Fibromyalgia Co-morbidities

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General remarks[edit]

Generally speaking, these are disorders which have a statistical relationship to fibromyalgia in that if a patient suffers from one of them then there is a greater probability that they will have fibromyalgia as well. This list is a product of literature reviews. It turned out to be surprisingly long. This fact suggests that we are dealing with some broad phenomenon with wide applicability to many disorders.

Many co-morbidities are central sensitization syndromes and feature over-reactivity to stimuli, and therefore seem to be part of the same disease process as fibromyalgia. Examples are migraine (light and sound oversensitivity), TMJ (tender head and face muscles) and IBS (over-reactive bowel). (These could be considered part a greater fibromyalgia syndrome.)

Other co-morbidities are less likely to be part of the disease process such as SLE, rheumatoid arthritis, osteoarthritis and Sjogren’s syndrome.

The author recommends that clinicians use it as a checklist, starting with asking patients if they have ever been diagnosed with any of them. However, they may still have many of them even if they were never diagnosed. This means that the patient needs a complete functional enquiry such as those found in standard general medical history forms. The physician should study the results of this enquiry with an eye to determine if positive findings are indicative of any fibromyalgia co-morbidities. (For example, if a fibromyalgia patient indicates on their functional enquiry that they have urinary symptoms, then the physician may suspect co-morbid interstitial cystitis.) In very complicated fibromyalgia patients with multiple co-morbidities, this process can be immensely complicated, time consuming and expensive, especially if multiple follow up tests are ordered. There is a need to keep the eye on the ball and to try to work at key underlying issues such as correcting sleep disturbances and psychological contributors to the syndrome. There is a danger that all the doctor’s time and energy is diverted into a massive investigation of symptoms without getting at underlying primary driving issues.

Allergic[edit]

  • Mast cell disorders, (Torresani, 2009) (Petra, 2014)
  • Chronic urticarial, (Torresani et al. 2009)
  • Allergic rhinitis, (Gultuna et al. 2019)

Arthritic[edit]

  • SLE, (Neumann, 2003) (Staud, 2006) (Middleton, 1994) (Araújo, 2015)
  • Sjogren’s, (Segal et al. 2014) (Rodriguez-Rodriguez et al. 2015) (Haliloglu, 2014)
  • Raynaud’s phenomenon, (Inanir et al. 2014) (Dönmez et al. 2012)
  • Carpal tunnel syndrome, (Nacir et al. 2012) (Richards, 1984) (somewhat disputed by several authors. See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1010301/?page=1)
  • TMJ, (Aaron et al. 2001)
  • Polymyositis, (Haliloglu et al. 2014) (Souza et al. 2011)
  • Joint hypermobility syndrome, (Russek et al. 2014)
  • Osteoarthritis, (Jacobson et al. 2015 for ages 55-95)
  • Rheumatoid arthritis (RA), (Jacobson et al. 2015 for ages 55-95) (Wolfe, 2004)
  • Inflammatory arthritis including RA, (Richards, 1984)
  • Psoriatic arthritis, (Zhao, 2019)
  • Ankylosing spondylitis, (Salaffi et al. 2014)

Autonomic[edit]

  • Dysautonomia, (Eisinger, 2007) (Martinez-Lavin 1998)

Cardiovascular[edit]

  • Low blood pressure, (Thieme et al. 2015)
  • Neurally Mediated Hypotension, (Barkhuizen, 2001)
  • Vasovagal syncope, (Vallejo et al. 2013, Furlan et al. 2005)
  • Coronary heart disease, (Chia-Hsien et al. 2015) and Su et al. 2015)
  • POTS (Postural tachycardia syndrome,) (Huang et al. 2015)
  • Secondary vascular dysregulation, (Flammer, 2013.)
  • Mitral valve prolapse, (Waylonis, 1992)

Dermatological[edit]

  • Hyperhidrosis in 32.0%, (Laniosz et al. 2014)
  • Burning sensations of the skin or mucous membranes in 3.4%, (Laniosz et al. 2014)
  • Unusual cutaneous sensations in 1.7%, (Laniosz et al. 2014)
  • Unexplained itch in 3.3%, (Laniosz et al. 2014)
  • A combined 1.9% with either neurotic excoriations, prurigo nodules, or lichen simplex chronicus
  • Dermatitis, other than neurodermatitis, in 9.1%, (Laniosz et al. 2014)
  • Primary erythromelalgia in Mexican women, (Vargas-Alarcon et al. 2012)
  • Photosensitivity, (Dönmez et al. 2012)

