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In Reply: Dr Jenkins raises the consideration of Chiari I malformations in the differential diagnosis of FMS. Only 1 controlled study, presented in abstract form, has evaluated a link of fibromyalgia to Chiari I malformations and cervical myelopathy.¹ In that study, 38 patients with fibromyalgia and 23 matched healthy controls underwent an MRI of the posterior fossa and cervical spine. There were no differences between groups in the mean anteroposterior spinal canal diameter or percentage of individuals judged to have stenosis at any cervical level. Surprisingly, 8 of 26 patients with fibromyalgia and 11 of 15 controls had evidence of cerebellar tonsils in the foramen magnum. Furthermore, a neurosurgeon who rated the overall MRI in a blinded fashion judged that 47% of the patients with fibromyalgia and 50% of pain-free controls would be surgical candidates.

The article by Wilke² that Dr Jenkins cited provides a balanced review of this controversy. . . . [Full Text of this Article]

Don L. Goldenberg, MD
dgoldenb@massmed.org
Department of Rheumatology
Newton-Wellesley Hospital
Newton, Mass

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