Fibromyalgia - Diagnosis and Treatment

Summary of features of Fibromyalgia

This disease is mainly found in women aged 20 to 50. Chronic generalized musculoskeletal pain with multiple tender areas are the important feature. Fibromyalgia is also associated with fatigue, headaches, numbness. There are no signs of inflammation and all the laboratory studies normal. Fibromyalgia partially responds to exercise, tricyclic antidepressants.

What is Fibromyalgia?

Fibromyalgia is one of the commonest rheumatic diseases involves 3 to 10% of the general population. It has in common a lot of features with the chronic fatigue syndrome, like both have increased incidence among women aged 20 to 50, absence of any inflammation or, objective findings, and no abnormal diagnostic laboratory test findings. Differential features are musculoskeletal pain is the important complain in fibromyalgia while lassitude dominates the chronic fatigue syndrome.


The cause of fibromyalgia is unidentified, but sleep disorders, depression, viral infections, and abnormal sensitivity to pain are some of the probable explanations. Fibromyalgia sometimes appears rarely as a complication of hypothyroidism, rheumatoid arthritis. In men it is sometimes a consequence of sleep apnoea.

What are the symptoms and examination findings of fibromyalgia?

The affected person complains of continual ache and inflexibility, commonly involving the whole body but particularly around the neck, shoulders, low back, and hips. This pain is commonly associated with lassitude, sleeping problems, numbness, chronic headaches, and irritable bowel symptoms (IBS). Even slight effort aggravates pain and increases the fatigue. When the patient is examined physically everything usually comes out as normal except there are some "trigger points" where pain produced by light pressure in various area of the body like shoulder blades, the medial fat pad of the knee, and the lateral aspects of the elbow.

Diagnosis of Fibromyalgia

Fibromyalgia is diagnosed by excluding all other possible causes. The detailed history from the patient usually help the doctor to skip many costly investigations. Rheumatoid arthritis and systemic lupus erythematosus (SLE) are two important diseases are excluded as both of them presents woth objective clinical findings and abnormal laboratory tests like ESR and C-reactive protein. Thyroid function tests is done as hypothyroidism can sometimes cause a secondary fibromyalgia syndrome. Polymyositis, another condition to be differentiated from fibromyalgia, produces mainly weakness rather than pain. The diagnosis of fibromyalgia probably should be with caution in a patient over age 50 and should not be accounted for any fever, weight loss, or other objective findings. Polymyalgia rheumatic is a condition appears after the age of 50 and causes shoulder and pelvic girdle pain. This is also associated with anemia and high ESR value.. Oncogenic osteomalacia, a Hypophosphatemic is differentiate from fibromyalgia by the low phosphate laevel and pain in fewer areas.

Treatment of fibromyalgia

Counseling and education is the mainstay of the treatment. Sufferes can be reassured that they have a diagnosable condition and is treatable. They must be assured that the course of the disease is not progressive.
Modest results are expected from amitriptyline, fluoxetine, chlorpromazine, or cyclobenzaprine. Amitriptyline is started at a dosage of 10 mg tab orally at bedtime and step by step increased to 40–50 mg depending on result and side effects. Less than half of the patients find a persistent improvement. Exercise programs are also advantageous. NSAIDs generally do not wok in this case. Tramadol and acetaminophen combinations reported some good results in short trials. Opioids and corticosteroids should not be used as they are ineffective. Acupuncture also could not prove its efficacy.