Fibromyalgia is a chronic, soft-tissue/myofascial pain disorder associated with tender points. Other symptoms of fibromyalgia include sleep disturbance, fatigue, headache, morning stiffness, extremity numbness and anxiety.
Epidemiology
Fibromyalgia is a very common rheumatologic condition that often goes underdiagnosed. It is much more common in women than men. The condition is typically diagnosed in women between 20 and 50 years of age.
Pathophysiology
The etiology of fibromyalgia is unknown. There are some families that have a strong incidence of the disorder, but a genetic or familial cause has not been linked to it yet. Scientists have theorized that there is a central sensitization to pain or that there is dysregulation in pain perception in the hypothalamic-pituitary-adrenal axis.
Symptoms
Patients typically complain of multiple sites of pain. Fatigue is also a very common component, although poor sleep is a symptom. Some patients will describe a muscular burning, soreness, stiffness or tightness.
According to Dr. Yong-Yeow Chong, of Singapore General Hospital, patients with fibromyalgia often experience pain from stimuli that are normally nonpainful and hyperintense pain from normally painful stimuli. Headaches, anxiety, depression and memory issues can also be associated with fibromyalgia.
Diagnosis
Fibromyalgia is a diagnosis of exclusion. This means that other causes of musculoskeletal pain, fatigue and psychological disturbance must be ruled out. In order to make a diagnosis of fibromyalgia, there must be widespread pain involving both sides of body in both the upper and lower extremities for more than three months. There must also be 11 out of 18 tender points. The areas of tender points are the occiput (base of the skull posteriorly), medial border of the scapula, upper outer buttocks, posterior to greater trochanter of the femur (lower buttocks), anterior cervical spine at c5-c7, upper anterior trapezius, second rib space, lateral epidondyle, and medial knee fat pad.
Pharmacologic Treatments
According to Dr. Sangita Chakrabarty, of Meharry Medical College in Nashville, Tennessee, there is the strongest evidence in favor of treatment with amitryptyline and cyclobenzaprine (flexeril). There is moderate evidence for using duloxetine (Cymbalta), venlafaxine (Effexor), fluoxetine, pregabalin and tramadol. There is no evidence for treatment with corticosteroids, melatonin, nonsteroidal anti-inflammatories, opioids or thyroid hormone.
Non-Pharmacologic Treatments
According to Chakrabarty, there is strong evidence for patients to engage in cognitive behavioral therapy, cardiovascular exercise, patient education and multidisciplinary therapy. There is moderate evidence for acupuncture, balneotherapy, biofeedback, hypnotherapy and strength training. Evidence for chiropractic therapy, electrotherapy, massage therapy, ultrasound, flexibility exercise and trigger point injections is limited and weak at the current point.
