Fibromyalgia
Fibromyalgia is a chronic centralized pain syndrome causing widespread musculoskeletal pain with nonrestorative sleep, fatigue, and cognitive difficulty, driven by central sensitization rather than peripheral inflammation or structural damage. It is a positive clinical diagnosis made with the widespread pain index and symptom severity scale, not a diagnosis of exclusion. First-line treatment is patient education plus a graded aerobic exercise program, with duloxetine, milnacipran, or pregabalin as adjunctive pharmacotherapy.
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What this article covers
- Overview
Definition and cardinal presentation: fibromyalgia is a chronic pain-processing disorder causing widespread musculoskeletal pain with fatigue, nonrestorative sleep, and cognitive difficulty ("fibro…
- Epidemiology
General prevalence: about 2% to 3% of the population in classic rheumatology series, up to 8% of the US population by broader board-review estimates.
- Risk factors
Female sex and family history: female sex is the strongest demographic risk factor, and relatives of affected patients have higher rates of the condition, consistent with twin-study genetics.
- Pathophysiology
Central sensitization is the core mechanism: central nervous system hyperexcitability with impaired descending inhibitory pain control generates pain without a nociceptive stimulus, plus allodynia…
- Clinical features
Chronic widespread pain: diffuse, multifocal, migratory, waxing-and-waning musculoskeletal pain across multiple body regions, described as widespread arthralgia and myalgia rather than a focal or single-joint process.
- Differential diagnosis
Polymyalgia rheumatica: diffuse aching and stiffness, but almost exclusively after age 50, with markedly elevated inflammatory markers and a response within days to low-dose glucocorticoids, unlike…
- Diagnosis
First, establish that fibromyalgia is a positive clinical diagnosis, not one of exclusion: made by matching the symptom pattern to validated diagnostic criteria; a diagnosis reached this way does not…
- Management
First-line for all patients: education and a graded aerobic exercise program.
- Complications
Functional impairment: chronic pain, fatigue, and cognitive difficulty limit work, household, and social function if not actively managed.
- Prognosis
Chronic but not destructive: fibromyalgia does not cause synovial damage, joint destruction, or objective tissue injury, distinguishing its course from inflammatory arthritides even though the symptom burden can be substantial.
- Prevention
No established primary prevention: fibromyalgia arises from genetic predisposition plus a triggering stressor, and no intervention is proven to prevent it.
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