Fibromyalgia

Patients with fibromyalgia typically present with chronic, waxing and waning, widespread body pain. Comorbid symptoms such as fatigue, memory difficulties, and sleep and mood difficulties are common.

Physical examination is typically normal but there is often diffuse tenderness, which may be assessed by counting the number of tender points or by palpating several areas of the body.

The aetiology of fibromyalgia is not known; however, evidence suggests that presentation is through the process of central sensitisation, and the 'centralisation' of pain is a key factor for diagnosis.

Treatments that are effective for acute pain or pain due to nociceptive input will be less beneficial for patients experiencing chronic pain secondary to pain centralisation.

Effective therapies include education, exercise, cognitive behavioural approaches, tricyclic antidepressants, gabapentinoids, and serotonin-noradrenaline reuptake inhibitors. Combinations of these treatments have been found to have an increased benefit for patients.

Fibromyalgia is a syndrome characterised by widespread pain in the body present for at least 3 months and is thought to be related to amplified pain signals in the spinal cord and brain.

This topic does not cover the diagnosis or treatment of juvenile fibromyalgia.