Fibromyalgia (FM) is a common condition of unknown etiology characterized by widespread muscle pain, sleep disturbances, fatigue, and various subjective neurological complaints. FM also frequently co-occurs with chronic fatigue syndrome, a condition similar to FM, whose hallmark is persistent, disabling fatigue. Many mechanisms for FM have been postulated but none has gained widespread acceptance or withstood the rigors of repeated scientific inquiry. Chiari I malformation (CIM), a hindbrain malformation associated with impairment of cerebral spinal fluid (CSF) flow, and syringomyelia, a cavitation of the spinal cord found in up to 80 percent of CIM patients, are neurological disorders. Although CIM patients typically seek medical attention for valsalva or exercise-related headaches, some present with non-specific complaints that are difficult to associate with CIM or syringomyelia. Common misdiagnoses for CIM include migraine, psychiatric disorder, multiple sclerosis, and FM. Successful treatment for symptomatic CIM patients, with or without syringomyelia, involves surgery to correct the presumed underlying pathophysiology by normalizing CSF flow in the hindbrain and enlarging the posterior fossa of the cranium. The overall safety and efficacy of the most common approach, a posterior fossa craniectomy and cervical laminectomy to expand the posterior fossa volume, is well supported in the literature. Recently, some FM patients have been treated with a posterior fossa and cervical operation. This procedure, performed by a select group of neurological surgeons, has attracted the attention of patients, the media, and the medical community. Hundreds, perhaps several thousand, of these operations have been performed without any scientific support for the safety or efficacy of this intervention in FM. The purpose of this study is to establish the relationship of hindbrain anomalies and cervical cord problems to FM.
The Specific Aims are to: 1) determine the prevalence of CIM and cervical syringomyelia among patients with FM (with and without CFS) and pain- and fatigue-free controls using magnetic resonance (MR) imaging; 2) compare the clinical correlates and physical examination findings in these FM patients with and without CIM. There are plans to gather information on symptoms, and perform blinded neurological and MR examinations in 213 FM patients and 71 pain- and fatigue-free control subjects. MR sequences will quantitate posterior fossa anatomy, posterior fossa CSF volume, tonsillar position, and cervical spinal cord and canal pathology. To measure physiological parameters such as CSF velocity and direction of flow in the craniocervical junction, there are plans to employ cardiac gated phase-contrast cine-MR imaging. This study will assess the usefulness of MR imaging in the evaluation of FM patients with and without CFS, and may identify those who might benefit from surgery for hindbrain abnormalities and dissuade others from undergoing a potentially harmful intervention.
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