Dr. Winfield is to be congratulated for his thoughtful editorial on fibromyalgia syndrome (FMS) and its related bio-psycho-social aspects (Winfield JB. Does pain in fibromyalgia reflect somatization? Arthritis Rheum 2001;44:751–3). He correctly points out that patients with FMS have many physical findings related to biologic abnormalities that strongly correlate with increased pain states. They include hyperalgesia, allodynia, abnormal temporal summation of second pain, neuroendocrine abnormalities, and abnormal activation of pain-related brain regions. He also emphasized the important fact that many FMS patients are distressed and often lack adequate coping skills. Although current evidence indicates that the definition of FMS selects for patients who show signs of maladaptation, the FMS criteria have nevertheless been very helpful for research purposes. The same may be true for somatization. This diagnosis relies on the lack of clinical findings in patients with otherwise-characteristic physical symptoms. When applied to FMS patients, however, one obviously has to neglect the presence of at least one abnormal clinical finding, i.e., mechanical hyperalgesia (tender points). At this time, we have conclusive evidence that many chronic pain patients, including FMS patients, have detectable neurologic abnormalities that relate to abnormal central pain processing. The cause for these pathologic changes, however, is still unknown. Nevertheless, many of us who study FMS agree that the pain these patients experience is real and deserves our attention. The diagnosis of somatization should therefore focus our attention on those patients who need more help with the bio-psycho-social aspects of their pain experience.
To the Editor:
Roland Staud MD*, * University of Florida Gainesville, FL