Fibromyalgia

Fibromyalgia is a chronic pain disorder characterized by diffuse muscle pain and stiffness, chronic fatigue, and sleep disturbances. The majority of patients are middle aged females at presentation, with a history of widespread pain, defined as pain both above and below the waist, and both on the left and right side of the body. They also have the presence of tender points on examination. The criteria for diagnosis is 11 painful points of a possible 18, as established by the American College of Rheumatology. Nonrestful sleep is typically how these patients describe their sleep patterns. Unfortunately, it remains a poorly understood disorder. Treatment options are limited. Tricyclic antidepressants and aerobic conditioning remain the mainstay of treatment. Narcotics, in general, have met with particularly poor results in this patient population, and are generally avoided. Trigger point injections can be used in select patients, but one must be aware of the potential to flare the pain. Psychologic support in the form of individual and group therapy sessions is usual welcomed by this patient population. Overall, fibromyalgia remains a difficult disorder to treat, and these patients require a multidisciplinary effort to improve their level of function. Complete pain relief is probably a less than realistic goal, unfortunately.