Endocrine[edit]

  • Diabetes in women, (Yanmaz, 2012) (Lichtenstein, 2018)
  • Hashimoto’s thyroiditis, (Haliloglu, 2017)

Gastrointestinal[edit]

  • Irritable bowel syndrome, (Hudson JI et al. 1992) (Kurland JE et al. 2006) (Moshiree B, et al. 2007) (Also Jacobson et al. 2015 for ages. 55-95)
  • Esophageal dysmotility, (Clauw et al. 1995)
  • Coeliac disease, (Rodrigo et al.2013)
  • GERD (age 55-95), (Jacobson et al. 2015)
  • Functional dyspepsia, (Chang, 1998)

Gynecological and sexual[edit]

  • Sexual dysfunction, (Bazzichi L et al. 2012)
  • Vulvodynia, (Ghizzani, 2014, Arnold et al. 2006)
  • Restless genital syndrome/ReGS/Genital restlessness, (Akcali A et al. 2009)
  • Breast cysts, (Shaver et al. 2006)
  • Premenstrual syndrome, (Shaver et al. 2006)
  • Mastalgia, (Johnson et al. 2006, Genc et al. 2011, Sen et al. 2015)
  • Severe menstrual pain/dysmenorrhea, (Wei et al. 2015) (Poyhia, 2001)
  • Female sexual dysfunction, (Besiroglu, 2019)
  • Impaired sexual function in men, (Batmaz, 2013)
  • Endometriosis, (Nunes, 2014)

Hearing[edit]

  • Hyperacusis (reduced painful sound thresholds), (Gerster et al. 1984)

Immune[edit]

  • Primary immunodeficiency (IgG), (Barton, 2017)
  • Thyroid autoimmunity/autoimmune thyroiditis, (Baxxichi, 2007)

Infectious[edit]

  • HIV, (Cassisi et al. 2011)
  • Hepatitis B, (Yazmalar et al. 2015), (Ozsahin, 2013)
  • Hepatitis C, (Carey, 2012) (Mohammad, 2012)

Metabolic[edit]

  • Obesity, (Dias, 2017)

Nasal[edit]

  • Rhinitis, (Cleveland, 1992) (Baraniuk et al. 2010)

Neurological[edit]

  • Migraine, (Hudson JI et al. 1992) (Poyhia, 2001) (Ifergane, 2006)
  • Tension headaches, (Clauw, 2015) (de Tommaso, 2008) (Cho, 2017)
  • Multiple sclerosis, (Marie et al. 2012)
  • Epilepsy, (Ottman, 2011)

•*Small fiber neuropathy (with reduced nerve fiber density), (Giannoccaro et al. 2014) (Caro et al. 2014) (Levine et al. 2015)

  • Stroke, (Tseng, 2016)

Oral[edit]

  • Xerostomia, (Rhodus et al. 2003)
  • Glossodynia, (Rhodus et al. 2003)
  • Dysphagia, (Rhodus et al. 2003)
  • Dysgeusia, (Rhodus et al. 2003)
  • TMD, (Rhodus et al. 2003) (Hoffmann et al. 2011) (Hedenberg-Magnusson et al. 1999) (Ayouni, 2019)

Pain syndromes[edit]

  • Chronic cervical myofascial pain, (Cakit et al. 2010)
  • Painful neuropathic disorders, (Berger et al. 2007)
  • Diabetic neuropathy, (Berger et al. 2007)
  • Post-herpetic neuralgia, (Berger et al. 2007)
  • Back pain with neuropathic involvement (high odds ratio), (Berger et al. 2007)
  • Neck pain with neuropathic involvement (high odds ratio), (Berger et al. 2007)
  • Cancer with neuropathic pain (high odds ratio,) (Berger et al. 2007)
  • Causalgia (high odds ratio), (Berger et al. 2007) (Eisinger, 2007) phantom limb pain, (Berger et al. 2007)
  • Trigeminal neuralgia, (Berger et al. 2007)
  • Atypical facial pain (high odds ratio), (Berger et al. 2007)
  • Other chronic pain disorders, (Yunus, 2012)

