Fibromyalgia is an abnormal condition causing widespread pain, fatigue, mood disorders and cognitive dysfunction. The pain can be described as stabbing, shooting, and throbbing with muscular aches. Patients with fibromyalgia often have fatigue, difficulty sleeping and sensitivity to touch, light and noise. These patients often have other associated problems such as headaches, irritable bowel, restless leg and temporomadibular joint dysfunction (TMJ).
No one knows what actually causes fibromyalgia but a combination of environmental and genetic factors have been proposed. An inflammatory model of disease has been studied. Changes in the central nervous system have been previously documented but their cause is unknown.
The American College of Rheumatology adopted criteria for the diagnosis of fibromyalgia which includes widespread pain for at least 3 months and the presence of pain at 11 of 19 predetermined tender points on the body. Fibromyalgia can also be diagnosed using the Widespread Pain Index (WPI) and Symptom Severity (SS) Scale. It can also be further divided into Type A and Type B using these indices. Treatment of fibromyalgia is multi-modal. Treatment includes psychological and social interventions. Medications for treatment include pregabalin(Lyrica), duloxetine (Cymbalta) and milnacipran(Savella). Each medication has its own mechanism of action and side effect profile.
Other treatments include cognitive behavioral therapy, acupuncture, and biofeedback. Physical deconditioning is a problem and physical therapy is an important component of treatment.