Widespread Pain

Fibromyalgia

Definition

Fibromyalgia is a chronic pain syndrome characterised by generalised pain and stiffness in the muscles and joints.

Aetiology

The aetiology of fibromyalgia is unknown, but may be related to autoimmune diseases, rheumatoid arthritis, sarcoidosis, and hypothyroidism.

Prevalence varies from 1% to 11% and occurs more frequently in females (3.4% females versus 0.5% males). Signs and symptoms increase with age and a hereditary trend is present.

There are indications that fibromyalgia is primarily a neurological disorder due to  central disturbance of the processing of afferent nociceptive information closely related to central sensitisation.

Signs and symptoms

As well as generalised pain and stiffness in the muscles and joints, fibromyalgia is frequently accompanied by complaints such as fatigue, sleeping disorders, paraesthesia, headache, irritable bowel syndrome, swollen fingers, dysmenorrhoea, cognitive deficit, and reduced physical capacity. The severity is season-dependent and increases with cold and humidity.

Diagnostics

Physical Examination

A general physical examination and extensive neurological examination are very important in order to exclude other causes.

The diagnosis is made based on the finding of defined painful 'tender points'. If 11 of 18 'tender points' examined are found to be positive, fibromyalgia is likely.

Additional Somatic Diagnostics

  • Excluding other possible causes dependent on the medical discipline.
  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment consisting of various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

 

Pharmacological treatment:

  • Anti-convulsive drugs
  • Tricyclic antidepressants
  • SSRIs
  • Topical anaesthetica
  • Opioids