Fibromyalgia is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites. The diagnosis is likely if a patient is tender in at least 11 of 18 tender points.
It accounts for 10% of cases in the rheumatology clinic. It is more common in women.
- Risk factors
- Female sex
- Middle age
- Low household income
- Divorced
- Low educational status
- Associated conditions
- Chronic fatigue syndrome
- Irritable bowel syndrome
- Chronic headaches syndrome
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Pathophysiology
- Aberrant peripheral and central pain processing
- Signs and symptoms
- Chronic widespread pain
- 3 months
- Constant, deep, aching or burning in nature
- Profound fatigue
- Morning stiffness > 30 minutes
- Tender points on examination, particularly at muscle-tendon junctions
- Allodynia – pain in response to a non-painful stimulus
- Hyperaesthesia – exaggerated perception of pain in response to a mildly painful stimulus
- Cognitive difficulties (”fibro fog”))
- Impaired concentration, attention, and memory
- Paraesthesia and numbness of the hands and feet
- Headaches (migraine and tension type)
- Sleep disturbance
- Low mood and anxiety
- Chronic widespread pain
- Treatment
- Explain that the condition is relapsing and remitting with no easy cures
- Graded exercise program (aerobic and strength-based)
- Relaxation, rehabilitation, and physiotherapy
- Cognitive behavioral therapy
- Amitriptyline to relieve pain and improve sleep
- Pregabalin if amitriptyline is ineffective
- Duloxetine or SSRIs if there is comorbid anxiety and depression
