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Fibromyalgia

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