The Fibromyalgia Spectrum

Dr. Mark J. Pellegrino’s work continues that of Dr. Muhammad Yunus, who founded the DSS umbrella model for seeing commonalities between fibromyalgia (FM) and certain other conditions. Pellegrino’s model differs in that he sees FM as the main character, with overlapping conditions or subsets. These eight subsets describe the fibromyalgia spectrum.

Overlapping Circles

The eight subsets that comprise the fibromyalgia spectrum can be thought of as three overlapping circles with Fibromyalgia at the center. The fibromyalgia circle overlaps on one side with the “normal” entity in the circle to its left, and on the other side with the diseased entity in the circle on its right. The first subset is the most normal subset of fibromyalgia and the eighth subset is the most diseased. Each number stands for its own subset with its own distinct characteristics.

Here are the eight subsets of the fibromyalgia spectrum according to the Pellegrino model:

1. Predisposed state-The subject is asymptomatic, but at risk for FM by dint of a hereditary predisposition.

2. Prodromal (preceding) state-There is no FM as yet; however, common associated conditions are present. No diagnosis of FM can be made until there is typical fibromyalgia pain.

3. Undiagnosed Fibromyalgia-There is chronic pain in at least 11 out of 18 points, but the symptoms are so mild that the patient has not yet sought medical treatment or a diagnosis. Only a very knowledgeable physician might diagnose FM at this point.

4. Regional Fibromyalgia-The subject has been diagnosed with FM, but the pain is localized and not yet widespread, such as in the upper body or lower back. The symptoms may come and go. Regional FM may be triggered by trauma.

5. Generalized Fibromyalgia-There is widespread pain and there might be many associated conditions present. FM is still considered to be the primary disease.

6. Fibromyalgia with particular associated conditions-The patient now needs specialized attention or treatment for one or more associated conditions that coexist with FM.

7. Fibromyalgia with coexisting mild disease-These patients are afflicted by FM as well as other diseases which now demand equal time and attention. These other diseases may exacerbate the FM.

8. Secondary Fibromyalgia reactive to disease-These subjects have FM secondary to their primary disease, for instance: lupus, rheumatoid arthritis. Pellegrino believes that if the subject had not had the primary disease, he would not have developed the secondary disease (FM).

No Turning Back

According to the Pellegrino model, one can move up but not down the spectrum though remission (or staying within the same subset) is possible.