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Dr. Pellegrino has seen more than 25,000 FM patients in his practice at the Ohio Rehab Center, and has been a fibromyalgia patient himself since childhood.[hr]

The eight subsets of the Fibromyalgia spectrum are as follows:

  • 1.  Predisposed state – The person is at risk for developing FM due to hereditary factors.  This may include one or both parents with Fibromyalgia or a rheumatic/connective tissue disease, or a sibling or first-degree relative with Fibromyalgia.
  • 2.  Preceding state – Clinical Fibromyalgia is still not present. There is no widespread pain or painful tender points.  Associated conditions common with Fibromyalgia may be present in this stage, such as headaches, restless leg syndrome, fatigue, or irritable bowel syndrome. Pain may be present at times, but intermittently (not chronic, persistent pains). Even though the individual may have one or more associated condition(s), widespread persistent pain is not present, so therefore Fibromyalgia is not yet present.
  • 3.  Undiagnosed Fibromyalgia – The individual has chronic pain with painful tender points.  A patient may go into remission but they will still stay in the same subset within the spectrum that may or may not meet the American College of Rheumatology-defined 11 of 18 criteria.  At this stage the person has milder symptoms and but has not seen a doctor or been diagnosed.
  • 4.  Regional Fibromyalgia – Individuals in this stage have been diagnosed with Fibromyalgia, but not generalized. Chronic pain is limited to one or a few areas such as the upper body or the low back. The symptoms may wax and wane.  Usually, this subset is triggered by a trauma.
  • 5.  Generalized Fibromyalgia – Those in this stage will have widespread pain and tender points.  They will usually meet the American College of Rheumatology-defined 11 of 18 criteria, but as previously explained, one can still have generalized Fibromyalgia with fewer tender points.  Present may be various associated conditions.  Secondary Fibromyalgia from a primary disease is not included in this subset.
  • 6.  Fibromyalgia with certain associated conditions – People in this subset have developed associated conditions that Dr. P. says appear to be from “separate entities”.  These include ME/CFS, IBS, fatigue, depression and tension and/or migraine headaches.  None of these conditions in themselves have “classic” disease laboratory markers or cause tissue destruction, yet they may require treatments in addition to the overall Fibromyalgia treatment.  Another associated condition is dysautonomia.
  • 7.  Fibromyalgia with co-existing mild disease – People in this category have Fibromyalgia along with a specific disease.  The disease doesn’t necessarily cause FM but can aggravate FM.  Some of the co-existing mild disease may include hormonal problems, infectious problems, neurological conditions, and lung conditions.
  • 8.  Secondary Fibromyalgia reactive to disease – People in this subset have a primary disease (lupus, RA) and this is what caused their Fibromyalgia.  The primary disease requires treatment, and Fibromyalgia may improve with this treatment. However, the Fibromyalgia often requires its own treatment, and can continue to be a major problem even when the primary disease is treated or is in remission.