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September 18, 1987

Painful Questions About Fibromyalgia-Reply

JAMA. 1987;258(11):1477. doi:10.1001/jama.1987.03400110058017

In Reply.—  Dr Bohr argues that fibromyalgia cannot be distinguished from affective disorders. However, recent investigations demonstrate an overlap of fibromyalgia and affective disorder, but also provide data that fibromyalgia is not simply an affective disorder. The characteristic and uniform locations of the tender points and the pathophysiological (albeit nonspecific) abnormalities demonstrated in the muscle and soft tissue at these tender points indicate a peripheral process. Dolorimeter and manual examination of tender points demonstrates that a tender-point examination can distinguish patients with fibromyalgia from normal controls as well as patients with rheumatoid arthritis and has interobserver as well as intraobserver reliability. Sleep electroencephalograms have described different sleep disorders in patients with fibromyalgia compared with those with affective disorders.1Three of the four controlled studies utilizing the Minnesota Multiphasic Personality Inventory (MMPI) and other psychological tests found no increased prevalence of depression in patients with fibromyalgia compared with controls.2