCain GA, Reynolds
J,
The first (6) WJ,
 Preface x
v

Romano TJ, Russell IJ, Sheon RP: The American 6. Russell IJ: Proposed study to develop and
lege
Col- of Rheumatology 1990 Criteria for the a clinical
validate case definition for the fibromyalgia
tionofFibromyalgia.ArthritisRheum33:160-
Classifica- applicable to the community practice setting.
syndrome
4. Wolfe F: Stop using the American
172,1990. Pain 11(4):109-111,
J Musculoske
Rheumatology
College of Criteria in the clinic. J 7. White KP: Developing and validating a
2003.
1671-1672,30(8):
Rheumatol case definition for the fibromyalgia syndrome
clinical
5. Yunus MB, Masi AT, Aldag JC: Preliminary
2003. clinical
for use practice.
in J Musculoske Pain 11(4):117-
teria
cri-for primary fibromyalgia syndrome (PFS): 118,8.RaphaelKG:
2003. Proposed methodsfor
variate analysis of a consecutive series of
Multi- clinical case definition
validation of a of the fibromyalgia
pain patients, and normal subjects. Clin Exp
PFS, other Musculoske
syndrome. J Pain 11(4):113-115,
7:63-69,
Rheumatol 2003.
1989.
Editorial
s Introductio
Canadian
n: Consensus
on Fibromyalgia
Document
Syndrome

The National ME/FM Action Network the stipulations was that at least one
ada] spearheaded the drive for the
[Can- of the panel must be nominated by
member
ment of an expert consensus
develop- five
eachstakeholder
of the groups of
would include
document, whicha clinical definition, versities,
government, uni- industry, and
clinicians,
and treatment protocols, and a
diagnostic There were to be at least ten
advocacy.
pertinent research
discussion of for the panel, fouron
members ofthe
whom could come from
drome [FMS].Syn-
Fibromyalgia As increasing numbers of Canada. The members of the panel
outside
patients
of FMS asked about knowledgeable either
must be practicing MDs, actively
it quickly became clear that there
doctors, diagnosing
treating and/orFMS, or MDs or PhDs
for more
was a neededucation about FMS among clinical research
involved in of the illness. The
care practitioners.
primary The Network sent to provide
focus was the generalist with a
questionnaire
out a to doctors across tion thatdefini-
clinical addressed a broader
what items
Canada asking would be most helpful in pathogenesis of the illness, as well as
spectrum of the
them with
assisting their FMS patients. The diagnostic and treatment protocols.
provide
concurred
physicians that a clinical definition, as would have autonomy over their
The panel
diagnostic
well as and treatment protocols, docume
prime consensus
were of nt.The expert medical subcommittee
The National ME/FM Action Network
importance. Canada selected an expert consensus
of Health
approached
then two clinicians
FMS, which
panel for consisted of thirteen
experienced
knowledgeable in FMS,
and Dr. Anil Jain of This thirteen-member consensus
members.
and Dr. Bruce Carruthers of British
Ontario
who agreed to co-author a draft ceived
panel hada total
re- of forty-six
Columbia, included numerous
Lydia Neilson, President of the
document. nominations, which nominations from
FM ActionME/Network, met with the stakeholder group. The members of
each
National
Alan Rock, then Minister of Health, to sensus
the con-panel represented clinicians,
Honourable
cuss the results of the doctors
dis- medical
university faculty, and researchers in
draft document.
survey and the The Honourable Alan FMS. Collectively,
the area of they had diagnosed
responded
Rock by stating the draft clinical treated
and/or more than twenty thousand
tion was
defini- a milestone in the fight tient pa-
FMS
complex
against this tragic
and s. Health Canada planned for a
Health Canada set up an expert
condition. Workshop
Consensus to be held on March 30 to
subcommittee,
medical which established the 2001.1,All members of the expert
April
of Reference
Terms for the consensus panel were sent the draft document,
consensus
panel. One of which
[Haworth co-indexing entry note]: Introduction: Canadian Consensus Document on Fibromyalgia Syndrome. Jain, Anil
Carruthers, and Marjorie
Kumar, Bruce M. I. van de Sande. Co-published simultaneously inJournalofMusculoskeletalPain [The Haworth Medical
printofTheHaworthPress,Inc.]Vol.11,No.4,2003,pp.1-2;and:TheFibromyalgiaSyndrome:AClinicalCaseDefinitionforPractitioners
Press, an im-
[ed: I. Jon Russell] TheHaworth Medical Press, an imprint of TheHaworth Press, Inc., 2003, pp.1-2. Single or multiple copies
available
of for aare
this article fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. [EST]. E-mail
docdelivery@haworthpress.c
address:
om].
http://www.haworthpress.com/we
2003b/JMP
by The Haworth Press, Inc. All rights
Digital Object Identifer:
reserved. 1
10.1300/J094v11n04_01
2 THEFIBROMYALGIASYNDROME:ACLINICALCASEDEFINITIONFORPRACTITIONERS

went through three rounds of revision

the
priorConsensus
to
Crystaal [Biovail Pharmaceuticals]
Workshop.
agreed
kindlyto fund the workshop without
any
havingdirect involvement or any
est in theinter-
financial outcome. They hired
Medicine
Science and Canada to organize and
worksho
facilitate the
p. The document received consensus,
ciple, at the workshop with directive
in prin-
ous members
for vari- to revise some
document
sections. The compiled by Marjorie
was
Sande
van de and sent back to the panel.
100% consensus by the members of
There was
sensus
the con-panel on the final
document.
AnilKumarJain,BSc,MD
BruceM.Carruthers,MD,CM,FRCP[C]
CoeditorsoftheConsensusDocument

MarjorieI.vandeSande,BEd,GradDipEd
ConsensusCoordinator
DirectorofEducation
NationalME/FMActionNetwork
AnilKumarJain
BruceM.Carruthers
MarjorieI.vandeSande
 ARTICLE

Fibromyalgia
Canadian Clinical Working Case Definition,
Syndrome:
and Treatment ProtocolsA Consensus
Diagnostic
Jain et Document
Anil Kumar
al. Bruce
Jain M.
Marjorie I. van de
Carruthers
Stephen
Sande R.
C. C. Stuart
Barron
James V.
Donaldson
Emerson
Dunne
Gingrich