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
- Psychosocial
stress such as marital disharmony.
- Alcoholism
in the family.
- Injury
or assault.
- Law
income.
- 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
- Poorly
localized.
- Can’t
ignore.
- Severe
in intensity.
- Reduce
the functional capacity.
- Worsened
by physiotherapy.
- 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
- Pain
is present above and below the waist.
- Pain
is present on both side of body.
- 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.
Stiffness
Sleep disturbances
Anxiety
Depression
Cognitive dysfunction - Difficulty in concentration, short
term memory loss.
Clinical features
Usual symptoms
- Multiple regional pain
- Marked fatigability
- Marked disability
- Broken,non-restorative steep
- Low affect, irritability,weepiness
- Poor concentration,forgetfulness
Variable locomotor symptoms
- Early morning stiffness
- Numbness, tingling of all fingers
- Swelling of hands, fingers
Additional, variable, non-locomotor symptom
- Non-throbbing bifrontal headache (tension headache)
- Colicky abdominal pain, bloating, variable bowel habit (irritable bowel syndrome)
- Bladder fullness, nocturnal frequency (irritable bladder)
- Hyperacusis,dyspareunia, dtecomfort when touched (allodynia)
- 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.
