Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 20-46: Fibromyalgia + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Most frequent in women aged 20–50 Chronic widespread musculoskeletal pain syndrome with multiple tender points Fatigue, headaches, numbness common Objective signs of inflammation absent; laboratory studies normal +++ General Considerations ++ Affects 3–10% of the general population Cause is unknown, but aberrant perception of painful stimuli, sleep disorders, depression, and viral infections have all been proposed Shares many features with the myalgic encephalomyelitis/chronic fatigue syndrome An increased frequency among women aged 20–50 Absence of objective findings Absence of diagnostic laboratory test results While many of the clinical features of the two conditions overlap, musculoskeletal pain predominates in fibromyalgia whereas lassitude dominates the myalgic encephalomyelitis/chronic fatigue syndrome Fibromyalgia can be a complication of hypothyroidism, rheumatoid arthritis or, in men, sleep apnea + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ Chronic aching pain and stiffness, frequently involving the entire body but with prominence of pain around the neck, shoulders, low back, and hips Fatigue, sleep disorders, subjective numbness, chronic headaches, and irritable bowel symptoms are common Even minor exertion aggravates pain and increases fatigue Physical examination is normal except for "trigger points" of pain produced by palpation of various areas such as Trapezius Medial fat pad of the knee Lateral epicondyle of the elbow +++ Differential Diagnosis ++ Rheumatoid arthritis Systemic lupus erythematosus Polymyositis produces weakness rather than pain Polymyalgia rheumatica Produces shoulder and girdle pain Is associated with an elevated sedimentation rate and anemia Occurs after age 50 Hypophosphatemic states, such as oncogenic osteomalacia + Diagnosis Download Section PDF Listen +++ ++ Diagnosis of exclusion Thyroid function tests are useful because hypothyroidism can produce a secondary fibromyalgia syndrome + Treatment Download Section PDF Listen +++ +++ Conservative Measures ++ Patient education is essential; while therapies are imperfect, course is not progressive Cognitive behavioral therapy, including programs that emphasize mindfulness meditation, is often helpful Exercise programs are also beneficial, particularly tai chi and yoga +++ Medications ++ The following have modest efficacy: Fluoxetine Duloxetine Milnacipran Cyclobenzaprine Pregabalin Gabapentin Low-dose naltrexone Nonsteroidal anti-inflammatory drugs are generally ineffective Tramadol and acetaminophen combinations have ameliorated symptoms modestly in short-term trials Opioids and corticosteroids are ineffective and should not be used to treat fibromyalgia + Outcome Download Section PDF Listen +++ +++ Prognosis ++ All patients have chronic symptoms With treatment, however, many do eventually resume increased activities Progressive or objective findings do not develop + References Download Section PDF Listen +++ + +Cheng CA et al. Effectiveness of Tai Chi on fibromyalgia patients: a meta-analysis of randomized controlled trials. Complement Ther Med. 2019 Oct;46:1–8. [PubMed: 31519264] + +Metyas S et al. Low dose naltrexone in the treatment of fibromyalgia. Curr Rheumatol Rev. 2018;14(2):177–80. [PubMed: 28325149] + +Prabhakar A et al. The role of complementary and alternative medicine treatments in fibromyalgia: a comprehensive review. Curr Rheumatol Rep. 2019 Mar 4;21(5):14. [PubMed: 30830504] + +Wolfe F et al. Diagnosis of fibromyalgia: disagreement between fibromyalgia criteria and clinician-based fibromyalgia diagnosis in a university clinic. Arthritis Care Res (Hoboken). 2019 Mar;71(3):343–51. [PubMed: 30724039]