Fibromyalgia (Fibrositis)
                        =========================

þ Tender Points:
 - in fibromyalgia, there are nine paired points that are almost invariably
x   tender.  Testing for tenderness there, and for control points that
   shouldn't be tender, helps establish the diagnosis.
  + Tender points:
   1. Insertion of nuchal muscles into occiput
   2. Upper trapezius, midpoint
   3. Petoralis muscle - just lateral to second costochondral junction
   4. 2 cm below lateral epicondyle
   5. Upper gluteal region
   6. 2 cm posterior to Greater Trochanter
   7. Medial knee in area of anserine bursa
   8. Paraspinous, 3 cm lateral to midline at the level of the mid-scapula
   9. Above the Scapula spine near the medial border
  + Control points:
   1. Middle of forehead
   2. Volar aspect of Mid-forearm
   3. Thumbnail
   4. Muscles of anterior thigh

[Benner RM: Fibrositis. In: Kelly WN, Harris ED, Rudy S, Sledge CB (eds):
Textbook of Rheumatology, 4th ed. Philadelphia, WB Saunders, 1993.]

þ Flexeril and fibromyalgia
  [Tofferi, J. K., J. L. Jackson, et al. (2004). "Treatment of fibromyalgia with 
  cyclobenzaprine: A meta-analysis." Arthritis Rheum 51(1): 9-13.]
  OBJECTIVE: To systematically review the effectiveness of cyclobenzaprine in 
  the treatment of fibromyalgia. METHODS: Articles describing randomized, 
  placebo-controlled trials of cyclobenzaprine in people with fibromyalgia were 
  obtained from Medline, EMBase, Psyclit, the Cochrane Library, and Federal 
  Research in Progress Database. Unpublished literature and bibliographies were 
  also reviewed. Outcomes, including global improvement, treatment effects on 
  pain, fatigue, sleep, and tender points over time, were abstracted. RESULTS: 
  Five randomized, placebo-controlled trials were identified. The odds ratio for 
  global improvement with therapy was 3.0 (95% confidence interval [95% CI] 1.6-
  5.6) with a pooled risk difference of 0.21 (95% CI 0.09-0.34), which 
  calculates to 4.8 (95% CI 3.0-11) individuals needing treatment for 1 patient 
  to experience symptom improvement. Pain improved early on, but there was no 
  improvement in fatigue or tender points at any time. CONCLUSION: 
  Cyclobenzaprine-treated patients were 3 times as likely to report overall 
  improvement and to report moderate reductions in individual symptoms, 
  particularly sleep.