慢性广泛性疼痛的诊断混淆因素：并非总是纤维肌痛。
Diagnostic confounders of chronic widespread pain: not always fibromyalgia.
作者信息
Häuser Winfried, Perrot Serge, Sommer Claudia, Shir Yoram, Fitzcharles Mary-Ann
机构信息
Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany.
Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany.
出版信息
Pain Rep. 2017 Apr 30;2(3):e598. doi: 10.1097/PR9.0000000000000598. eCollection 2017 May.
INTRODUCTION
Chronic widespread pain (CWP) is the defining feature of fibromyalgia (FM), a worldwide prevalent condition. Chronic widespread pain is, however, not pathognomonic of FM, and other conditions may present similarly with CWP, requiring consideration of a differential diagnosis.
OBJECTIVES
To conduct a literature search to identify medical conditions that may mimic FM and have highlighted features that may differentiate these various conditions from FM.
METHODS
A comprehensive literature search from 1990 through September 2016 was conducted to identify conditions characterized by CWP.
RESULTS
Conditions that may mimic FM may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. Characteristics pertaining to the most commonly identified confounding diagnoses within each category are discussed; clues to enable clinical differentiation from FM are presented; and steps towards a diagnostic algorithm for mimicking conditions are presented.
CONCLUSION
Although the most likely reason for a complaint of CWP is FM, this pain complaint can be a harbinger of illness other than FM, prompting consideration of a differential diagnosis. This review should sensitize physicians to a broad spectrum of conditions that can mimic FM.
引言
慢性广泛性疼痛（CWP）是纤维肌痛（FM）的标志性特征，这是一种在全球普遍存在的病症。然而，慢性广泛性疼痛并非FM所特有，其他病症也可能表现出类似的慢性广泛性疼痛，因此需要考虑进行鉴别诊断。
目的
进行文献检索，以确定可能模仿FM的医学病症，并突出那些可将这些不同病症与FM区分开来的特征。
方法
进行了一项从1990年至2016年9月的全面文献检索，以确定以慢性广泛性疼痛为特征的病症。
结果
可能模仿FM的病症可分为肌肉骨骼、神经、内分泌/代谢、精神/心理以及药物相关几类。讨论了每类中最常见的混淆诊断的相关特征；给出了有助于与FM进行临床鉴别的线索；并提出了针对模仿病症的诊断算法步骤。
结论
尽管主诉慢性广泛性疼痛最可能的原因是FM，但这种疼痛主诉可能是FM以外其他疾病的先兆，促使考虑进行鉴别诊断。本综述应使医生对一系列可能模仿FM的病症保持敏感。
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