Condition: Fibromyalgia
Brief Overview: Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties, often described as "fibro fog." It is considered a disorder of central pain processing with heightened sensitivity to pain.
Prevalence: Affects approximately 2-4% of the population, with a higher prevalence in women, especially those between the ages of 20 and 55.
Etiology: The exact cause of fibromyalgia is unknown but is believed to involve a combination of genetic predisposition, environmental triggers (e.g., infections, trauma), and abnormal central nervous system pain processing.
Risk Factors:
• Female sex
• Family history of fibromyalgia
• History of physical or emotional trauma
• Stress or mood disorders
• Other chronic pain conditions
Commonly Associated Conditions:
• Irritable bowel syndrome (IBS)
• Migraines or tension headaches
• Temporomandibular joint (TMJ) disorders
• Depression and anxiety
• Chronic fatigue syndrome
Common Medications:
• Antidepressants (e.g., amitriptyline, duloxetine)
• Anticonvulsants (e.g., pregabalin, gabapentin)
• Pain relievers (e.g., acetaminophen, NSAIDs)
• Muscle relaxants
Common Labs, Imaging, and Tests:
• Diagnosis is clinical and based on history and physical examination.
• Rule out other conditions with tests such as:
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Thyroid function tests
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Erythrocyte sedimentation rate (ESR)
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C-reactive protein (CRP)
Common Symptoms:
• Widespread musculoskeletal pain
• Fatigue
• Sleep disturbances (e.g., nonrestorative sleep, insomnia)
• Cognitive difficulties ("fibro fog")
• Sensitivity to temperature, light, and noise
• Mood disorders (e.g., depression, anxiety)
Common Treatments:
• Medications (antidepressants, anticonvulsants, analgesics)
• Physical therapy and exercise programs
• Cognitive-behavioral therapy (CBT)
• Stress management techniques
• Complementary therapies (e.g., acupuncture, massage)
Physical Findings:
• Tender points on examination (e.g., neck, shoulders, hips, knees)
• No signs of inflammation or joint deformity
Potential Complications and Contraindications:
• Reduced quality of life due to chronic pain and fatigue
• Potential for overuse of medications or treatment resistance
• Contraindications for certain medications (e.g., CNS depressants in patients with sleep apnea)
General Health and Lifestyle Guidance:
• Encourage regular, low-impact exercise (e.g., swimming, yoga)
• Promote good sleep hygiene practices
• Suggest relaxation techniques (e.g., mindfulness, meditation)
• Emphasize the importance of a whole foods balanced diet
Suggested Questions to Ask Patients:
• How would you rate your pain?
• Do you experience fatigue or difficulty concentrating?
• Have you noticed any patterns or triggers for your symptoms?
• How do your symptoms impact daily activities or sleep?
Suggested Talking Points:
• Explain that fibromyalgia is a real and manageable condition.
• Reassure patients that their symptoms are understood and validated.
• Discuss the importance of a multidisciplinary approach to treatment such as with medications, counseling, diet, movement, acupuncture, massage, etc.
• Highlight the role of exercise, stress management, and therapy in symptom control.