Psychological/ Psychiatric[edit]

  • Anxiety disorder, (cited in Bernik et al. 2013)
  • Depression, (cited in Bernik et al. 2013) Jacobson et al. 2015 for patients ages 55-95
  • Alexythymia, (Maes et al. 2014)
  • Major depression, (Hudson JI et al. 1992)
  • Panic disorder, (Hudson JI et al. 1992)
  • Hysteria, (Vural M et al. 2014)
  • PTSD, (Häuser et al. 2013) (Russek et al. 2014) (Cohen et al. 2002) (Amital et al. 2006)
  • Kinesiophobia, (Russek et al. 2014)
  • Obsessive-compulsive personality disorder tendencies, (Russek et al. 2014)
  • Bipolar disorder, (Di Tommaso Morrison et al, 2017)

Respiratory[edit]

  • Asthma (age 55-95), (Jacobson et al. 2015)
  • COPD (age 55-95), (Jacobson et al. 2015)

Sleep[edit]

  • Insomnia, (Wu, 2017) (Huang, 2019)
  • Light sleep light sleep, (Moldofsky, 1993)
  • Non-restorative sleep pattern, (Moldofsky, 1989) (Moldofsky, 2008) (Dauvilliers et al., 2001)
  • Sleep apnea, (Köseoğlu, 2017) (Meresh, 2019) (Germanowicz,2006)
  • PTSD (with its associated nightmares), (Sherman, 2000)
  • Periodic limb movements of sleep/PLMS, (Al-Alawi, 2006)
  • Restless leg syndrome, (Jacobson et al. 2015 for ages 55-95) (Hoogwout 2015)
  • Hypnik/Hypnic jerk/Hypnagogic jerks/Sleep starts (this likely does not qualify as disease but is included here to give a more complete picture). A PubMed search done in 2017 failed to turn up any studies of this in fibromyalgia. However, a general google search did turn up a number of casual mentions. It seems that it is presently unknown if hypnic/hypnik jerks are more common in fibromyalgics.

Urological[edit]

  • Interstitial cystitis/lower urinary tract symptoms, (Clauw, 2015)
  • Bladder cystitis, (Shaver, et al. 2006)
  • Chronic prostatitis, (Gasperi et al. 2017)

Vestibular[edit]

  • Vestibular symptoms, (Clauw et al. 1995)
  • Compromised balance confidence, (Russek, 2014)
  • Vertigo, (Russek, 2014)

Other unclassified[edit]

  • Chronic fatigue syndrome, (Goldenberg, 1990) (Hudson et al. 1992) (Aaron, 2000) (Aaron et al. 2001)
  • Multiple chemical/drug sensitivity syndrome, (Slotkoff et al. 1997)
  • Behçet's disease, (Melikoglu et al. 2013)
  • Sicca Syndrome, (Barkhuizen A, 2001)

Other possible co-morbidities mentioned in the scholarly or lay literature (more study needed)[edit]

  • Bruxism, (Bracha, 2005, however the article is vague)
  • Bipolar, (Kudlow et al. 2015)
  • Idiopathic nonallergic rhinopathy, (Baraniuk et al. 2010)
  • CRPS (fibromyalgia is a predictor to develop CRPS after a fracture to the radius), (Lipman, 2019)
  • Psycho-vestibular syndrome (Author’s term)
  • Meniere's disease, (Hadj-Djilani Am, 1984)
  • Non-allergic rhinitis, (Frieri, 2012)

Suspected co-morbidities[edit]

These are unproven co-morbidities that are suspected by the author based on an uncontrolled study.

  • Rare immunological diseases (based on the high number of referrals from a tertiary care center to the author’s fibromyalgia clinic) (Further study is needed of the possible role of natural killer cells in such cases.)
  • Male and female homosexuals (based on numbers of referrals to author’s fibromyalgia clinic)
  • New immigrants to developed countries arriving from unstable counties. For example, there were more than the expected numbers of newly immigrated gypsies to Canada being referred to the author’s fibromyalgia clinic. Immigration can be very stressful. Most cases seen to day involved patients that were having major problems adjusting to a new life in a more developed county. Some had been gainful employed and respected in their country of origin, but became unemployed or had to accept jobs that they considered to be beneath them in Canada. Language barriers and difficult getting a good job made some of the newcomers disillusioned and they suffered identity problems due to erosion of self-respect.

