Fibromyalgia

Neurosensory disorder characterised by chronic MSK pain

Aetiology

  • Higher prevalence in women (6:1)
    • Commonest cause of MSK pain in women 22-50
  • May begin after emotional or physical trauma
  • May occur as a primary condition but is also seen in approximately 25% of patients with RA and approximately 50% of patients with SLE

Pathophysiology

  • It is thought to be a disorder of central pain processing or a syndrome of central sensitivity
    • Patients tend to have a lower threshold of pain and of other stimuli, such as heat, noise, and strong odours
  • Not associated with inflammation
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Clinical presentation

  • Persistent (≥ 3 months) widespread pain
    • Pain/tenderness on both sides of the body, above and below the waist, and includes the axial spine
  • Fatigue - disrupted and unrefreshing sleep
  • Headaches
  • Cognitive and memory impairment
  • Anxiety, depression
  • Non-cardiac chest pain
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Investigations

Clinical diagnosis:
  • Patient experiences widespread pain and associated symptoms (unrefreshed sleep, cognitive symptoms, fatigue etc.)
  • Symptoms have been present at the same level for ≳3 months
  • No other condition otherwise explains the pain (diagnosis of exclusion - rule out other causes)

Management

  • Patient education
  • Graded exercise programme
  • CBT
  • Complementary medicine e.g. acupuncture
  • Anti-depressants e.g. tricyclics, SSRIs
  • Analgesia - atypical analgesia including tricyclics (e.g. amitriptyline), gabapentin and pregabalin may be beneficial