Myofascial
Fibromyalgia
search
Fibromyalgia
, Fibrositis
See Also
ACR Fibromyalgia Diagnostic Criteria
(
ACRFDC
)
Tender Point
s
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
Gene
ral medical patients: 5%
Gene
ral 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
Paresthesia
s (63%)
Anxiety (48%)
Dry Mouth
(36%)
Recurrent Headache
s (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
Hernia
tion 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
Gene
ral 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 Point
s (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]
Type your search phrase here