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Condition/Disorder Synonyms

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  • Fibromyalgia syndrome (FM, FMS)

  • Chronic fatigue syndrome

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ICD-9-CM Code

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  • 729.1 Myalgia and myositis unspecified

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ICD-10-CM Code

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  • M79.7 Fibromyalgia

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Preferred Practice Patterns1

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Key Features

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Description

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  • Widespread musculoskeletal pain and fatigue for at least three months

  • Commonly involves mood disturbances

  • Preliminary new criteria from American College of Rheumatology in 2010 include Widespread Pain Index and Symptom Severity Score instead of tender points

  • Current criteria: tender points in at least 11 of 18 areas

    • Arms, chest, buttocks, knees, low back, neck, rib cage, thighs, shoulders

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Essentials of Diagnosis

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  • Diagnosis based primarily on symptoms of widespread pain

  • Fatigue, typically begins on rising from sleep

  • Morning stiffness, typically lasting all day, does not diminish with activity

  • Controversy over diagnosing as psychosomatic disorder

  • Tenderness with palpation in at least 11 of 18 areas throughout the body

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General Considerations

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  • Widespread pain throughout entire body

  • Fatigue

  • Sleep disturbances

  • Memory Difficulty

  • Morning stiffness

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Demographics

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  • 75 to 90% of cases in females

  • Female-to-male ratio 9:1

  • Affects 2 to 4% of general population

  • Most people develop symptoms between ages 20 to 55 years

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Clinical Findings

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Signs and Symptoms

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  • Widespread pain and fatigue

  • Headaches

  • Tenderness in multiple specific anatomic locations

  • Mood disturbances, depression, anxiety

  • Muscle pain

  • Cognitive dysfunction

  • Irritable bowel

  • Morning stiffness

  • Sleep disturbances with constant interruptions of sleep

  • Muscle spasm

  • Nerve pain

  • Sympathetic hyperactivity

  • Associated symptoms may include paresthesias, burning, tingling

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Functional Implications

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  • Pain and stiffness may limit daily activities

  • Difficulty concentrating and performing tasks

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Possible Contributing Causes

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  • Cold or humid weather

  • Non-restorative sleep

  • Stress

  • Anxiety

  • Physical or mental fatigue/trauma

  • Myofascial pain

  • Rheumatoid arthritis

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Differential Diagnosis

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  • Chronic fatigue syndrome

  • Hypothyroidism

  • Lyme disease

  • Systemic lupus erythematosus

  • Rheumatoid arthritis

  • Polymyalgia rheumatica

  • Sleep disorders

  • Depression

  • Chronic neck and back pain

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • CBC, ESR, C-reactive protein, rheumatoid factor, thyroid profile to look for negative results

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Imaging

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  • X-ray

  • MRI

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Diagnostic Procedures

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  • Widespread Pain Index (WPI)

  • Symptom Severity Score

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Findings and Interpretation

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  • X-ray negative

  • MRI negative

  • Negative laboratory tests, such as CBC, ESR, C-reactive protein, rheumatoid factor, thyroid profile

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Treatment

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Medication

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  • Analgesics (Tylenol, Ultram)

  • Low-dose anti-depressants ...

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