To the Editors:

The diagnostic criteria described by Wolfe et al and published recently in Arthritis Care & Research were based on research that aimed “to develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination” (1). The resulting diagnostic criteria form a hold-all accommodating both fibromyalgia and myofascial pain syndrome (MPS), when the latter affects several body regions. This seems scientifically and clinically unsatisfactory. MPS is a distinct entity with important differences from fibromyalgia, the most important being response to treatment. Inactivation of a myofascial trigger point by injection or by other physical means can abolish pain and prevent chronicity. Such treatments would aggravate pain in individuals with pure fibromyalgia.

Although few randomized controlled trials regarding MPS and the treatment thereof have been published, a large amount has been written by good clinicians: Bonica and Sola (2), Travell and Simons (3), and Starlanyl and Copeland (4) have all written books or book chapters. More recently, Shah et al (5) published important data on the biochemical abnormalities found in trigger points.

Adopting diagnostic criteria that further blur the lines between fibromyalgia and MPS will hinder good clinical care and further confuse research.


Dr. Thompson has received consulting fees, speaking fees, and/or other honoraria (less than $10,000 each) from Eli Lilly, Pfizer, and Valeant Canada.

  • 1
    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010; 62: 60019.
  • 2
    Bonica JJ, Sola AE. In: BonicaJJ, LoeserJD, ChapmanCR, FordyceWE, editors. Bonica's management of pain. 2nd ed. Philadelphia: Lea & Febiger; 1990. p. 35267, 1484–514.
  • 3
    Travell JG, Simons DG. Myofascial pain and dysfunction: the trigger point manual. Baltimore (MD): Williams & Wilkins; 1983.
  • 4
    Starlanyl DJ, Copeland ME. Fibromyalgia and chronic myofascial pain syndrome: a survival manual. Oakland (CA): New Harbinger; 2001.
  • 5
    Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 2005; 99: 197784.

Ellen N. Thompson MB, BS, FRCP*, * Ottawa, Ontario, Canada.