This page is currently under review – Nov 23
History
- Generalised musculoskeletal pains
- Tired all the time and poor sleep
- Fatigue and poor concentration
- Associated with facial pain, irritable bowel syndrome, tension headaches
- History of stressful life events often dating back to childhood.
Examination
- Multiple tender spots on palpation (figure). Tender spots are also typical on the anterior trunk
Investigations
- Routine bloods (normal)
- Anti-CCP antibodies (negative)
- X-rays and other imaging are unhelpful except to exclude other diseases.
Referral
Patients with fibromyalgia should not normally be referred to rheumatology unless you are uncertain about the diagnosis. Referral to the pain clinic may be appropriate if the patient’s symptoms don’t respond to the measures outlined in Primary Care Management.
Management
Treatment is symptomatic. Associated depression may also require treatment
Education:
- Explain that they have fibromyalgia and it’s a condition where the perception of pain is abnormal.
- Explain that there is no cure but treatments are available to help control pain. Explain the importance of pacing activities
Pain control:
- Analgesics and NSAIDs are seldom helpful
- Gabapentin
- Amitriptyline
- Nortriptyline
- Fluoxetine
Sleep disturbance:
- General advice on sleep hygiene
Physiotherapy:
- Graded exercise programme
Clinical psychology:
- Cognitive behaviour therapy
Please see Resources and links tab for additional information
