Fibromyalgia (or Fibrositis)

Definition

Diffuse musculoskeletal aching and pain with multiple predictable tender
points.

Main Features

Primary fibromyalgia, without important associated disease, is uncommon
compared to concomitant fibromyalgia. It may occur in childhood but is
most common in the fourth and fifth decades. The sex ratio is 6:1 female
to male. Concomitant fibromyalgia occurs with any other musculoskeletal
condition, where it may act to intensify the pain of the associated
condition. The syndrome is chronic, and remissions are uncommon. Pain:
Widespread aching of more than three months' duration, often poorly
circumscribed and perceived as deep, usually referred to muscle or bony
prominences. Most common areas are cervical, thoracic, and lumbar.
Although pain in the trunk and proximal girdle is aching, distal limb
pain is often perceived as associated with swelling, numbness, or stiff
feeling. Day-to-day fluctuation in pain intensity and shifting from one
area to another are characteristic, although the pain is usually
continuous. Stiffness is present in 80% and is perceived as an increased
resistance to joint movement, particularly toward the end of the range
of movement. Both pain and stiffness are maximal within the broad
sclerotomic and myotomic areas of reference of the lower segments of the
cervical and lumbar spine. Fatigue is present in 80%, and is often
severe enough to interfere with daily activities. Sleep disturbance is
present in 75%, and waking is unrefreshed or tired. Multiple tender
points: Discrete local areas of deep tenderness widely dispersed
throughout the body and involving a variety of otherwise normal tissues
are a pathognomonic feature provided about 60% of examined sites are
tender. Tender points are found within muscle and over tendons, muscle
insertions, and bony prominences. Tender point sites are "tender" in
many normal individuals but are reported as "painful," often with
grimace or withdrawal when palpated, in those with fibromyalgia. The
predictable location of these tender points and their multiplicity are
essential features of the syndrome.