Controversial[edit]

These are controversial because of conflicting reports.

  • Pro: Crohn’s disease (Buskila, 1999 said 49% FM in pts with CD) [This seems very high.]
  • Pro: ulcerative colitis (Buskila, 1999) said 19% FM in patients with UC
  • Con: Crohn’s (Palm, 2001)
  • Con: ulcerative colitis (Palm, 2001)

Partial alphabetical bibliography of articles establishing various diseases as being fibromyalgia co-morbidities[edit]

This list is presented here in support of the items listed under the main heading “Fibromyalgia Co-morbidities”. There are many other references in the literature that could have been added, but the point was that for each item there should be at least one reference here to support its inclusion.

The list of co-morbidities is very useful if it is converted into a checklist and presented to patients that might have fibromyalgia. However, most patients will not be familiar with all the medical terms in it, and so the list needs to be transformed into simple questions or symptom checklist items. The subheadings on the list such as “neurological” can make results quicker and easier to interpret for the doctor, and so some extent the patient.

Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Aaron LA, Burke MM, Buchwald D. Arch Intern Med. 2000;160(2):221–227.

Fibromyalgia and other unexplained clinical conditions. Aaron LA1, Buchwald D. Curr Rheumatol Rep. 2001 Apr;3(2):116-22. Chronic diffuse musculoskeletal pain, fibromyalgia and co-morbid unexplained clinical conditions. Aaron LA1, Buchwald D. Best Pract Res Clin Rheumatol. 2003 Aug;17(4):563-74.

Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Afari N1, Ahumada SM, Wright LJ, Mostoufi S, Golnari G, Reis V, Cuneo JG. Psychosom Med. 2014 Jan;76(1):2-11 available in full online at: http://www.ncbi.nlm.nih.gov/pubmed/24336429.

Posttraumatic stress disorder, tenderness, and fibromyalgia syndrome: are they different entities? Daniella Amitala,4, Leah Fostickb , Michael L. Polliackb , Shlomo Segevc , Joseph Zoharb , Alan Rubinowd , Howard Amitale, Journal of Psychosomatic Research 61 (2006) 663 – 669, available in full online at: https://www.ariel.ac.il/images/stories/site/projects/APL/Papers/FM_PTSD.pdf

Prevalence, risk factors and impact on daytime sleepiness and hypertension of periodic leg movements with arousals in patients with obstructive sleep apnea. Al-Alawi A1, Mulgrew A, Tench E, Ryan CF. J Clin Sleep Med. 2006 Jul 15;2(3):281-7.

The relationship between sleep quality and fibromyalgia symptoms. Andrade A1, Vilarino GT1, Sieczkowska SM1, Coimbra DR1, Bevilacqua GG1, Steffens RAK1,2. J Health Psychol. 2018 Jan 1:1359105317751615. doi: 10.1177/1359105317751615.

Comorbidity between fibromyalgia and temporomandibular disorders: a systematic review. Imen Ayouni 1, Raja Chebbi 2, Zeglaoui Hela 3, Monia Dhidah 2 Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Jul;128(1):33-42, DOI: 10.1016/j.oooo.2019.02.023.

[The association of fibromyalgia and systemic lupus erythematosus change the presentation and severity of both diseases?]. [Article in Portuguese] Araújo AL1, Paliares IC1, Araújo MI1, Novo NF1, Cadaval RA1, Martinez JE2. Rev Bras Reumatol. 2015 Jan-Feb;55(1):37-42.

Vulvodynia: characteristics and associations with comorbidities and quality of life. Arnold LD, Bachmann GA, Rosen R, Kelly S, Rhoads GG. Obstetrics and Gynecology. 2006;107(3):617–624, available in full online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1431685/

Comorbidity of fibromyalgia and psychiatric disorders. Arnold LM, Hudson JI, Keck PE Jr, et al. J Clin Psychiatry. 2006;67:1219–1225 Relationships among rhinitis, fibromyalgia, and chronic fatigue. Baraniuk JN1, Zheng Y. Allergy Asthma Proc. 2010 May-Jun;31(3):169-78.

