Fibromyalgia

 

• Pathophysiology and epidemiology

  • Unclear pathophysiology, and typically thought of as functional.
  • 2% prevalence, commonest in women and middle age.

• Signs and symptoms

  • Chronic widespread pain, sometimes with neuropathic features.
  • Neurocognitive: fatigue, poor sleep, mood disorder, poor concentration and memory.

• Diagnosis

  • Diagnosis is clinical, based on unexplained widespread pain.
  • Basic tests to rule out other causes – e.g. FBC, CRP, TFT, CK – but extensive testing only indicated if history and exam suggest it.
  • Tender points may be present on examination, but not required to make the diagnosis.

• Management

  • Non-pharmacologic treatment is key: patient education, CBT, exercise, Tai Chi.
  • Pharmacologic treatment should be targeted at specific symptoms.

• Prognosis

  Symptoms fluctuate, but typically persist to some degree long-term.