Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: Dr Jenkins raises the consideration
of Chiari I malformations in the differential diagnosis of FMS. Only 1 controlled
study, presented in abstract form, has evaluated a link of fibromyalgia to
Chiari I malformations and cervical myelopathy.1 In
that study, 38 patients with fibromyalgia and 23 matched healthy controls
underwent an MRI of the posterior fossa and cervical spine. There were no
differences between groups in the mean anteroposterior spinal canal diameter
or percentage of individuals judged to have stenosis at any cervical level.
Surprisingly, 8 of 26 patients with fibromyalgia and 11 of 15 controls had
evidence of cerebellar tonsils in the foramen magnum. Furthermore, a neurosurgeon
who rated the overall MRI in a blinded fashion judged that 47% of the patients
with fibromyalgia and 50% of pain-free controls would be surgical candidates.
Goldenberg DL. Management of Fibromyalgia Syndrome—Reply. JAMA. 2005;293(7):796-797. doi:10.1001/jama.293.7.796-c