Fibromyalgia

Patients with fibromyalgia also can be classified according to whether the onset of symptoms is acute or insidious. Patients who report an acute onset often attribute their symptoms to the occurrence of a "precipitating" event such as a defined infectious process (e.g., Lyme disease, or infection with parvovirus B19, coxsackievirus, hepatitis C, infectious mononucleosis).

Early studies of neuropeptide levels in fibromyalgia patients and controls produced the earliest evidence that dysregulation of central nervous system (CNS) function may contribute to abnormalities in pain sensitivity or pain inhibition in the patient volunteers. Subsequent investigations have consistently confirmed the early observations. However, before examining the implications of these studies for understanding the pain responses of persons with fibromyalgia, it is necessary to briefly review the events that underlie nociceptive transmission and the perception of pain.

Fibromyalgia Treatment Therapy

Physical therapy may be supplemented by palliative interventions such as massage therapy.
Finally, persons who are experienced in providing CBT interventions should administer these therapies to patients who require training in pain coping skills and who appear able to practice and incorporate these skills in their daily routines. We are aware that, overall, the efficacy of CBT training for fibromyalgia has not been established in placebo-controlled trials. However, our experience is consistent with that of Turkthat there are subgroups of patients who do respond well to CBT training.

Summary of the treatment of patients with fibromyalgia

In summary, the treatment of patients with fibromyalgia is a complex and difficult endeavor that requires the integrated efforts of a large number of health professionals from various disciplines. It frequently is not possible to develop an interdisciplinary treatment team in many health-care settings. Thus, it may be necessary to obtain consultations from, or refer patients to, centers capable of such therapeutic programs.

Musculoskeletal Symptom of fibromyalgia syndrome

These symptoms include morning stiffness (lasting <1 hour), and diffuse arthralgias and myalgias, as well as subjective, but not demonstrable, joint and soft tissue swelling mainly of the hands and feet. Indeed, patients often indicate that they have had to remove their rings or change shoe sizes because of "swelling" of the metacarpophalangeal and proximal and/or distal interphalangeal joints as well as the dorsal aspect of hands and fingers, feet, and toes, yet by physical examination no joint swelling is demonstrable.

Nonmusculoskeletal Symptom of fibromyalgia syndrome

The most prominent "nonmusculoskeletal" manifestations associated with fibromyalgia are fatigue and sleep disturbances. The intensity of the fatigue described by patients with fibromyalgia tends to be variable. Only rarely is fatigue the primary symptom that limits patients' activities of daily living; this differs from the reports of patients with chronic fatigue syndrome for whom fatigue is the dominant and truly incapacitating feature of the disorder.

Due to symptoms involving multiple organ systems, patients with fibromyalgia syndrome may present to a variety of specialists; it is not uncommon for them to undergo unnecessary and often invasive diagnostic or treatment procedures.

How Fibromyalgia is diagnosis?

Fibromyalgia constitutes one of the most common diagnoses in referral-based rheumatology practices. The frequency of fibromyalgia, which varies from 3% to 20% in these practices, likely depends on the interest in the disorder among rheumatologists, the degree of medical sophistication among patients, and the awareness of the condition among the referral sources

Primary care–based studies have confirmed that fibromyalgia is a disorder that predominantly affects women. The frequency of fibromyalgia among men and women in the primary care setting varies between 1.9% and 3.7%). It is important to recognize, however, that not all patients with fibromyalgia are correctly identified in primary care settings. Indeed, some patients may be diagnosed as having myalgias, arthralgias, soft tissue rheumatism, regional pain syndromes, or panniculitis, or they may be ultimately diagnosed with disorders such as SLE, RA, polymyositis, polymyalgia rheumatica, or Sjögren syndrome.

More information on Fibromyalgia Diagnosis

Fibromyalgia constitutes one of the most common diagnoses in referral-based rheumatology practices. The frequency of fibromyalgia, which varies from 3% to 20% in these practices, likely depends on the interest in the disorder among rheumatologists, the degree of medical sophistication among patients, and the awareness of the condition among the referral sources.

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