Introduction
Fibromyalgia is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites. The cause of fibromyalgia is unknown.
Epidemiology
- Incidence: 60.00 cases per 100,000 person-years
- Peak incidence: 30-40 years
- Sex ratio: more common in females 5:1
| Condition | Relative incidence |
|---|---|
| Polymyalgia rheumatica | 1.40 |
| Fibromyalgia | 1 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
Features
- chronic pain: at multiple site, sometimes 'pain all over'
- lethargy
- cognitive impairment: 'fibro fog'
- sleep disturbance, headaches, dizziness are common
Diagnosis
Diagnosis is clinical and sometimes refers to the American College of Rheumatology
classification criteria which lists 9 pairs of tender points on the body. If a patient is tender in at least 11 of these 18 points it makes a diagnosis of fibromyalgia more likely
classification criteria which lists 9 pairs of tender points on the body. If a patient is tender in at least 11 of these 18 points it makes a diagnosis of fibromyalgia more likely
Management
The management of fibromyalgia is often difficult and needs to be tailored to the individual patient. A psychosocial and multidisciplinary approach is helpful. Unfortunately there is currently a paucity of evidence and guidelines to guide practice. The following is partly based on consensus guidelines from the European League against Rheumatism (EULAR) published in 2007 and also a BMJ review in 2014.
- explanation
- aerobic exercise: has the strongest evidence base
- cognitive behavioural therapy
- medication: pregabalin, duloxetine, amitriptyline