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Fibromyalgia Cheat Sheet (DRAFT) by

Presentation, management etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.


- 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
- Systemic illness
- Lupus
- RA
- AS
- TMJ dysfun­ction


- 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


- No orthop­edi­c/o­bje­ctive test to rule in fibrom­yalgia
- Neuro exam unrema­rkable
- Diagnosis of exclusion


- Hypoth­yro­idism
- Anemia
- Inflam­matory arthro­pathy
- Lyme Disease
- MS
- Malignancy
- Celiac disease
- Migraine
- Statin reaction
- Hyperm­obility syndrome
- Parasitic diseases
- Hormone deficiency


- 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)