Fibromyalgia in 300 adult index patients with primary immunodeficiency. Barton JC1, Bertoli LF2, Barton JC3, Acton RT4. Clin Exp Rheumatol. 2017 May-Jun;35 Suppl 105(3):68-73. Epub 2017 Apr 19, https://www.ncbi.nlm.nih.gov/pubmed/28422000.

Sexuality of men with fibromyalgia: what are the factors that cause sexual dysfunction? Batmaz I1, Sarıyıldız MA, Dilek B, Inanır A, Demircan Z, Hatipoğlu N, Atar M, Cevik R. Rheumatol Int. 2013 May;33(5):1265-70. doi: 10.1007/s00296-012-2567-1. Epub 2012 Nov 4.

Association between thyroid autoimmunity and fibromyalgic disease severity. Bazzichi, L., Rossi, A., Giuliano, T., De Feo, F., Giacomelli, C. et al. (2007). Clin Rheumatol 26, 2115–2120. https://pubmed.ncbi.nlm.nih.gov/17487449/.

Characteristics and healthcare costs of patients with fibromyalgia syndrome. A Berger,1 E Dukes,2 S Martin,2 J Edelsberg,1 and G Oster1, Int J Clin Pract. 2007 Sep; 61(9): 1498–1508. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040193/table/tbl2/.

Fibromyalgia comorbid with anxiety disorders and depression: combined medical and psychological treatment. Bernik M1, Sampaio TP, Gandarela L. Curr Pain Headache Rep. 2013 Sep;17(9):358.

The association between fibromyalgia and female sexual dysfunction: a systematic review and meta-analysis of observational studies. Besiroglu MDH1, Dursun MDM2. Int J Impot Res. 2019 Jul;31(4):288-297. doi: 10.1038/s41443-018-0098-3. Epub 2018 Nov 22.

Sleep Disturbances in Fibromyalgia Syndrome: Relationship to Pain and Depres-sion, Silvia M. Bigatti, PhD,1 Ann Marie Hernandez, MS,1 Terry A. Cronan, PhD,2 and Kevin L. Rand, PhD1 Arthritis Rheum. 2008 Jul 15; 59(7): 961–967.doi: 10.1002/art.23828.

The clenching-grinding spectrum and fear circuitry disorders: clinical insights from the neuroscience/paleoanthropology interface. Bracha HS1, Ralston TC, Williams AE, Yamashita JM, Bracha AS. CNS Spectr. 2005 Apr;10(4):311-8.)

Comorbidity of fibromyalgia and psychiatric disorders. Buskila D1, Cohen H. Curr Pain Headache Rep. 2007 Oct;11(5):333-8.

Fibromyalgia in inflammatory bowel disease. Buskila, D., Odes, L.R., Neumann, L., Odes, H.S. (1999). J Rheumatol 26, 1167–1171, https://pubmed.ncbi.nlm.nih.gov/10332985/.

Comorbidity of fibromyalgia and cervical myofascial pain syndrome. Cakit BD1, Taskin S, Nacir B, Unlu I, Genc H, Erdem HR. Clin Rheumatol. 2010 Apr;29(4):405-11.

Prevalence of fibromyalgia among patients with chronic hepatitis C infection: relationship to viral characteristics and quality of life. Mohammad A, Carey JJ, Storan E, Scarry M, Coughlan RJ, Lee JM. J Clin Gastroenterol. 2012;15:407–412, abstract available online at: https://pubmed.ncbi.nlm.nih.gov/22499073/)

Evidence of abnormal epidermal nerve fiber density in fibromyalgia: clinical and immunologic implications. Caro XJ1, Winter EF. Arthritis Rheumatol. 2014 Jul;66(7):1945-54 available in full online at: http://onlinelibrary.wiley.com/doi/10.1002/art.38662/epdf

Chronic widespread pain and fibromyalgia: could there be some relationships with infections and vaccinations? Cassisi G1, Sarzi-Puttini P, Cazzola M. Clin Exp Rheumatol. 2011 Nov-Dec;29(6 Suppl 69):S118-26.

The association of functional gastrointestinal disorders and fibromyalgia. Chang L1. Eur J Surg Suppl. 1998;(583):32-6.

Increased Risk of Coronary Heart Disease in Patients with Primary Fibromyalgia and Those with Concomitant Comorbidity-A Taiwanese Population-Based Cohort Study. Chia-Hsien Su,1,2 Jiunn-Horng Chen,3,4,* Joung-Liang Lan,3,4 Yu-Chiao Wang,3,5 Chun-Hung Tseng,3,6 Chung-Yi Hsu,3,7 and Lichi Huang8PLoS One. 2015 Sep 14;10(9):e0137137 available in full online at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569466/.

