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.