What is Fibromyalgia
- Is a syndrome characterized by fatigue, diffuse muscle pain and stiffness, sleep disturbance, and the presence of tender points on physical examination.
- There is no unknown etiology, but theories have suggested a variety of possible pathophysiologic mechanisms, such as neural-hormonal disturbance, antecedent physical trauma, viral infection, immune dysregulation, psychiatric disturbances, and heightened sensitivity to pain.
- Complications include disability and inability to maintain functional roles.
- Fatigue, poor or nonrestorative sleep.
- Generalized muscle aches and stiffness
- Irritable bowel syndrome
- Tension headaches
- Paresthesias, sensation of swollen hands
- Presence of pain in 11 of 18 defined tender point sites
- Anterior: low cervical, second rib, lateral epicondyle, knee.
- Posterior: occiput, trapezius, supraspinatus, gluteal, greater trochanter.
- Complete history and physical examination to rule out other disorders.
- Complete blood count, blood chemistries, erythrocyte sedimentation rate, thyroid-stimulating hormone, and arthritis panel rule out other disorders.
- X-rays and imaging studies are all normal.
- Cardiovascular fitness training
- Electromyogram biofeedback
- Cognitive behavioral therapy
- Electrical stimulation or acupuncture.
- Nonsteroidal anti-inflammatory drugs, acetaminophen or tramadol to relieve pain.
- Antidepressants to help control chronic pain and depression.
- Muscle relaxants, such as cyclobenzaprine, to relieve muscle tension and spasm.
- Sleep agents and antianxiety agents may be considered.
- Monitor pain level and effectiveness of treatment plan.
- Assess functional ability.
- Encourage regular use of analgesics and antidepressants as directed.
- Encourage regular exercise routine, including stretching, aerobic activity, and muscle-strengthening exercises.
- Suggest referrals to physical therapist or pain specialists for additional pain control modalities as needed.
- Suggest regular night time ritual to promote sleep.
- Discourage staying up late and erratic sleep habits.
- Encourage relaxation periods or short nap during day as needed for fatigue.
- Advise limiting caffeine intake during day and especially after 4 p.m.
- Encourage patient to look at fibromyalgia as a chronic condition that can be controlled.
- Help patient plan schedule and pace activities to accomplish routine activities.