22/09/2022
FIBROMYALGIA:
A disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way our brain and spinal cord process painful and nonpainful signals.
The primary symptoms of fibromyalgia include:
- Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.
- Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.
- Cognitive difficulties. A symptom commonly referred to as "fibro fog" impairs the ability to focus, pay attention and concentrate on mental tasks.
Fibromyalgia often co-exists with other conditions, such as:
- Irritable bowel syndrome
- Chronic fatigue syndrome
- Migraine and other types of headaches
- Interstitial cystitis or painful bladder syndrome
- Temporomandibular joint disorders
- Anxiety
- Depression
- Postural tachycardia syndrome
Diagnosis: ACR Criteria 2016 (Image Below 👇)
Management:
Early diagnosis and patient education form the key components of a multidisciplinary management approach recommended by the European League against Rheumatism (EULAR).
> Non-pharmacological management -
- Should be considered as the first step in the management of fibromyalgia—a key component of multimodal pain management, avoiding pharmacological-related S/Es:
- Exercise: Both aerobic and strengthening exercise programmes are recommended.
- CBT
- Acupuncture
- Mindfulness/mind–body therapy; Meditative movement therapies: t’ai chi, yoga, body awareness therapy.
> Pharmacological management -
- Should be considered in relation to individual symptoms in association with pain such as fatigue and disability.
- Amitriptyline (TCA): Moderate effect on sleep and fatigue 25 mg daily has been shown to improve pain intensity, with no additional benefit demonstrated at 50 mg dose.
- Pregabalin (gabapentinoids): 75–300 mg twice daily. Very small effect on fatigue and sleep. Minimal effect on disability.
- Duloxetine (SNRI): 60 mg/day has been effective at reducing >30% pain, effects on sleep and disability, but no effect on fatigue
- Milnacipran has been reported to have 30% pain reduction, a small benefit on fatigue and disability, and no effect on sleep
- Opioids, NSAIDs, and SSRIs have poor evidence. Furthermore, opioids should be avoided because of the risk of addiction, dependence, and other adverse effects.
- IV infusion therapies (Ketamine/Lignocaine/Magnesium) More research needed.
- Vitamin deficiency correction (Mg+, Selenium, CoQ10, Zinc, Vit D, B Vitamins).
