🌸 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.
