Fibromyalgia

Fibromyalgia

Fibromyalgia is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites. The cause of fibromyalgia is unknown.

Epidemiology

• women are around 5 times more likely to be affected
• typically presents between 30-50 years old

Features

Pain, lethargy, multiple tender points in body --> ? fibromyalgia

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Importance: 37

• chronic pain: at multiple site, sometimes 'pain all over'
• lethargy
• cognitive impairment: 'fibro fog'
• sleep disturbance, headaches, dizziness are common

Diagnosis is clinical and sometimes refers to the American College of Rheumatology
classification criteria which lists 9 pairs of tender points on the body. If a patient is tender in at least 11 of these 18 points it makes a diagnosis of fibromyalgia more likely

The management of fibromyalgia is often difficult and needs to be tailored to the individual patient. A psychosocial and multidisciplinary approach is helpful. Unfortunately there is currently a paucity of evidence and guidelines to guide practice. The following is partly based on consensus guidelines from the European League against Rheumatism (EULAR) published in 2007 and also a BMJ review in 2014.

• explanation
• aerobic exercise: has the strongest evidence base
• cognitive behavioural therapy
• medication: pregabalin, duloxetine, amitriptyline

+PassMedicine Notes

Fibromyalgia is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites. The cause of fibromyalgia is unknown.

Epidemiology

• women are around 5 times more likely to be affected
• typically presents between 30-50 years old

Features

• chronic pain: at multiple site, sometimes 'pain all over'
• lethargy
• cognitive impairment: 'fibro fog'
• sleep disturbance, headaches, dizziness are common

Diagnosis is clinical and sometimes refers to the American College of Rheumatology classification criteria which lists 9 pairs of tender points on the body. If a patient is tender in at least 11 of these 18 points it makes a diagnosis of fibromyalgia more likely The management of fibromyalgia is often difficult and needs to be tailored to the individual patient. A psychosocial and multidisciplinary approach is helpful. Unfortunately there is currently a paucity of evidence and guidelines to guide practice. The following is partly based on consensus guidelines from the European League against Rheumatism (EULAR) published in 2007 and also a BMJ review in 2014.

• explanation
• aerobic exercise: has the strongest evidence base
• cognitive behavioural therapy
• medication: pregabalin, duloxetine, amitriptyline