Introduction:  Individuals with FM have classically been described as having a completely normal physical examination except for the finding of tenderness.  However, most studies of FM have been performed by rheumatologists, who may not always perform a detailed neurological evaluation as part of the physical exam.  The purpose of this study was to do such an examination in both FM pts. and controls, to determine whether FM pts. exhibited abnormalities in physical exam, as well as to determine whether abnormalities were related to MRI findings in the cervical region. Methods: Before beginning the study, three physicians from two different study sites were trained in the performance of a thorough neurological evaluation by a neurosurgeon.  The examination took approximately 40 minutes to complete, and included comprehensive sensory, motor, cranial nerve, spinal and reflex evaluations. The results of these examinations were then summarized by a single observer, blinded to subject group, as being normal, mildly abnormal or markedly abnormal.  Results: 39 FM subjects and 20 controls had this evaluation performed.  The FM subjects demonstrated significantly more abnormalities on many portions of the neurological exam, especially in motor (53% abnl. vs. 0 of controls), reflexes (31% abnl. vs. 10% of controls), gait (33% abnl. vs. 15% of controls) and sensory (23% abnl. vs. 5% controls) components.  There was no relationship between MRI findings and physical examination findings in either group. Conclusions:  FM patients often have abnormal neurological examinations.  Such findings could have several explanations including:  1) structural or compressive lesions, 2) the effects of pain on motor performance and balance, 3) hyperreflexia secondary to hypervigilance, or 4) hyperalgesia/allodynia. Further studies will be necessary to determine the precise mechanism(s), and the appropriate diagnostic paradigms for individuals with symptoms of FM and an abnormal neurological examination. Disclosure:  This study was supported by the National Fibromyalgia Research Association.

Abstract presented at:
American College of Rheumatology
Annual Meeting in Philadelphia
October-November 2000