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Email: Ben Fazio
Level 1 - 689 Centre Road
Bentleigh East 3165
Phone: 03 95637222
Mobile: 0412 656 837
ABN: 39 109 587 788
Last updated 18/09/2006
Webmaster MHTS
FIBROMYALGIA
Fibromyalgia is a rheumatologic condition characterized by spontaneous, widespread soft tissue pain, sleep disturbance, fatigue and extensively distributed areas of tenderness known as tender points. Estimates of prevalence are 3.4 percent for women and 0.5 percent for men.
Fibromyalgia can be perplexing to patients and physicians because of the lack of associated abnormalities on readily available diagnostic tests. Despite this, recent findings about the pathogenesis and pathophysiology of fibromyalgia have dispelled the belief that the disorder is psychosomatic. While no laboratory test can confirm fibromyalgia, most patients present with a history of widespread pain, physical findings and comorbid conditions. With experience, the disorder may be diagnosed with confidence on initial presentation or after a period of observation and minimal diagnostic testing. The family physician is ideally suited to treat fibromyalgia because its management calls for a longitudinal relationship, a willingness to try different therapeutic modalities and an understanding of the interrelationship of the biopsychosocial aspects of health.
American College of Rheumatology Criteria for Classification of Fibromyalgia
- Widespread pain for at least three months, defined as the presence of all of the following:
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Pain on the right and left sides of the body
Pain above and below the waist (including shoulder and buttock pain)
Pain in the axial skeleton (cervical, thoracic or lumbar spine, or anterior chest) - Pain on palpation with a 4-kg force in 11 of the following 18 sites (nine bilateral sites, for a total of 18 sites):
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Occiput: at the insertions of one or more of the following muscles: trapezius, sternocleidomastoid, splenius capitus, semispinalis capitus
Low cervical: at the anterior aspect of the interspaces between the transverse processes of C5-C7
Trapezius: at the midpoint of the upper border
Supraspinatus: above the scapular spine near the medial border
Second rib: just lateral to the second costochondral junctions
Lateral epicondyle: 2 cm distal to the lateral epicondyle
Gluteal: at the upper outer quadrant of the buttocks at the anterior edge of the gluteus maximus muscle
Greater trochanter: posterior to the greater trochanteric prominence
Knee: at the medial fat pad proximal to the joint line
Exercise. Aerobic and strength-training activities have been associated with significant improvements in pain, tender point counts and disturbed sleep in patients with fibromyalgia.17 Unfortunately, maintenance of exercise regimens tends to be poor in patients with fibromyalgia. Strategies for improving compliance, such as having the patient work out with a companion, can be discussed with the patient.
Massage. Gentle massage and myofascial release can reduce the pain associated with the tender points in the muscles. Trigger point therapy can be used as part of an ongoing treatment. Rememer that fibromyalgia is a name given to a collection of symptoms that include fatigue and generalised or localised muscular aches and pains and unfortunately there is no cure at this time.