is a disorder characterized by widespread chronic musculoskeletal pain, accompanied by fatigue, memory problems, sleep disturbances, headaches, depression, and anxiety.
Approximately 10 million Americans (2-4%) have fibromyalgia with a ratio of about 8 to 2, women over men.
Evidence suggests that both the ascending and descending pain pathways operate abnormally, resulting in central amplification of pain signals. Patients with FM also exhibit changes in the levels of neurotransmitters that cause augmented central nervous system pain processing; levels of several neurotransmitters that facilitate pain transmission are elevated in the cerebrospinal fluid and brain, and levels of several neurotransmitters known to inhibit pain transmission are decreased.
To meet the fibromyalgia criteria for diagnosis, patients must have:
- Widespread pain in all four quadrants of the body for a minimum of three months
- At least 11 of the 18 specified tender points. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs. These points hurt when light pressure is put on them.
There is no cure for fibromyalgia. Multi-disciplinary approaches for management and relief of symptoms are often recommended.These include:
1. Nonpharmacological therapies (education, exercise, cognitive behavioral therapy)
2. Pharmacological therapies:
- Tricyclic antidepressant (Amitriptyline)
- Serotonin-norepinephrine reuptake inhibitor (Duloxetine)
- Gabapentinoids (gabapentin and pregabalin)