Fibromyalgia

Background

• a disorder of pain regulation, sometimes classified as a kind of central sensitization
• chronic musculoskeletal pain not explained by another systemic disorder
• more common in women than men

Clinical Features

• chronic musculoskeletal pain
• insomnia
• fatigue
• decreased concentration
• headache
• parasthesias

Differential Diagnosis

• Rheumatoid arthritis
• Sjogren's syndrome
• Systemic lupus erythematosus
• Ankylosing spondylitis
• Myopathyies: metabolic or statin-induced
• Myasthenia gravis
• Myofascial pain syndrome
• Multiple sclerosis
• Psychiatric disorders

Management

• Tricyclic antidepressants
• Select SNRIs (duloxetine, venlafaxine, milnacipran)
• Anticonvulsants (pregabalin, gabapentin)