19 Jun 2014

Fibromyalgia clinical features

Fibromyalgia, common clinical condition in which there is widespread musculoskeletal pain and tenderness. It is also called as CWP  (chronic widespread pain). Although it is primarily a pain syndrome it may be associated with neuropsychiatric manifestations. This is more commonly seen in women with a female to male sex ratio 9:1. It can occur at any age  but incidence increase with increase in age. Fibromyalgia produces negative impact on social and psychological functioning.

Risk factors of fibromyalgia 
  1. Psychosocial stress such as marital disharmony.
  2. Alcoholism in the family.
  3. Injury or assault.
  4. Law income.
  5. Self reported childhood abuse. 
Clinical features
Clinical features include wide spread pain and neuropsychiatric manifestation. Patient usually complain of pain in one region of body initially, later pain becomes widespread.

Characteristics of pain
  1. Poorly localized.
  2. Can’t ignore.
  3. Severe in intensity.
  4. Reduce the functional capacity.
  5. Worsened by physiotherapy.
  6. Unresponsive to NSAIDS (Analgesic).
Duration of pain
Pain is present almost through out the day on most days for at least 3 months.

Site of pain
  1. Pain is present above and below the waist.
  2. Pain is present on both side of body.
  3. It involve the axial skeleton (neck, chest, back). 
Patients also complain about headache. Facial and jaw pain, abdominal and pelvic pain.

Neuropsychiatric manifestations are the following
Fatigue - It is very common, more  severe in the morning. There will be severe disability, so the patient experience difficulty in doing house work, shopping etc although they can dress, feed and groom themselves.
Sleep disturbances 
Cognitive dysfunction - Difficulty in concentration, short term memory loss.

Clinical features
Usual symptoms
  1. Multiple regional pain
  2. Marked fatigability
  3. Marked disability
  4. Broken,non-restorative steep
  5. Low affect, irritability,weepiness
  6. Poor concentration,forgetfulness
Variable locomotor symptoms
  1. Early morning stiffness      
  2. Numbness, tingling of all fingers 
  3. Swelling of hands, fingers
Additional, variable, non-locomotor symptom
  1. Non-throbbing bifrontal headache (tension headache)
  2. Colicky abdominal pain, bloating, variable bowel habit (irritable bowel syndrome)
  3. Bladder fullness, nocturnal frequency (irritable bladder)
  4. Hyperacusis,dyspareunia, dtecomfort when touched (allodynia)
  5. Frequent side-effects with drugs (chemical sensitivity) 
Comorbid conditions associated with fibromyalgia include other musculoskeletal pain, infectious disease, metabolic and psychiatric disorders. Twenty percentages (20%) of patients have associated degenerative or inflammatory rheumatoid disease.
On examining the patient there wont be any evidence of synovitis or joint damage, neurologic deficit or wasting. Some time evidence of osteoarthritis may be present. On touching certain body part people complain of increased pain.

Why people develop fibromyalgia?

Possible causative mechanisms in fibromyalgia.
The exact mechanism is not known. There is alteration in pain processing in brain and patients have increased sensitivity to pain. There is decreased threshold to pain perception and tolerance at certain sites throughout the body. Certain peripheral pain generators act as trigger such as arthritis, bursitis, neuropathy and other degenerative and inflammatory conditions.

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