• Clinical science

Fibromyalgia

Abstract

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.

Epidemiology

  • Sex: > (9:1)
  • Age range: 20–50 years (but may occur earlier)

Epidemiological data refers to the US, unless otherwise specified.

Etiology

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

References:[1]

Clinical features

Common symptoms

  • Chronic, widespread pain, primarily at points where muscles and tendons attach to bone (tender points)
  • Headache
  • Fatigue
  • Morning stiffness
  • Unrefreshing sleep
  • Cognitive dysfunction (“fibro fog”)
  • Paresthesias
  • Further symptoms of autonomic dysfunction: digestive problems, weight fluctuation, palpitations, sexual dysfunction, night sweats

Common associations

The symptoms associated with the following disorders sometimes resemble FM, but these conditions may also occur alongside FM.



References:[2][1][3][4][5][6][7][8]

Diagnostics

Fibromyalgia is a clinical diagnosis

  • There are two different diagnostic criteria
    • The 1990 American College of Rheumatology (ACR) Fibromyalgia Diagnostic Criteria
      • Tender points: ≥ 11 of 18 fibromyalgia-associated localized areas of pain
      • Pain-affected areas: all four regions of the body and the axial skeleton
      • Duration: ≥ 3 months
    • The 2010 ACR Preliminary Diagnostic Criteria
      • Evaluating:
        • Intensity and extent of widespread pain
        • Severity of cognitive and somatic symptoms
      • Without tender point examination
  • Laboratory values and imaging are normal (helpful for excluding other causes or comorbidities).

References:[2][8][9][10][11]

Differential diagnoses

References:[7][8]

The differential diagnoses listed here are not exhaustive.

Treatment

Initial approach

Non-responders

  • Multidisciplinary management (e.g., rheumatologist, psychiatrist) and adequate pain management
  • Combination therapy with the drugs mentioned above



References:[7][12][13][14]