Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, mood disorders and sleep disorders. It's now believed to be a disorder of central pain processing where there's an exaggerated response to a painful stimulus or a painful response to a nonpainful stimulus.
Epidemiology:
It affects women 10 times more often than men.
It's more common in relatives of patients with fibromyalgia.
Pathophysiology:
The pathophysiology of fibromyalgia is unclear. Though its occurrence in families suggests that it's affected by genetic predisposition, environmental and psychological factors. In addition to emotional stress, medical illness, surgery and trauma.
Signs and symptoms:
Musculoskeletal pain/ stiffness/ aching.
Headache.
Fatigue/ exhaustion.
Cognitive difficulties (e.g. memory problems, poor vocabulary, etc..)
Light-headedness and dizziness.
Anxiety and/or depression.
Irritable bowel syndrome.
Symptoms are aggravated by cold and humid weather, poor sleep, and physical or mental stress. While improved by warm and dry weather, moderate physical activity, adequate sleep, and relaxation.
Diagnosis:
Fibromyalgia is not a diagnosis of exclusion and should be identified by its own characteristics.
The ACR criteria have two components that must be present for diagnosis of fibromyalgia:
Widespread pain involving both sides of the body, above and below the waist as well as the axial skeletal system, for at least three months.
Presence of 11 tender points among the nine pairs of specified sites (18 points) as shown in figure 1.
Figure 1.
An important portion of the physical examination for a diagnosis of fibromyalgia is to systematically palpate the 18 sites, this amount of pressure does not produce significant tenderness or pain in patients without fibromyalgia.
Diagnosis is based on clinical findings with aid of history taking. On the other hand, diagnostic tests and imaging have limited roles as they're mostly used to rule out other pathologies.
Management:
Pharmacological therapy: Unfortunately, there no current medications for completely treating fibromyalgia. Nevertheless, the use of antidepressants, muscle relaxants and anticonvulsants has shown great response in managing the symptoms of fibromyalgia.
2. Non-pharmacological therapy:
Cardiovascular exercise.
Cognitive behavioral therapy.
Patient education (group format using lectures, written materials, demonstrations).
Multidisciplinary therapy (e.g. exercise and cognitive behavioral therapy, patient education and exercise).
Current evidence-based guidelines emphasize the value of multimodal treatments, which encompass both non-pharmacological and selected pharmacological treatments tailored to individual symptoms, including pain, fatigue, sleep problems and mood problems.
References:
Häuser, W., Ablin, J., Fitzcharles, MA. et al. Fibromyalgia. Nat Rev Dis Primers 1, 15022 (2015). https://doi.org/10.1038/nrdp.2015.22
Daniel J. Clauw,
Fibromyalgia: An Overview,
The American Journal of Medicine,
Volume 122, Issue 12, Supplement,
2009,
Pages S3-S13,
ISSN 0002-9343,
Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician. 2007 Jul 15;76(2):247-54. PMID: 17695569 Assessed and Endorsed by the MedReport Medical Review Board