Fibromyalgia

Fibromyalgia syndrome is a commonly encountered syndrome characterized by diffuse persistent musculoskeletal pain, stiffness, tenderness, sleep disturbance and easy fatigability, affecting predominantly women.

Fibromyalgia can be a secondary problem in:

Rheumatoid Arthritis 12%
Systemic Lupus Erythematosus 22%
Primary Sjögren's Syndrome 11%

Differential diagnosis

Polymyalgia rheumatica
Myositis or myopathies
Neuropathies, multiple sclerosis and myasthenia gravis
Spondylarthropathies
Hypermobility disorders
Substance abuse
Endocrinopathies: hypo/ hyperthyroidism, diabetes, hypoglycemia, and parathyroid disorders

Syndromes which overlap with fibromyalgia

Depression
Restless leg syndrome
Irritable bowel syndrome
Irritable bladder syndrome
Migraine
Chronic fatigue syndrome
Myofascial pain
Multiple Chemical Sensitivity Syndrome

Symptoms

Criterion
Symptoms
Sleep disturbance
"Pain all over"
Fatigue
Morning stiffness>15 minutes
Paresthesias
Anxiety
Headache
Prior depression
Irritable bowel syndrome
Sicca symptoms
Urinary urgency
Dysmenorrhea history
Raynaud's phenomenon

Modulating Factors
Noise
Cold
Poor sleep
Anxiety
Humidity
Stress
Fatigue
Weather change
Warmth

% Positive

74.6
67.0
81.4
77.0
62.8
47.8
52.8
331.5
29.6
35.8
26.3
40.6
16.7

24.0
79.3
76.0
69.0
59.6
63.0
76.7
66.1
78.0

Classification Accuracy

73.8
73.6
71.7
67.2
63.6
62.9
62.3
58.0
57.1
55.4
54.2
53.4
51.6

68.5
66.6
65.2
63.7
63.6
60.4
60.3
60.3
50.8

Diagnostic trigger points

Occiput
Trapezius
Supraspinatus
Gluteal
Greater trochanter
Lower cervical
Second rib
Lateral epicondyle
Knee

Criteria for diagnosis of fibromyalgia

History of widespread pain which has been present for at least three months.
Definition: Pain is considered widespread when all of the following are present: pain in both sides fo the body, pain above and below the waist. In addition, axial skeletal pain (cervical spine, anterior chest, thoracic spine or low back pain) must be present. Low back pain is considered lower segment pain.
Pain in 11 of 18 tender point sites on digital palpation
Definition: Pain, on digital palpation, must be present in at least 11 of the following 18 tender point sites:
Occiput - at the suboccipital muscle insertions.
Low cervical - at the anterior aspects of the intertransverse spaces at C5-C7.
Trapezius - at the midpoint of the upper border.
Supraspinatus - at origins, above the scapula spine near the medial border.
Second rib - upper lateral to the second costochondral junction.
Lateral epicondyle - 2 cm distal to the epicondyles.
Gluteal - in upper outer quadrants of buttocks in anterior fold of muscle.
Greater trochanter - posterior to the trochanteric prominence.
Knee - at the medial fat pad proximal to the joint line.

Digital palpation should be performed with an approximate force of 4kg. A tender point has to be painful at palpation not just "tender."

	Fibromyalgia Network
	Oregon Fibromyalgia Foundation
	National Fibromyalgia Research Association