Fibromyalgia (much of this is lifted from the current fact sheet
Fibromyalgia Introduction
Fibromyalgia syndrome (FM) is defined as a common rheumatological syndrome
characterized by chronic, diffuse musculoskeletal pain and tenderness with a number of
associated symptoms, among which sleep disturbances, fatigue, and affective dysfunction
Epidemiology and Economics
Affects 2–10% of the general population, in all ages, ethnic groups, and cultures.
Its gender distribution is up to seven times more common in females than males.
FM’s impact on an individual’s quality of life and physical function is substantial.
In the United States, about 15% of patients receive disability funding because of their
Pathophysiology
The pathophysiology of FM is not completely clarified, but a number of neuroendocrine,
neurotransmitter-related, and neurosensory disturbances, as well as genetic
predisposition, have been implicated in its generation.
Neuroendocrine: Dysfunction of the hypothalamic-pituitary-adrenal axis, including
blunted cortisol responses; abnormal growth hormone regulation
Neurotransmitter: Decreased serotonin in the central nervous system; elevated levels of
substance P and nerve growth factor in the spinal fluid
Neurosensory: Central amplification of pain and/or reduced antinociception (central
sensitization, abnormalities of descending inhibitory pain pathways)
Genetic: Strong familial aggregation for FM; evidence for a role of polymorphisms of
genes in the serotoninergic, dopaminergic, and catecholaminergic systems in the
Clinical Features
FM has either a gradual or a post-traumatic onset
The pain is described as a persistent, diffuse, deep, aching, throbbing, sensation in
Clinical symptoms associated with FM are affective dysfunction, cognitive deficits,
short-term memory loss, headache, nonrestorative sleep, and daytime tiredness
A number of clinical conditions occur more frequently in FM than in the general
fatigue, including chronic fatigue syndrome
dysmenorrhea, interstitial cystitis, other rheumatic conditions, and
FM patients have abnormal reactivity to painful stimuli:
hypersensitivity to painful stimuli applied to somatic structures, not only
in painful sites but also in normal control areas
lower pain thresholds to thermal, mechanical, electrical and chemical
enhanced temporal summation (pain on repeated stimulation is greater)
after infusion of hypertonic saline, muscle pain with a longer duration and
referred pain that spreads to a larger area than in controls
Abnormal responses to pain seen on functional brain neuroimaging:
Diagnostic Criteria
The present criteria for FM diagnosis are those established by the American College of
1) A history of widespread pain (involving all 4 limbs and the trunk) of at least 3
2) Tenderness to digital palpation (with a pressure of 4 kg) in at least 11 of 18 (9
symmetrical) predetermined body districts called tender points (TePs) (a tender point
is defined as a site of exquisite tenderness in soft tissues, in contrast to the trigger
points of myofascial pain syndrome). Diagnosis and Treatment
FM does not threaten the patient’s life but can cause severe disability and thus
substantially compromise quality of life. Complete resolution of symptoms is almost
never achieved, but significant improvement can be obtained with adequate therapy.
Management of FM is typically multimodal:
education for affected individuals, family, and society
encouragement for the patient to take an active role in self-care
physical therapy, primarily with an exercise program (aerobic,
strengthening), with the addition of physical modalities, such as massage
moderate doses of medications proven to be effective:
i. low-dose tricyclic antidepressants (amitriptyline)
ii. dual serotonin-norepinephrine reuptake inhibitors
iii. selective serotonin reuptake inhibitors
iv. antiepileptics (gabapentin, pregabalin)
References
Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA 2004;292:2388–95.
Russell IJ, Bieber CS. Myofascial pain and fibromyalgia syndrome. In: McMahon SB, Koltzenburg M, editors.
Melzack and Wall’s textbook of pain, 5th ed. Edinburgh: Churchill Livingstone; 2005. p. 669–81.
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