A poorly understood disorder causing generalized aching and stiffness of the muscles of the trunk, hips, and shoulders. Parts of the affected muscles (known as trigger points) are tender to the touch; common tender sites are the base of the skull and the muscles near the shoulderblades. Fibromyalgia commonly develops during periods of stress and may follow a chronic course. Treatment may consist of heat, massage, and drugs such as nonsteroidal anti-inflammatory drugs and, sometimes, antidepressant drugs, which may relieve the symptoms.
n. a disorder characterized by pain in the fibrous tissue components of muscles without any inflammation (compare fibromyositis). Widespread aching and stiffness with specific tender points are accompanied by extreme fatigue and often associated with headache, numbness and tingling, and various other symptoms. Fibromyalgia is frequently triggered by anxiety, stress, sleep deprivation, and straining or overuse of muscles; it appears to be closely related to *CFS/ME/PVF.
Symptoms These vary, with pain and fatigue generally prominent, sometimes causing considerable disability. Patients can usually dress and wash independently but cannot cope with a job or household activities. Pain is mainly axial, but may affect any region. ANALGESICS, NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) and local physical treatments are generally ine?ective.
Patients often have a poor sleep pattern, waking exhausted. Unexplained headache, urinary frequency and abdominal symptoms are common, but no cause has been found. Patients generally score highly on measures of anxiety and DEPRESSION. Fibromyalgia is not an ideal description; idiopathic di?use-pain syndrome and non-restorative sleep disorder are increasingly preferred terms.
Clinical ?ndings are generally unremarkable; most important is the presence of multiple hyperalgesic tender sites (e.g. low cervical spine, low lumbar spine, suboccipital muscle, mid upper trapezius, tennis-elbow sites, upper outer quadrants of buttocks, medial fat pad of knees). In ?bromyalgia, hyperalgesia (excessive discomfort) is widespread and symmetrical, but absent at sites normally non-tender. Claims by patients to be tender all over are more likely to be due to fabrication or psychiatric disturbance. OSTEOARTHRITIS and periarticular syndrome are much more common and should be excluded, together with other conditions, such as hypothyroidism (see THYROID GLAND, DISEASES OF), SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and in?ammatory myopathy (see MUSCLES, DISORDERS OF), which may present with similar symptoms.
Cause There is no investigational evidence of in?ammatory, metabolic or structural abnormality, and the problem seems functional rather than pathological. SEROTONIN de?ciency has a signi?cant role in ?bromyalgia syndrome.
Management Controlled trials have con?rmed the usefulness of low-dose AMITRIPTYLINE or DOTHIEPIN together with a graded exercise programme to increase aerobic ?tness. How this works is still unclear; its e?cacy may be due to its normalising effects on the sleep centre or ‘pain gating’ (reduction of pain sensation) at the spinal-cord level. Prognosis is often poor. Nevertheless, suitable advice and training can help most patients to learn to cope better with their condition and avoid unnecessary investigations and drug treatments.... fibromyalgia syndrome
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