Fibromyalgia

What it is

Fibromyalgia is a syndrome of widespread pain throughout the body with tender points at specific anatomical sites, described elsewhere as a neurosensory disorder of chronic musculocutaneous pain. Its cause is unknown and its pathogenesis is not fully understood. Women are 10 times more likely to be affected, and it typically presents between 30-50 years old, the same peak age given elsewhere.

How it presents

The core complaint is chronic pain at multiple sites, sometimes described as pain all over, together with poor sleep and exhaustion. Around it sit:

• Lethargy and fatigue
• Sleep disturbance, unrefreshing sleep and insomnia
• Morning stiffness and arthralgias
• Headaches and dizziness, migraine or tension headache
• Concentration difficulties and depressive mood
• Irritable bowel syndrome, urge incontinence, muscle cramps, palpitations, dry mouth and restless legs syndrome

A history of psychiatric disorders such as depression and generalized anxiety disorder is common, and the pain is myalgia over specific trigger points without joint involvement. The patient may complain of swelling although objectively no swelling is present. On examination there are characteristic tender points over multiple areas of the body with no signs of inflammation, that is no notable swelling, deformity or erythema.