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Fibromyalgia
Aka: Fibromyalgia, Fibrositis- See Also
- Epidemiology
- Associated Conditions: Common Comorbid Chronic Conditions
- Associated Conditions: General
- Associated Conditions: Miscellaneous Symptoms
- Severe Fatigue (81%)
- Morning stiffness longer than 15 minutes (77%)
- Sleep Disorder (75%)
- Non-restorative sleep (alpha-delta sleep)
- Sleep Apnea
- Nocturnal Myoclonus
- Restless Leg Syndrome
- Atypical Paresthesias (63%)
- Anxiety (48%)
- Dry Mouth (36%)
- Recurrent Headaches (53%)
- Dysmenorrhea (41%)
- Past History of Major Depression (31%)
- Irritable Bowel Syndrome (30%)
- Urinary urgency (26%)
- Cold sensitivity or Raynaud's Phenomenon (17%)
- Reduced functional ability
- Aerobic deconditioning
- Exacerbating Factors
- Post-exertional increase in muscle pain
- Stress or Abuse
- Signs
- See Diagnosis below
- Differential diagnosis
- Other Myofascial Conditions
- Psychiatric Conditions
- Rheumatic, Endocrine and Neurologic Conditions
- Labs (Should be Normal)
- Standard Evaluation
- Complete Blood Count (CBC)
- Erythrocyte Sedimentation Rate (ESR)
- Chemistry Panel (Chem7)
- Thyroid Stimulating Hormone (TSH)
- Creatinine Phosphokinase (CPK)
- Additional tests when indicated
- Antinuclear Antibody (ANA)
- Rheumatoid Factor (RF)
- Standard Evaluation
- Diagnosis: General Criteria
- Fibromyalgia is a diagnosis of exclusion
- Widespread musculoskeletal pain ("I hurt all over")
- Regional: Each of 4 body quadrants involved
- Pain on left and right side of body
- Pain above and below waist
- Axial skeleton pain present
- Cervical spine
- Anterior chest
- Thoracic Spine
- Low back
- Pain worse in the morning and at the end of the day
- Symptoms persist at least 3 months
- Diagnosis
- New criteria (2010)
- Older criteria (1990)
- See Tender Points (11 of 18 present)
- Management
- See Fibromyalgia Non-Pharmacologic Management
- See Fibromyalgia Pharmacologic Management
- Fibromyalgia Impact Questionnaire
- http://www.myalgia.com/FIQ/fiq.pdf
- Assess for associated functional Impairment
- Resources: Patients
- Fransen (1997) Fibromyalgia Help Book, Smith House
- Starlanyl (1996) Fibromyalgia and Myofascial Pain, NHP
- Resources: Organizations
- Arthritis Foundation
- National Fibromyalgia Research Association
- USA Fibromyalgia Association
- UK Fibromyalgia Association
- References
- Berman (1999) J Fam Pract 48(3):213-18
- Gremillion (1998) Phys Sportsmed, 26(4) 55-65
- Hadler (1997) Postgrad Med 102(2):161-77
- Klippel (1997) Primer Rheumatic Diseases, p.124-7
- Reiffenberger (1996) Am Fam Physician 53(5):1698-1704
- Wilke (1996) Postgrad Med 100(1):153-70
- Yunus (1996) Consultant, p. 1260-74
- Yunus (1996) Consultant, p. 1279-85