Fibromyalgia among patients with chronic migraine and chronic tension‐type headache: A multicenter prospective cross‐sectional study. Cho, S.J., Sohn, J.H., Bae, J.S., Chu, M.K. (2017). Headache 57, 1583–1592.

Fibromyalgia: more than just a musculoskeletal disease. Clauw DJ1. Am Fam Physician. 1995 Sep 1;52(3):843-51, 853-4.

Fibromyalgia and Related Conditions. 2015 May;90(5):680-692. Clauw DJ1. Mayo Clin Proc.

Chronic rhinitis: an underrecognized association with fibromyalgia. Cleveland CH Jr1, Fisher RH, Brestel EP, Esinhart JD, Metzger WJ. Allergy Proc. 1992 Sep-Oct;13(5):263-7.

Fibromyalgia comorbidity in primary headaches. de Tommaso M, Sardaro M, Serpino C, et al. Cephalalgia. 2008;29(4):453–464.

Sleep disturbances in fibromyalgia syndrome: the role of clinical and polysom-nographic variables explaining poor sleep quality in patients. Diaz-Piedra C1, Catena A2, Sánchez AI3, Miró E3, Martínez MP3, Buela-Casal G2. Sleep Med. 2015 Aug;16(8):917-25. doi: 10.1016/j.sleep.2015.03.011. Epub 2015 Apr 14.

Prevalence of post-traumatic stress disorder in fibromyalgia patients: overlapping syndromes or post-traumatic fibromyalgia syndrome? Cohen H1, Neumann L, Haiman Y, Matar MA, Press J, Buskila D. Semin Arthritis Rheum. 2002 Aug;32(1):38-50.

Prevalence of fibromyalgia in patients treated at the bariatric surgery outpatient clinic of Hospital de Clinicas do Parana ‐ Curitiba. Dias, D.N., Marques, M.A., Bettini, S.C., Paiva, E.D. (2017). Revista Brasileira de Reumatologia 57, 425–430.

Fibromyalgia and bipolar disorder: Extent of comorbidity and therapeutic implications, M.C. Di Tommaso Morrison, Francesco Carinci, Gianfranco Lessiani, E. Spinas, Journal of biological regulators and homeostatic agents 31(1):17-20 · January 2017  https://www.researchgate.net/publication/317030612_Fibromyalgia_and_bipolar_disorder_Extent_of_comorbidity_and_therapeutic_implications

Autoimmune rheumatic disease associated symptoms in fibromyalgia patients and their influence on anxiety, depression and somatisation: a comparative study. Dönmez S1, Pamuk ÖN, Ümit EG, Top MŞ. Clin Exp Rheumatol. 2012 Nov-Dec;30(6 Suppl 74):65-9.

Dysautonomia, fibromyalgia and reflex dystrophy, Jean Eisinger 1Arthritis Res Ther. 2007; 9(4): 105.

The primary vascular dysregulation syndrome: implications for eye diseases. Flammer J1, Konieczka K, Flammer AJ, EPMA J. 2013 Jun 7;4(1):14 available in full online at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693953/.

Comorbid fibromyalgia: A qualitative review of prevalence and importance, M.‐A. Fitzcharles, S. Perrot, W. Häuser, European Journal of Pain, Volume22, Issue9, October 2018, Pages 1565-157626 May 2018, https://doi.org/10.1002/ejp.1252, available in full online at: https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1252. [This is a detailed review article with many useful sources on fibromyalgia co-morbidities.]

Is there a relationship between fibromyalgia and rhinitis? Frieri M1, Argyriou A. Allergy Asthma Proc. 2012 Nov-Dec;33(6):443-9.

Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia. Furlan R1, Colombo S, Perego F, Atzeni F, Diana A, Barbic F, Porta A, Pace F, Malliani A, Sarzi-Puttini P. J Rheumatol. 2005 Sep;32(9):1787-93.

