There is no ‘tell-tale’

sign elicitable by inspection, palpation, percussion or auscultation for this spectrum of illnesses. Laboratory investigations always draw a blank. Chronic pain disorders, therefore, cannot be diagnosed by this conventional approach.[5] Although chronic wide spread pain, fatigue, sleep disturbance and mental fogging are some of the hallmarks of these illnesses, familiarity with classification criteria is a prerequisite to identify a good number Buparlisib order of them. There are patients, however, with these illnesses that do not fulfill any criteria. Neurochemical misbalances, rather than anatomical lesions are more likely to cause these disorders; nor are they straightforward psychiatric illnesses, in spite of many reports of mind-body link in these conditions.[6, 7] While rheumatology clinics in the western and developed world are flooded with such patients and rheumatologists in those parts of the world are more familiar with these illnesses, developing world is less familiar with these maladies. Now that the epidemic seems to be reaching the less developed world, many unanswered questions need to be addressed on this subject. Is it globalization that is bringing it to the developing world, where people earlier could tolerate small aches and

pains better? Is it much less common amongst the underprivileged section of the society? Do lifestyle, dietary factors and other socioeconomic factors have some influence on pain threshold, if not on Ribociclib supplier causation

of these new world diseases? Painful disorders with anatomical lesions like inflammatory arthropathies, connective tissue diseases and osteoarthritis may also cause vicious cycle of ‘pain begetting more pain’, which may be termed as secondary fibromyalgia.[8] On the contrary and paradoxically enough, there is a paradigm shift in the understanding of pain disorders; it is now believed widely that pain itself can cause localised inflammation in a significant proportion of cases and thereby induces this novel mechanism to perpetuate the vicious cycle of pain.[9] Whether this has a therapeutic implication is arguable, but breaking this cycle is important in arresting the pain process. Mimics of fibromyalgia comprise a wide spectrum. Buspirone HCl On the one end, there are highly treatable low grade metabolic disorders like hypothyroidism and vitamin D deficiency causing chronic widespread pain. These relatively common disorders need to be excluded or diagnosed and treated, as the case may be, in a chronic pain scenario.[10] On the other end of this spectrum, there are more serious organic pathologies like enthesopathic pain of spondyloarthropathies and at times, out of proportion pain and tenderness of leukemic arthropathies, especially in children presenting as vague aches and pains. Attending physician need to be sensitized to avoid misdiagnosing these conditions as fibromyalgia.