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*Dr. Yusra Abdulbaqi Naser, Dr. Hanan Abdulrazzaq Sultan and
Dr. Azhar Dawood Salman


The basic clinical manifestations of fibromyalgia (FM), in terms of pain, fatigue, dysfunctional sleep, and tenderness were described by Smythe and Moldofsky[1] in 1977 and elaborated by Yunus and colleagues[2] in 1981. The 1990 American College of Rheumatology (ACR) fibromyalgia classification paper listed many other symptoms that were commonly reported by FM patients (paresthesia, anxiety, headaches, irritable bowel, urinary urgency, sicca symptoms, noise and cold intolerance, dysmenorrhea, depression, low back pain, neck pain, Raynaud phenomenon, and weather-related effects).[3] An Internet survey conducted by the National Fibromyalgia Association (NFA) on 2569 people who have diagnosed fibromyalgia reported the rank order of symptoms as: morning stiffness, fatigue, nonrestorative sleep, pain, forgetfulness, poor concentration, difficulty falling asleep, muscle spasms, anxiety, and depression (Table 1).[4] A similar questionnaire from the German Fibromyalgia Association (DFV) was mailed to 3996 patients and was completed by 699 patients; the rank order of the most frequent symptoms was: muscle pain, morning stiffness, nonrestorative sleep, poor concentration, lack of energy, low productivity, and forgetfulness.[5] Since that time, many of these symptoms have been subject to further study and the patients‟ perspective has been more rigorously evaluated as part of the OMERACT (Outcome Measures in Rheumatology Clinical Trials) process.

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