Chronic Prostatitis and Comorbid Non-Urological Overlapping Pain Conditions: A Co-Twin Control Study. Marianna Gasperi, PhD,1,2 John N. Krieger, MD,3 Christopher Forsberg, MA,4 Jack Goldberg, PhD,3,4 Dedra Buchwald, MD,5 and Niloofar Afari, PhD1,2, J Psychosom Res. 2017 Nov; 102: 29–33, doi: 10.1016/j.jpsychores.2017.09.005, available in full online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683425/.

Is there an association between mastalgia and fibromyalgia? Comparing prevalence and symptom severity. Genc V1, Genc A, Ustuner E, Dusunceli EB, Oztuna D, Bayar S, Kurtais Y. Breast. 2011 Aug;20(4):314-8.

Sleep disordered breathing concomitant with fibromyalgia syndrome. Germanowicz, D., Lumertz, M.S., Martinez, D., Margarites, A.F. (2006). J Bras Pneumol 32, 333–338.

Hearing and vestibular abnormalities in primary fibrositis syndrome. Gerster JC, Hadj-Djilani A. J Rheumatol. 1984 Oct;11(5):678-80, https://www.ncbi.nlm.nih.gov/pubmed/6595407.

Pain Symptoms in Fibromyalgia Patients with and without Provoked Vulvodynia. Ghizzani A1, Di Sabatino V2, Suman AL3, Biasi G1, Santarcangelo EL4, Carli G3. Pain Res Treat. 2014;2014:457618.

Small nerve fiber involvement in patients referred for fibromyalgia. Giannoccaro MP1, Donadio V, Incensi A, Avoni P, Liguori R. Muscle Nerve. 2014 May;49(5):757-9.

High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Goldenberg DL, Simms RW, Geiger A, Komaroff AL. Arthritis Rheum. 1990;33(3):381–387.

Clinical Management of Fibromyalgia, Don L. Goldenberg, available in preview mode at Google Books at: http://books.google.ca/books?id=Hd23Rtvfj8IC&pg=PA12&dq=pronociception&source=gbs_selected_pages&cad=3#v=onepage&q&f=false.

Fibromyalgia in the Patients With Allergic Rhinitis: Its Prevalence and Impact on the Quality of Life, Selcan Gultuna, MD, Nihal Tezel, MD, Funda Seher Ozalp Ates, PhD, American Jnal of Rhinology & Allergy, July 29, 2019, https://doi.org/10.1177/1945892419864526.

Meniere's disease and fibrositis syndrome (psychogenic rheumatism). Relation-ship in audiometric and nystagmographic results. Hadj-Djilani A, Gerster JC. Acta Otolaryngol Suppl. 1984;406:67-71.

Sleep in fibromyalgia patients: subjective and objective findings. Harding SM1. Am J Med Sci. 1998 Jun;315(6):367-76.

Posttraumatic stress disorder in fibromyalgia syndrome: Prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome. Häuser W1, Galek A, Erbslöh-Möller B, Köllner V, Kühn-Becker H, Langhorst J, Petermann F, Prothmann U, Winkelmann A, Schmutzer G, Brähler E, Glaesmer H. Pain. 2013 Aug;154(8):1216-23.)

Fibromyalgia in patients with thyroid autoimmunity: Prevalence and relationship with disease activity. Haliloglu, S., Ekinci, B., Uzkeser, H., Sevimli, H., Carlioglu, A., Macit, P.M. (2017). Clin Rheumatol 36, 1617–1621.

Presence of orofacial pain and temporomandibular disorder in fibromyalgia. A study by questionnaire. Hedenberg-Magnusson B, Ernberg M, Kopp S. Swed Dent J.,1999;23(5-6):185-92.

Temporomandibular disorders and associated clinical comorbidities. Hoffmann RG1, Kotchen JM, Kotchen TA, Cowley T, Dasgupta M, Cowley AW Jr. Clin J Pain. 2011 Mar-Apr;27(3):268-74.

Fibromyalgia in patients with other rheumatic diseases: prevalence and relationship with disease activity. Haliloglu S1, Carlioglu A, Akdeniz D, Karaaslan Y, Kosar A. Rheumatol Int. 2014 Sep;34(9):1275-80.)

Temporomandibular disorders and associated clinical comorbidities. Hoffmann RG1, Kotchen JM, Kotchen TA, Cowley T, Dasgupta M, Cowley AW Jr. Clin J Pain. 2011 Mar-Apr;27(3):268-74.)

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