Fibromyalgia
- Chronic widespread pain, reduced pain thresholds to palpation, fatigue |
- Described as "irritable everything" |
- Involved structures not well defined (PNS, ANS, CNS, neurotransmitters, endrocrine system, immune system, mitochondrial dysfuntion, adrenal fatigue, psychological origins) |
- Usually no pathological/biochemical explanation |
Demographics/Risk factors
- Any age (usually at midlife, risk increases as age increases) |
- Women more than men |
- Genetics |
- Obesity |
- Repetitive injury |
- Trauma |
- PTSD |
- Systemic illness |
- Lupus |
- RA |
- AS |
- TMJ dysfunction |
Presentation
- Middle aged/older adult |
- Chronic neuropathic pain (>3 months) which is diffuse and symmetrical |
- Muscle, tendon, joint stiffness with tenderness to touch |
- Headaches and dizziness |
- Usually moderate pain, but can be severe |
- Pain affected by smoking, worse quality of life, sleep problems, increased anxiety, sedentary lifestyle |
- Fibro-fog - cognitive deficits, lack of concentraction, slower processing, memory lapses, fatigue, mood swings and insomnia |
- Depression/anxiety common |
Imaging
- No orthopedic/objective test to rule in fibromyalgia |
- Neuro exam unremarkable |
- Diagnosis of exclusion |
DDx
- Hypothyroidism |
- Anemia |
- Inflammatory arthropathy |
- Lyme Disease |
- MS |
- Malignancy |
- IBS |
- Celiac disease |
- CFS |
- Migraine |
- MFPS |
- Statin reaction |
- Hypermobility syndrome |
- Parasitic diseases |
- Hormone deficiency |
Management
- Sleep study (correlation with sleep apnoea) |
- Rule out other suspected causes (CBC, T3, T4, TSH, ESR, CRP, RA Factor, ANA) |
- Aerobic exercises (walk, cycle, swim) and CBT effective |
- Avoid sedentary lifestyle and regular exercises |
- Resistance training |
- Graded motor imagery (pt performs repetition of pain free movment, ask patient to sit down and imagine perfoming 10 additional perfect pain free repeitions) |
- Tai Chi, Yoga, mindfulness, hypnosis,mediation |
- Emphasis to patient the benign nature of the disease |
- LIGHT touch massage/myofascial techniques if the patient can handle it |
- Dietary advice (weight loss, stop eating pro-inflammatory foods) |
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