Fibromyalgia
A disorder characterized by widespread muscle pain and tenderness. It is often misunderstood, or even unrecognized. This diagnosis is given after multiple other pathologies have been ruled out.
Demographics:
Predominant age: 30-50 years
Sex: female to male 9:1
Prevalence: 4 per 1000 persons
Clinical Presentation:
• History of widespread pain that moves around the body
• Multiple trigger points on both sides of the body
• Fatigue
• Sleep disturbances
• Stiffness
• Cognitive and memory problems
• Anxiety and/or depression
• Migraine or tension headaches
• Temporomandibular disorder, irritable bowl syndrome, gastroesophageal reflux, irritable bladder, and pelvic pain may also accompany the pain and tenderness
• All symptoms tend to fluctuate over time and are often exacerbated by stress
Differential Diagnosis
• polymalgia rheumatica
• referred discogenic spine pain
• rheumatoid arthritis
• localized tenderness
• connective tissue disease
• osteoarthritis
• thyroid disease
• spondyloarthropathies
• Lab tests to rule out other pathology include complete blood count, erythrocyte sedimentation rate, rheumatoid factor, and creatine phosphokinase
Criteria for diagnosis described by the American College of Rheumatology:
• History of widespread pain
• Pain in 11 of 18 tender points on digital palpation (note that the number of trigger points to establish a diagnosis is debated)
Clinical Bottom Line: Treat and refer
Treatment should include patient education and reassurance, mild to moderate aerobic exercises, particularly swimming, and gentle stretching.
A referral to a rheumatologist and a psychiatrist may be helpful in treating fibromyalgia.
References:
Please refer to “Fibromyalgia” section of the reference list.
Demographics:
Predominant age: 30-50 years
Sex: female to male 9:1
Prevalence: 4 per 1000 persons
Clinical Presentation:
• History of widespread pain that moves around the body
• Multiple trigger points on both sides of the body
• Fatigue
• Sleep disturbances
• Stiffness
• Cognitive and memory problems
• Anxiety and/or depression
• Migraine or tension headaches
• Temporomandibular disorder, irritable bowl syndrome, gastroesophageal reflux, irritable bladder, and pelvic pain may also accompany the pain and tenderness
• All symptoms tend to fluctuate over time and are often exacerbated by stress
Differential Diagnosis
• polymalgia rheumatica
• referred discogenic spine pain
• rheumatoid arthritis
• localized tenderness
• connective tissue disease
• osteoarthritis
• thyroid disease
• spondyloarthropathies
• Lab tests to rule out other pathology include complete blood count, erythrocyte sedimentation rate, rheumatoid factor, and creatine phosphokinase
Criteria for diagnosis described by the American College of Rheumatology:
• History of widespread pain
• Pain in 11 of 18 tender points on digital palpation (note that the number of trigger points to establish a diagnosis is debated)
Clinical Bottom Line: Treat and refer
Treatment should include patient education and reassurance, mild to moderate aerobic exercises, particularly swimming, and gentle stretching.
A referral to a rheumatologist and a psychiatrist may be helpful in treating fibromyalgia.
References:
Please refer to “Fibromyalgia” section of the reference list.