Fibromyalgia is characterized by chronic widespread pain, also known as the multisite pain, which presents for at least 3 months. It involves the head, chest, abdomen, and back in addition to the arms and legs. Initially, patients commonly localize the pain in the neck and shoulders.
Fibromyalgia is most commonly seen in females aged 20 to 55. It is the most common cause of generalized, musculoskeletal pain in women of this age.
Multiple soft tissue and joint sites should be palpated during the physical examination. There should be no redness or swelling of soft tissues or joints. Patients with fibromyalgia usually have at least six sites involved.
Patients with fibromyalgia may feel pain that is described as aching, burning, gnawing, soreness, or stiffness. The patient may experience stiffness in the morning.
Patients with fibromyalgia may experience non-dermatomal paresthesias. Arms and legs can equally be affected.
Insomnia is a common symptom of fibromyalgia. Despite having slept for 8 to 10 hours, patients report feeling exhausted the next morning. They struggle to fall back asleep after waking up early in the morning.
Fatigue is another common symptom of Fibromyalgia. Patients may experience it after waking up, despite getting 8-10 hours of sleep.
Fibromyalgia patients experience cognitive difficulties, also known as "fibro fog." They generally report difficulties paying attention and performing tasks that involve fast thought process.
Regular aerobic and strength training exercises, such as walking, swimming, or tai chi, help improve fibromyalgia symptoms and quality of life. It is preferred over pharmacological treatment due to less side effects and the tremendous advantages of exercise.
TCAs, especially amitriptyline, are widely used to treat fibromyalgia. They function by inhibiting serotonin and norepinephrine reuptake into neuronal terminals.
TCAs can be substituted with SNRIs in patients with significant fatigue and depression. The mechanism of action is similar to that of TCAs.
Gabapentin can be administered in patients with severe sleep disturbance. It is an analog of gamma-aminobutyric acid (GABA), which binds to voltage-gated calcium channels in the central nervous system.
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