Fibromyalgia - Chronic Widespread Pain

Here's a bit of information on Fibromyalgia, which is a condition sometimes seen in Lupus patients. Thankfully, I'm a one-disease gal (Lupus only), but many of my friends in Lupus Support Group have FM and Lupus. Read on to find out more!

(All information below courtesy of Medscape: Today)

FM is a medical condition characterized and defined by the hallmark of chronic widespread nonarticular musculoskeletal pain.[1]

Another characteristic feature is that no physical reasons for the pain, such as injury or inflammation, can be localized -- in fact, this often leads to belief by health care workers that patients are simply "malingering," and this can potentially delay diagnosis and treatment. In fact, many patients with FM are not diagnosed, and few patients are receiving appropriate treatment.[2] Current thinking based on the latest evidence is that FM is not a discrete illness but is rather part of a large continuum of central pain and somatic syndromes caused by dysfunction of central pain processing. It may even be a more global problem with sensory processing that is not just limited to processing of pain because people with FM are also sensitive to several different types of stimuli.[2]

It is important that health care professionals are aware of the characteristics of FM pain and have a high index of suspicion for further workup if necessary to make an accurate diagnosis.

Other characteristics of FM pain include the following:
Diffuse or multifocal pain
Aching all over
Stiffness that is typically present upon arising in the morning and improves as the day progresses
Neurologic qualities (eg, aching, numbness, tingling, burning)
Dysthesias or paresthesias
Pain "moves around" to various parts of the body
Pain comes and goes very rapidly, or "waxes and wanes"
Discomfort occurs with touch or when wearing tight clothing
Low back pain that radiates into the buttocks and legs
Pain and tightness in the neck and across the upper posterior shoulders
Pain in visceral structures

Many of these are characteristics of "central pain" and are quite different from "peripheral" pain, where both the location and severity of pain are typically more constant.
Two other important features of FM pain are a subjective swollen joint feeling without objective swelling and paresthesias without objective neurologic findings.[1,3] In addition, the duration of the pain is an important feature to determine because patients with long-standing pain are more likely to have FM.[4]

And here's a typical patient profile for FM:

CW, a 44-year-old mother of 3 children aged 5, 7, and 11 years, who has recently taken a new job, presents to her primary care physician for a follow-up visit for management of her chronic pain due to fibromyalgia (FM). She reports a visual analog scale pain score of 7 out of 10, which is worse compared with her last visit 6 months ago. She is concerned that "I can't concentrate at work and learn my new job because of the constant aching pain, and I can't seem to think clearly." She also complains of trouble sleeping and fatigue. She would like to start exercising but has avoided it because of pain. She specifically complains of pain in her knees, which she reports being swollen and inflamed for the last several months, and this finding was confirmed on physical exam.

Medical history: She was diagnosed with FM 10 years ago by a neurologist and has been managed by various primary care physicians since then. She also has irritable bowel syndrome and chronic nonallergic rhinitis.

Family history: Her mother has FM and her father has coronary artery disease and type 2 diabetes mellitus.

Medications: Sertraline 50 mg bid, Zolpidem tartrate 10 mg at bedtime, Ibuprofen 800 mg tid

For more information on FM, diagnosis and treatment, click here and here!