Key learning
- Chronic pain disorder of unknown aetiology
- Affects middle-aged females
- Presents with widespread pain often elicited at 'tender points' over body
- Clinical diagnosis, investigations rule out other causes
- Management revolves around symptom control, patient education/psychological support
Pathophysiology
- Not fully understood, thought to involve abnormalities in pain processing and amplification of pain signals in the central nervous system.
Epidemiology
- Common, affecting approximately 2-8% of the population
- Higher prevalence in females
Risk factors
- Depression/anxiety
- Dissatisfaction with family/work
- Associated with chronic fatigue syndrome, IBS, chronic headache syndromes
History
- Chronic widespread, chronic dull/aching pain
- Affects both sides of body
- Above and below waist
- Persist for > 3 months
- Associated fatigue and unrefreshing sleep
- Joints feel swollen (no objective swelling on examination)
- May report cognitive difficulties (fibromyalgia fog)
- Low mood
- Symptoms may worsen with physical or emotional stress
Examination Findings
- Physical examination typically reveals no specific abnormalities
- Tender points elicited at specific sites on palpation
Investigations
To rule out other causes:
- FBC/ESR/CRP- inflammatory causes
- CK- rhabdomyolysis
- Calcium- hypocalcaemia
- TFTs- hypothyroidism
Diagnosis
- Based on clinical assessment
- Presence of at least 11/18 tender points on palpation
Management
Aim to improve symptoms and quality of life
- Patient education
- Graded exercise
- Refer for cognitive-behavioural therapy (CBT)
- Pharmacotherapy for symptom management (e.g., analgesics, antidepressants)
- Neuropathic medications can help pain and sleep (amitriptyline/pregabalin/gabapentin/duloxetine)