Fibromyalgia Syndrome

Fibromyalgia appears to be a form of neural dysfunction, but without demonstrable neural deficits on clinical testing, that presents as chronic widespread non-inflammatory musculoskeletal pain. It presents an enormous management problem. It is not to be confused with so-called fibrositis or tender trigger points.

The main diagnostic features are:

1. a history of widespread pain (neck to low back)

2. pain in 11 of 18 painful points on digital palpation

Other features

• Female:male ratio = 4:1

• Usual age 29–37: diagnosis 44–53

• Poor sleep pattern

• Fatigue (similar to chronic fatigue syndrome)

• Psychological disorders (e.g. anxiety, depression)

• Others (e.g. headache, irritable digestive tract)

Patients require considerable explanation, support and reassurance. It is difficult to treat. The best evidence to date supports the value of educational programs and regular aerobic exercise.

Treatment

• Refer to a specialist for diagnosis and shared care

• Explanation, reassurance and counselling

• Attention to sleep disorders, stress factors and physical factors

• Rehabilitation exercise program (e.g. walking, swimming or cycling)

• Paracetamol (max. dose 4 g/d) for pain (first line)

• Psychotherapy/cognitive behaviour therapy

Medication

Consider as a trial:

• antidepressants (of proven short-term value), e.g. amitriptyline (10–25 mg (o) nocte to max. 50 mg), dothiepin (25 up to 75 mg nocte) or

• duloxetine 30 mg (o) nocte to 60 mg in 2 wks

Note: NSAIDs are of no proven value.