Fibromyalgia
Overview
- The typical patient with fibromyalgia is a female in her 50’s but, of course, the disease can occur across ages and can also occur in men. It’s roughly estimated to occur at least 3 times as often in women as men.
Diagnostic Criteria
Diffuse Pain
- There is pain at 6 out of 9 potential sites: head (1), extremities (4), chest (1), abdomen (1), back: upper and lower (2)
Fatigue/Insomnia
- Fatigue or insomnia must be present.
> 3 Months Duration
- These symptoms must have been present for at least 3 months.
Additional Features
Tenderness/MSK Stiffness
- Additional features that may be present are tenderness and/or musculoskeletal stiffness.
“Fibro Fog”/Central Sensitization
- And “fibro fog (aka brain fog)” (dyscognition) and/or central sensitization (hypersensitivity to various environmental stimuli).
Differential Diagnosis
- Since fibromyalgia is a diagnosis of exclusion, it’s essential to rule-out any identifiable pathologic disorder.
Common potential mimickers to rule-out are:
- Other rheumatologic or endocrinologic diseases; neurologic disease, specifically neuropathy or multiple sclerosis; infectious disease, specifically, lyme disease or infectious hepatitis.
Treatment
- The pathology of this disorder is still not established but from a treatment standpoint, a variety of antidepressants are used, especially:
- Duloxetine (which has a mixed serotoinergic and noradrenergic affect)
- Tricyclic antidepressants
- Anticonvulsants
- Note that these drugs are also commonly used in a variety of pain conditions, including migraine headache, which has a strong sensitization component.