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Fibromyalgia

Definition and Epidemiology

  • Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues.
  • More common in women and typically diagnosed in middle age.
  • Often associated with other conditions like irritable bowel syndrome, chronic fatigue syndrome, and depression.

Pathophysiology

  • The exact cause is unknown but thought to involve a combination of genetic and environmental factors.
  • Central sensitization theory suggests an abnormal processing of pain signals in the central nervous system, leading to heightened pain perception.
  • Often triggered by a stressful event, such as physical trauma, surgery, infection, or significant psychological stress.

Clinical Features

  • Widespread pain for more than three months.
  • Presence of specific tender points on physical examination.
  • Associated symptoms: fatigue, cognitive difficulties (often referred to as “fibro fog”), headaches, depression, and anxiety.
  • Sleep disturbances and morning stiffness.

Diagnosis

  • Diagnosis is clinical, based on history and physical examination.
  • No specific lab tests or imaging studies; these are primarily used to rule out other conditions.
  • A thorough examination to identify characteristic tender points is crucial.

Management

  • Multidisciplinary approach including medication, physical therapy, and psychological support.
  • Pharmacological:
    • Pain relievers (e.g., NSAIDs) and medications to improve sleep.
    • Antidepressants and anti-seizure drugs can help reduce pain and fatigue.
  • Non-pharmacological:
    • Regular exercise (aerobic and strength training).
    • Cognitive-behavioral therapy and stress management techniques.
    • Education about self-management techniques.

Prognosis

  • Fibromyalgia is a chronic condition with variable prognosis.
  • Symptoms can be managed effectively in many patients, but complete remission is rare.
  • Emphasis on long-term management to improve quality of life.

Patient Education

  • Understanding the chronic nature of the condition and the importance of comprehensive management strategies.
  • Importance of lifestyle modifications, including regular exercise, stress reduction, and sleep hygiene.
  • Encouragement to participate in support groups and counselling.

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