Fibromyalgia

Fibromyalgia, a disease of pain perception, is a long term chronic illness affecting 0.5-2% of general population. Females are 3-7 times more frequently affected than males and 10-16% patients can have an associated rheumatologic condition. It can start at any age and fatigue is an associated feature in almost 90% patients. Diagnosis of this condition is often delayed and patients usually consult many specialists before a definitive diagnosis is made.
Features: Pain all over body usually accompanied by fatigue and stiffness is the most common feature of fibromyalgia. Pain is on both sides of body. Patients describe pain in various ways, often emotionally. Pain often increases with exertion and does not respond to pain-killers. Other painful conditions such as chest pain, headache, abdominal pain and menstrual pain may accompany. Prolonged morning stiffness unrelieved by exercise is usually present.

Many more symptoms can be associated alongwith these complaints. These include -

  1. Weakness, fatigue, ill health, failure to cope
  2. Disturbed sleep, anxiety, depression, poor emotional function
  3. Morning stiffness, numbness, subjective joint swellings
  4. Numbness, intermittent diarrhea
  5. Overlap with other psychosomatic disorders such as migraine, depression, chronic fatigue and irritable bowel


Fibromyalgia Patients of fibromyalgia are generally classified on the basis of degree of tenderness, anxiety, depression, pain control and catastrophizing (patient believes that there no cure for her disease, feels helpless and gives up all attempts to manage the illness). At least 3 subsets can be recognized on the basis of severity of these symptoms.
Investigations: Pain on pressure at 11 out of 18 specified areas is required for clinical diagnosis of fibromyalgia although diagnosis can also be established with less number of tender areas alongwith other classical features. Other diseases causing generalised pain, especially anemia, diabetes, metabolic bone disease (vitamin D and Calcium deficiency) and thyroid disease as well as a few other rheumatologic conditions, need to be ruled out with proper clinical examination as well as few blood and other tests.
Treatment:Specialized multidisciplinary management can significantly improve quality of life in fibromyalgia patients. Simple pain killers (paracetamol and tramadol) may be used for short term pain relief although they may not be of any great help. Depression must be suitably managed. A few other drugs such as pregabalin and gabapentin may also be useful in some cases. Over-reliance on drugs must be discouraged. All patients of fibromyalgia should understand their disease, adopt a positive attitude and try to cope up with pain. Non-drug therapies such as graded exercises, cognitive behavioral therapy, heated pool therapy (balneotherapy), relaxation and music therapy are equally important. Difficult patients may require psychological assessment and expert management

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