2nd February 2024

Fibromyalgia

What is this?

It is a common musculoskeletal condition with a variety of somatic symptoms. It is generally a chronic pain that is widespread across the body for more than 3 months. The pain could be felt in arms, legs, head, and chest and could be throbbing, aching, or burning-type pain. 

It is associated with extensive pain that is enduring. The other supplementary symptoms here include extreme sensitivity to pain, fatigue, sleep disturbance, cognitive difficulties, low mood, anxiety, etc. 

Other syndromes of MUS can coexist, including Irritable Bowel syndrome and chronic fatigue syndrome.

Prevalence

It is seen in around 3% of the population worldwide. It is more common in women than men. Apart from that, it is known to be more common in middle age and in lower socio-economic status groups. It is also more common in those who are unemployed.

Aetiology

1. Central sensitisation
2. Fear-avoidance
3. Physical deconditioning

Pathophysiology

CNS sensitisation plays a central role such that the brain amplifies signals from peripheries and by modifying cortical processing > They feel more pain than expected (hyperalgesia), or they might feel pain without a stimulus present (allodynia)> Fear of pain > They avoid activities > The physical activities are deconditioned > lead to complete rest which is the reasonable behaviour but maladaptive that can be reinforced by friends and family

Core symptoms

Table 1: FFIBRO mnemonic. Epomedicine. Fibromyalgia: Mnemonic Approach [Internet]. Epomedicine; 2022 Mar 5 [cited 2023 Jan 9]. Available from: https://epomedicine.com/medical-students/fibromyalgia-mnemonic-approach/.

Assessment

History should be followed by a thorough physical examination and investigations

Management

Non-pharmacological methods should be offered initially 

• Psychoeducation and Exercise programme supervised by Physiotherapist
• CBT
• Self-management: Aiming to reduce disability and improve morale and well-being rather than reducing pain
• Stepped care: Graded physical exercise

Pharmacological method 

• Antidepressants
• Anticonvulsants as neuromodulator
• Management of comorbidity

References

• Epomedicine. Fibromyalgia: Mnemonic Approach [Internet]. Epomedicine; 2022 Mar 5 [cited 2023 Jan 9]. Available from: https://epomedicine.com/medical-students/fibromyalgia-mnemonic-approach/.
• Rahman, F., Underwood, M. and Carnes, D. (n.d.). CLINICAL REVIEW. [online] doi:10.1136/bmj.g1224.
• Clauw, D.J. (2014). Fibromyalgia. JAMA, 311(15), p.1547. doi:10.1001/jama.2014.3266.
• Psych Scene Hub. (2019). The Neuropsychiatry of Fibromyalgia – Etiology and Management. [online] Available at: https://psychscenehub.com/psychinsights/neuropsychiatry-of-fibromyalgia-etiology-and-management/
• Choy, E. (2015). ORL Fibromyalgia Syndrome. [online] doi:10.1093/med/9780198723233.001.0001.