Fibromyalgia

General Overview

• If accompanied by widespread pain (typically in muscles and joints), consider Fibromyalgia, requires all of:
  • Widespread pain index (WPI) ≥ 7 and symptom severity (SS) scale score ≥ 5 or WPI 3-6 and SS scale score ≥ 9
    • Shoulder, hip, jaw, chest, abdomen, upper/lower arm/leg/back
    • Fatigue, waking unrefreshed, cognitive symptoms
  • Symptoms present at similar level for ≥ 3 months
  • Absence of disorder that would otherwise explain pain

Treatment

• Psychotherapy
• Graduated exercise program (aerobic, resistance-training)
• Tai-Chi
• Low evidence for raw vegetarian diet

Consider pharmacologic treatment

• Amitryptyline 25-50mg PO qHS (most evidence)
• Pregabalin 150-450mg/day in divided doses
• Cyclobenzaprine 5-20mg PO qHS (sleep)
• Duloxetine 60mg PO daily (pain)
• Paroxetine, Fluoxetine