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FIBROMYALGIA
Lisa Rose-Jones, MD
April 27th, 2010
Clinical Manifestations
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Cardinal complaint is diffuse musculoskeletal pain
(may initially be localized)
Often difficulty distinguishing joint vs. muscle pain
Common to report swelling
Fatigue reported in more than 90% cases
Many pts report HA of the muscular or migraine-type
Cognitive difficulty
Mood Disturbances
Diagnosis
(Via American College of Rheumatology Guidelines )
~widespread Musculoskeletal pain
~excess tenderness in at least 11 of 18
predefined anatomic sites
*Requiring both criteria results in 80% sens/specificity from
distinguishing this from other chronic painful disorders
Proposed Pathophysiology
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Central Sensitization: Alteration in pain & sensory
processing
Pts sense discomfort from noxious stimuli at a lower
level of physical stimulation than do healthy controls
Endogenous analgesic systems appear to be
thwarted, reduced brain habituation to
somatosensory stimulation
Reduction in opioid receptors in brain (narcotics less
effective)
?genetic predisposition
Treatment
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1st discussing the diagnosis,
REASSURANCE! Patient education can
have a therapeutic effect
www.NFA.com
Cognitve Behavior Therapy
Aerobic Exercise
MEDICATIONS
~recommended 1st line is TCA like
Amitriptyline (avoid if older patient)
~If sleep is an issue: try Pregabalin* qhs (or
Gabapentin if $$ is an issue)
~if Fatigue is more prominent: Duloxtine* at
breakfast
~Milnacipran (another SNRI) had had good
results