Fibromyalgia

About Fibromyalgia

Fibromyalgia is a chronic pain disorder affecting approximately 2 to 4 percent of the global population, predominantly women. It is characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, cognitive dysfunction fibro fog, and mood disorders. The condition involves central sensitization, where the central nervous system amplifies pain signals. Patients experience pain from stimuli that are not normally painful allodynia and exaggerated pain from painful stimuli hyperalgesia. Associated symptoms include headaches, irritable bowel syndrome, interstitial cystitis, temporomandibular joint TMJ disorders, and restless legs syndrome. Diagnosis is clinical, based on widespread pain index WPI and symptom severity scale SS, with symptoms present for at least 3 months. The 2016 ACR criteria require WPI of 7 or higher and SS of 5 or higher, or WPI of 4 to 6 and SS of 9 or higher. Blood tests are normal, helping exclude other conditions. Treatment requires a multidisciplinary approach. Exercise, particularly aerobic exercise, has the strongest evidence of benefit. Cognitive behavioral therapy, sleep hygiene, and stress management help. Medications include SNRIs duloxetine Cymbalta, milnacipran Savella, gabapentinoids pregabalin Lyrica, and muscle relaxants cyclobenzaprine. Guidelines generally advise against opioids, which show little benefit and may worsen central sensitization.