synonyms: fibromyalgia, fibromyositis, fibrositis, idiopathic myalgia
- 729.1 Myalgia and myositis, unspecified
Fibromyalgia Etiology / Epidemiology / Natural History
- Fibromyalgis = Pain in all 4 quadrants of the body, as well as in the axial skeleton continuously for at least 3 months and the presence of at least 11 of 18 anatomically specific tender points. Tender points are painful areas when pressure (4 kg) is applied, without referred pain.
- Disturbances within the central nervous system (CNS) known as central sensitization represent the most likely etiology.
- Patients have demonstrated biochemical changes in the CNS, low levels of serotonin, 4-fold increase in nerve growth factor, elevated levels of substance P.
- Affects 2% of the general population. 3.4% of women and 0.5% of men.
- Women/male = 5/1, any age. Most common 20-50 y/o
Fibromyalgia Clinical Evaluation
- "I hurt all over all the time." Constant burning, aching, and soreness. Location migrates and intensity varies.
- Digital palpation performed with 4 kg force causing pain in 11 of 18 Tender Pointsindicates Fibromyalgia.
- Fatigue, nonrestorative sleep, paresthesias, memory difficulties.
Fibromyalgia Xray / Diagnositc Tests
- No tests diagnose fibromyalgia
- All routine labs will be normal including ESR, CRP.
Fibromyalgia Classification / Treatment
- Referral to Rheumatologist / PMR / Primary care
- Physical therapy, trigger-point injections, cognitive behavioral therapy, relaxation training, group therapy, biofeedback, stress management, exercise.
- Tricyclic antidepressants, serotonin/norepinephrine reuptake inhibitors, NSAIDs.
Fibromyalgia Associated Injuries / Differential Diagnosis
- Sleeping Disorders (60%)
- Restless-legs syndrome (25%)
- Myofascial pain syndrome
- Irritable bowel syndrome
- Lyme Disease
- Premenstrual syndrome
- Muliple sclerosis
- And many many more
- Recurrent flare-ups
Fibromyalgia Follow-up Care
- No cure exists. Education, lifestyle changes, stress reduction, increased physical activity can significantly improve symptoms.
Fibromyalgia Review References