Fibromyalgia syndrome (FMS) is a chronic pain disorder whose primary symptoms include widespread muscle pain and tender points as well as fatigue. At present, its cause is unknown. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, as many as 1 in 50 Americans, or 3-6 million Americans, have FMS. Women make up 80-90% of FMS patients, but the reason for this apparent gender bias is not known. Patients with rheumatoid arthritis, systemic lupus erythematosus, or ankylosing spondylitis may be more likely to develop FMS.

This month, Special Topics examines the most-cited research areas related to FMS over the past decade and over the past two years. A great deal of the studies in both periods deal with FMS pain itself—characterizing the pain, perceptual amplification of pain, using functional MRI to examine the function of the nociceptive system, abnormal sensitization, sensory dysfunction, spinal cord hypersensitivity, and neural responses to pain.

In the 10-year data pool, several treatments are examined. Most notable among the drug therapy studies is a report of a clinical trial examining the use of the antidepressants fluoxetine and amitriptyline alone and in combination. Non-pharmacological treatments include aerobics, stress management, and other exercise programs. One study examines the benefits of treating FMS patients in subgroups. Other papers on the 10-year list include longitudinal studies of disease status and severity, service utilization, and cost, as well as studies examining comorbid psychiatric symptoms and psychosocial factors.

The two-year paper list contains more drug studies than the 10-year list, most notably trials of the anticonvulsant pregabalin, and the antidepressants duloxetine and milnacipran. Other treatments garnering citations in the past two-years include self-management studies, physical exercise programs, homeopathic treatments, and cognitive behavioral approaches. Familial studies of FMS and depression are also examined. Two studies examine the use of the Tampa Scale for Kinesiophobia in FMS patients. One study looks at the possibility of an endocannabinoid deficiency as an explanation for the efficacy of cannabis in treating FMS and other treatment-resistant illnesses.

Methodology

To construct this database, papers were extracted based on title-supplied keywords for Fibromyalgia. The keywords used were as follows: 

fibromyalgia

The baseline time span for this database is 1996-February 28, 2006 (first bimonthly of 2006). The resulting database contained 1,161 (10 years) and  268 (2 years) papers; 2,677 authors; 41 countries; 269 journals; and 904 institutions.

Rankings

Once the database was in place, it was used to generate the lists of top 20 papers (two- and ten-year periods), authors, journals, institutions, and nations, covering a time span of 1995-February 28, 2006 (first bimonthly of 2006, a 10-year + 2-month period).

The top 20 papers are ranked according to total cites. Rankings for author, journal, institution, and country are listed in three ways: according to total cites, total papers, and total cites/paper. The paper thresholds and corresponding percentages used to determine scientist, institution, country, and journal rankings according to total cites/paper, and total papers respectively are as follows:

Entity:	Scientists	Institutions	Countries	Journals
Thresholds:	11	4	8	1
Percentage:	1%	10%	50%	50%

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