Fibromyalgia (fi-bro-my-AL-ja) syndrome (FMS) produces chronic body-wide pain, which migrates and can be felt from head to toe.

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Cervical Spinal Stenosis Abstract I

Can Spinal Cord Compression Cause the Fibromyalgia Syndrome?

Dan S. Heffez¹ M.D., Daniel G. Malone² M.D., Sam R. Banner¹ M.D., Alan Shepard¹ M.D., Ruth E. Ross¹ Ph.D. and James W. Robertson¹ B.S. (Sponsored by Daniel Malone)¹ Chicago Institute of Neurosurgery and Neuroresearch, Chicago, IL 60614 and ²University of Wisconsin at Madison, Madison, WI 53706

OBJECTIVE: The symptoms of cervical myelopathy mimic those of fibromyalgia. We established a prospective database to catalogue neurological findings in patients with fibromyalgia to examine the possible etiological role of spinal cord compression. The principal criterion for referral is cervical spinal canal or foramen magnum stenosis on a screening MRI scan. Patients complete a detailed questionnaire regarding current symptoms and past medical care and are examined by a neurologist and a neurosurgeon. Measures of balance, strength, coordination, and cognitive function are obtained using a battery of standardized tests.

METHODS: To date, forty-five consecutive fibromyalgia patients (87% female, median age 44 years, median duration of illness 6 years) have been evaluated for myelopathy. Neurological symptoms included fatigue (93%), fatigue upon exertion (98%), cognitive impairment (96%), diffuse pain (93%), headache (89%), weakness (89%), impaired balance (80%), paresthesiae (82%), clumsiness (71%), numbness (73%), dizziness (62%), and diplopia (71%). Neurological signs included hyperreflexia (80%), spinothalamic sensory level (79%), recruit of reflexes (44%), impaired tandem walk (32%), positive Romberg sign (31%), clonus (28%), Hoffman sign (26%), dysdiadokokinesia (28%), impaired position sense (19%) and dysmetria (19%). Only 3 patients had a normal neurological examination. Detailed MRI imaging of the cervical spine and foramen magnum revealed cervical stenosis (n=21), brainstem compression due to tonsillar ectopia (n=12) or, both cervical stenosis and tonsillar ectopia (n=11).

CONCLUSION: We conclude that some patients with fibromyalgia have cervical myelopathy on the basis of spinal cord or cervicomedullary compression. We recommend a thorough neurological examination and a screening MRI scan of the cervical spine and brain in all patients with fibromyalgia who do not respond to conventional medical therapy.

Presented at the National Fibromyalgia Research Association's Subgroups in Fibromyalgia Symposium, September 26-27, 1999, in Portland, Oregon.

National Fibromyalgia Research Association
PO Box 500, Salem, OR 97302

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