Makindo Medical Notes

🌸 Fibromyalgia is a chronic pain syndrome characterised by widespread musculoskeletal pain, fatigue, and sleep disturbance. It is a diagnosis of exclusion and often overlaps with other rheumatological or functional disorders.

📖 About

• Predominantly affects women (80–90%), typically aged 30–60 years.
• Frequently coexists with other rheumatological conditions (RA, SLE, Sjögren’s).
• Linked with disruption of stage 4 (deep) sleep and heightened sensitivity to stress.
• Often misdiagnosed as chronic fatigue syndrome (CFS), depression, or somatisation.

🩺 Clinical Features

• Generalised pain: stiffness, weakness, and diffuse aching in muscles and joints.
• Tender points: pain on digital palpation at ≥11 of 18 defined anatomical sites (classic exam question).
• Morning stiffness and symptom worsening with poor weather.
• Fatigue: worsens with exertion (physical or mental).
• Neuropsychological symptoms: poor concentration (“fibro fog”), low mood, anxiety.
• Other features: IBS, tension headaches, paraesthesia, Raynaud’s-like symptoms.

🔬 Investigations

Used mainly to exclude other diagnoses, as fibromyalgia has no specific biomarker.

• Bloods: FBC, ESR/CRP (to rule out inflammatory disease), CK (muscle disorders), TFTs (thyroid disease).
• Other: consider Hepatitis C serology in appropriate risk groups.
• Results are usually normal.

💊 Management

• Education & reassurance: explain chronic, non-deforming nature of disease.
• Lifestyle: graded aerobic exercise, stretching, yoga, mindfulness.
• Sleep hygiene: crucial; address insomnia and nocturnal pain.
• Stress management: CBT, relaxation strategies.
• Pharmacological:
  • Low-dose tricyclic antidepressant (e.g. amitriptyline at bedtime).
  • Duloxetine or pregabalin may be considered in refractory cases.
  • NSAIDs and opioids are generally not helpful and should be avoided.
• Physiotherapy alone tends to have limited benefit, but supervised programmes can aid motivation.

📌 Key Teaching Pearls

• Think of fibromyalgia when you see chronic widespread pain + fatigue + normal labs.
• It is a central pain processing disorder, not a peripheral joint/muscle disease.
• Multidisciplinary management works best (GP, rheumatology, psychology, physiotherapy).
• Always rule out mimics: hypothyroidism, polymyalgia rheumatica, inflammatory arthritis.