- Clinical science
Fibromyalgia (FM) is a neurosensory disorder characterized by chronic musculocutaneous pain. Patients typically present with functional complaints (e.g., fatigue, unrefreshing sleep, morning stiffness) and often have a history of psychiatric disorders (e.g., depression, generalized anxiety disorder). On physical examination, there is no notable swelling, deformity, or erythema, and laboratory tests are normal, as there is no inflammation. Instead, characteristic tender points allow for diagnosis. Although the syndrome is benign, it causes the patient significant psychological strain and discomfort. Treatment focuses on lifestyle changes and multidisciplinary pain management.
- Sex: ♀ > ♂ (9:1)
- Age range: 20–50 years (but may occur earlier)
Epidemiological data refers to the US, unless otherwise specified.
The pathophysiology of FM is still not fully understood, but its etiology is likely multifactorial. The interaction of the following factors may play a role:
- Genetic predisposition
- Environmental triggers (e.g., physical or psychosocial stress)
- Dysregulation of the neuroendocrine and autonomic nervous systems
- Chronic, widespread pain, primarily at points where muscles and tendons attach to bone (tender points)
- Morning stiffness
- Unrefreshing sleep
- Cognitive dysfunction (“fibro fog”)
- Further symptoms of autonomic dysfunction: digestive problems, weight fluctuation, palpitations, sexual dysfunction, night sweats
The symptoms associated with the following disorders sometimes resemble FM, but these conditions may also occur alongside FM.
- Functional somatic syndromes (e.g., chronic fatigue syndrome , , tension or migraine headaches, chronic pelvic and bladder syndromes); ; ;
- Psychiatric disorders (, )
- Sleep disorders (e.g., sleep movement disorders such as restless leg syndrome)
- Inflammatory rheumatic diseases (e.g., SLE), ) (
Fibromyalgia is a clinical diagnosis
- There are two different diagnostic criteria
- The 1990 American College of Rheumatology (ACR) Fibromyalgia Diagnostic Criteria
- The 2010 ACR Preliminary Diagnostic Criteria
- Laboratory values and imaging are normal (helpful for excluding other causes or comorbidities).
- Patient education: explain that the condition, though painful, is benign; coping strategies such as relaxation exercises
- Lifestyle changes: : dietary recommendations, sleep hygiene, regular physical activity
- Consider comorbidities (e.g., sleep disorders) in treatment planning
- Multidisciplinary management (e.g., rheumatologist, psychiatrist) and adequate pain management
- Psychological interventions (e.g., cognitive behavioral therapy)
- Physiotherapy (e.g., stretching, hydrotherapy, and heat application)
- Combination therapy with the drugs mentioned above