Fibromyalgia

• Facts:
  Generalized musculoskeletal pain
  Centrally mediate chronic pain syndrome
  MC in women 30 - 50 years old
• History / PE:
  Disturbed sleep
  Fatigue
  Muscle stiffness
  Pain worsens with exercise
• Diagnosis:
  Multiple ( >11 of 18) diffuse tender points
  Myofascial pain syndrome is < 11 of 18
  No evidence of joint swelling or laboratory abnormalities
• Treatment:
  Amitriptyline, cyclobenzaprine
  Physical therapy
  Avoid narcotics
• Associated With:
  Irritable bowel disease
  Depression
• Differential Diagnosis:
  Polymyalgia rheumatica (elevated ESR)
  Polymyositis (elevated CK, proximal muscle weakness)