Chapter 17 - Fibromyalgia

Summary

Fibromyalgia is an illness seen mostly in women and characterized by widespread body pain with abnormality located in the nervous system. A diagnosis of fibromyalgia should be considered when a patient presents with widespread body pain lasting for longer than 3 months, with associated tenderness to palpation of soft tissues, as well as the possible presence of symptoms of sleep disturbance, fatigue, cognitive symptoms, and mood changes. Nervous system, genetic, and psychological mechanisms likely all play a part in the final expression of fibromyalgia, with evidence showing abnormalities at multiple levels. Ideal management includes both non-pharmacological and pharmacological treatments in a multimodal approach incorporating a strong patient-centered internal locus of control. Non-pharmacological treatments with emphasis on a regular exercise program, stress management, and coping skills should be an integral part of any treatment strategy for fibromyalgia. The traditional pharmacological treatment paradigm begins with simple analgesics and tricyclic antidepressant medications (TCAs).