Fibromyalgia

Background

• A disorder of pain regulation, sometimes classified as a kind of central sensitization
• Chronic musculoskeletal pain not explained by another systemic disorder
• More common in women than men

Clinical Features

• Chronic musculoskeletal pain
• Insomnia
• Fatigue
• Decreased concentration
• Headache
• Paresthesias

Differential Diagnosis

• Rheumatoid arthritis
• Sjögren Syndrome
• Systemic lupus erythematosus
• Ankylosing spondylitis
• Myopathies: metabolic or statin-induced
• Myasthenia gravis
• Myofascial pain syndrome
• Multiple sclerosis
• Psychiatric disorders

Evaluation

• Clinical diagnosis

Management

• Tricyclic antidepressants
• Select SNRIs (duloxetine, venlafaxine, milnacipran)
• Anticonvulsants (pregabalin, gabapentin)
• Exercise program

Disposition

• Discharge