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Fibromyalgia
Aka: Fibromyalgia, Fibrositis
- See Also
- ACR Fibromyalgia Diagnostic Criteria (ACRFDC)
- Tender Points
- Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)
- Epidemiology
- Women account for more than 75-85% of Fibromyalgia patients
- Peak Incidence: ages 20 to 60 years old
- Incidence increases with age
- Most common rheumatic cause of chronic diffuse pain
- Most common cause of Chronic Pain in women ages 20 to 55 years old
- Incidence
- Rheumatology patients: 15%
- Only Osteoarthritis is more common in rheumatology practice
- General medical patients: 5%
- General female population: 2-3%
- Pathophysiology
- Increased central sensitivity to peripheral sensation (as with other functional pain syndromes)
- Pain system dysfunction related to abnormalities in the forebrain
- Risk Factors
- Post-Traumatic Stress Disorder (present in up to 45% of Fibromyalgia patients)
- Sexual abuse or rape
- Associated Conditions: Common Comorbid Chronic Conditions
- Rheumatoid Arthritis
- Osteoarthritis
- Lyme Disease
- Sleep Apnea
- Associated Conditions: Augmented pain and sensory processing disorders
- Chronic Fatigue Syndrome
- Tension Headache
- Migraine Headache
- Primary Dysmenorrhea
- Restless Legs Syndrome
- Periodic Limb Movement disorder
- Temporomandibular Joint pain
- Myofascial Pain Syndrome
- Interstitial Cystitis
- Irritable Bowel Syndrome
- Endometriosis
- Non-cardiac Chest Pain
- Chronic back pain
- Reduced functional ability
- Aerobic deconditioning
- Vulvodynia
- Post-Traumatic Stress Disorder
- Associated Conditions: Symptoms
- Severe Fatigue (81%)
- Morning stiffness longer than 15 minutes (77%)
- Sleep Disorder (75%)
- Non-restorative sleep (alpha-delta sleep)
- Sleep Apnea
- Nocturnal Myoclonus
- Restless Leg Syndrome
- Atypical Paresthesias (63%)
- Anxiety (48%)
- Dry Mouth (36%)
- Recurrent Headaches (53%)
- Dysmenorrhea (41%)
- Past History of Major Depression (31%)
- Irritable Bowel Syndrome (30-70%)
- Urinary urgency (26%)
- Cold sensitivity or Raynaud's Phenomenon (17%)
- Exacerbating Factors
- Post-exertional increase in muscle pain
- Emotional Stress or Abuse
- Signs
- See Diagnosis below
- Differential diagnosis
- Other Myofascial Conditions
- See Associated Conditions listed above
- Myofascial Pain Syndrome
- Chronic Fatigue Syndrome
- Psychiatric Conditions
- Masked Major Depression
- Somatoform Disorder
- Rheumatic, Endocrine and Neurologic Conditions
- Systemic Lupus Erythematosus (SLE)
- Rheumatoid Arthritis
- Polymyalgia Rheumatica (esp. age >60 years old)
- Polymyositis
- Diabetes Mellitus
- Myopathy or Neuropathy
- Myotonic Dystrophy
- Multiple Sclerosis
- Hypothyroidism
- Hyperparathyroidism
- Ankylosing Spondylitis
- Disc Herniation with radiculopathy
- Paraneoplastic Neuropathy
- Parkinson's Disease
- Infectious Conditions
- Epstein-Barr Virus (Mononucleosis)
- Parvovirus
- Q Fever
- Lyme Disease
- Miscellaneous Conditions
- Vitamin D Deficiency
- Statin-Induced Myopathy
- Eosinophilia-Myalgia Syndrome (rare, likely toxin related, such as L-Tryptophan ingestion)
- Labs
- Labs are normal in isolated Fibromyalgia
- Standard Evaluation
- Complete Blood Count (CBC)
- Basic Metabolic Panel (e.g. Chem8)
- Thyroid Stimulating Hormone (TSH)
- Additional tests when indicated (non-specific tests, order judiciously)
- Erythrocyte Sedimentation Rate (ESR)
- C-Reactive Protein (C-RP)
- Antinuclear Antibody (ANA)
- Rheumatoid Factor (RF)
- Creatinine Phosphokinase (CPK)
- Diagnosis: General Criteria
- Fibromyalgia is a diagnosis of exclusion
- Widespread musculoskeletal pain ("I hurt all over")
- Regional: Each of 4 body quadrants involved
- Pain on left and right side of body
- Pain above and below waist
- Axial skeleton pain present
- Cervical Spine
- Anterior chest
- Thoracic Spine
- Low back
- Pain worse in the morning and at the end of the day
- Symptoms persist at least 3 months
- Diagnosis: Specific diagnostic tools
- New criteria (2010)
- See ACR Fibromyalgia Diagnostic Criteria (ACRFDC)
- Older criteria (1990)
- See Tender Points (11 of 18 present)
- Management
- See Fibromyalgia Non-Pharmacologic Management
- See Fibromyalgia Pharmacologic Management
- Fibromyalgia Impact Questionnaire
- Assess for associated functional Impairment
- Resources: Patients
- Fransen (1997) Fibromyalgia Help Book, Smith House
- Paid link to Amazon.com (ISBN 0961522143)
- Starlanyl (1996) Fibromyalgia and Myofascial Pain, NHP
- Paid link to Amazon.com (ISBN 1572240466)
- Resources: Organizations
- Arthritis Foundation
- http://www.arthritis.org
- National Fibromyalgia Research Association
- http://www.teleport.com/~nfra
- USA Fibromyalgia Association
- http://www.fibromyalgiaassnusa.org
- UK Fibromyalgia Association
- http://www.community-care.org.uk/charity/fmauk.html
- References
- Money and Glauser (2017) Crit Dec Emerg Med 31(1): 15-21
- Klippel (1997) Primer Rheumatic Diseases, p.124-7
- Yunus (1996) Consultant, p. 1260-74
- Yunus (1996) Consultant, p. 1279-85
- Berman (1999) J Fam Pract 48(3):213-18 [PubMed]
- Gremillion (1998) Phys Sportsmed, 26(4) 55-65 [PubMed]
- Hadler (1997) Postgrad Med 102(2):161-77 [PubMed]
- Kodner (2015) Am Fam Physician 91(7): 472-8 [PubMed]
- Reiffenberger (1996) Am Fam Physician 53(5):1698-1704 [PubMed]
- Wilke (1996) Postgrad Med 100(1):153-70 [PubMed]