Fibromyalgia

By Majid Ghauri, MD

Spine & Pain Clinics of North America

. https://www.sapnamed.com/

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Fibromyalgia

Fibromyalgia is a disorder of chronic, widespread pain and tenderness. It typically presents in young or middle-aged women but can affect patients of either sex and at any age.

Signs and symptoms

Fibromyalgia is a syndrome that consists of the following signs and symptoms.

Persistent widespread pain greater than three months

Stiffness

Fatigue; disrupted and unrefreshing sleep

Cognitive difficulties

Multiple other unexplained symptoms, anxiety and/or depression, and functional impairment of activities of daily living.

Diagnosis

Fibromyalgia is a diagnosis of exclusion and patients must be thoroughly evaluated for the presence of other disorders that could be the cause of symptoms before a diagnosis of fibromyalgia is made. The clinical assessment may reveal objective evidence for a discrete or other illness, such as the following

Hypothyroidism

Rheumatoid arthritis

Systemic lupus erythematosus

Polymyalgia rheumatic

Other inflammatory or autoimmune disorders

Serious cardiac conditions in those with chest pain, dyspnea, and palpitations

Laboratory testing

Although patients with fibromyalgia do not have characteristic or consistent abnormalities on laboratory testing, routine laboratory and imaging studies can help to rule out diseases with similar manifestations and to assist in diagnosis of certain inflammatory diseases that frequently coexist with fibromyalgia. Such tests include the following

Complete blood count with differential

Metabolic panel

Urinalysis

Thyroid-stimulating hormone level

ESR and anti-nuclear antibodies.

Treatment

There is no cure for fibromyalgia, but education, lifestyle changes, and proper medications can help the individual to regain control and achieve significant improvement.

Models of pain behavior that interrelate biologic, cognitive, emotional, and behavioral variables form the basis for cognitive-behavioral and operant-behavioral approaches to adult pain management.

Non pharmacotherapy

Diet (good nutrition, vitamin supplementation, bone health, weight loss)

Stress management

Aerobic exercise (low-impact aerobics, walking, water aerobics, stationary bicycle)

Sleep therapy (education/instruction on sleep hygiene)

Psychologic/behavioral therapy (cognitive-behavioral, operant-behavioral)

Pharmacotherapy

Always combine pharmacologic and non-pharmacologic therapy in the treatment of fibromyalgia. Aggressively treat comorbid depression.

Medications used in the management of fibromyalgia include the following

Analgesics (NSAIDS, tramadol)

Skeletal muscle relaxants (cyclobenzaprine)

Antidepressants (amitriptyline, duloxetine, venlafaxine )

Anticonvulsants (pregabalin, gabapentin)

Alpha 2 agonists (clonidine)

Ketamine infusions