Fibromyalgia

• Fibromyalgia syndrome (FM, FMS)
• Chronic fatigue syndrome

• 729.1 Myalgia and myositis unspecified

• M79.7 Fibromyalgia

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation
• 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated With Peripheral Nerve Injury

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• Widespread pain throughout entire body
• Fatigue
• Sleep disturbances
• Memory Difficulty
• Morning stiffness

Demographics

• 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

Signs and Symptoms

• 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

Functional Implications

• Pain and stiffness may limit daily activities
• Difficulty concentrating and performing tasks

Possible Contributing Causes

• Cold or humid weather
• Non-restorative sleep
• Stress
• Anxiety
• Physical or mental fatigue/trauma
• Myofascial pain
• Rheumatoid arthritis

Differential Diagnosis

• Chronic fatigue syndrome
• Hypothyroidism
• Lyme disease
• Systemic lupus erythematosus
• Rheumatoid arthritis
• Polymyalgia rheumatica
• Sleep disorders
• Depression
• Chronic neck and back pain

Laboratory Tests

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

Imaging

• X-ray
• MRI

Diagnostic Procedures

• Widespread Pain Index (WPI)
• Symptom Severity Score

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

Medication

• Analgesics (Tylenol, Ultram)
• Low-dose anti-depressants (tricyclics, SSRI’s, SNRI’s)
• Pregabalin, duloxetine, milnacipran

• To other therapist for gentle osteopathic manipulative treatment
• To dietician for nutritional counseling
• To pain clinic for pain management
• To psychologist for cognitive-behavioral therapy, psychological support
  • Counseling
  • Support groups
  • Biofeedback
  • Relaxation techniques

• Limited walking and ...