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Fibromyalgia

Fibromyalgia is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Nonarticular, noninflammatory form of muscular and joint pain more common in females:
    • Widespread pain from stimuli that do not normally cause pain (allodynia)
    • >11 diffuse tender points
    • Fatigue
    • Sleep disturbance
    • Muscle stiffness
    • Difficulties with attention, memory
    • Limited physical findings
  • Not diagnosis of exclusion, may occur with other rheumatic diseases

Etiology

  • Mechanism:
    • Painful symptoms believed to result from greater activation of pronociceptive (pain-causing) system relative to antinociceptive (pain-dampening) system in brain and spinal cord.
  • Abnormalities identified as possible mechanism:
    • Increased substance P (facilitates pronociception)
    • Decreased biogenic amines (NE, serotonin, dopamine), which facilitate antinociception
    • Decreased gray matter in brain
    • Genetics: 1/3 of patients with fibromyalgia have a close relative who is affected:
      • Candidate genes include 5-HT2A, serotonin transporter, D4 receptor, others
    • Like many complex diseases, psychological factors play a role, with high incidence of psychiatric disorders.
    • In genetically predisposed individuals, likely starts as initial insult from age, trauma, illness, inflammation, etc.
    • Hypothalamus–pituitary–adrenal axis stress-response dysfunction has been indicated to precede development of fibromyalgia

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Citation

Rosen, Peter, et al., editors. "Fibromyalgia." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307227/all/Fibromyalgia.
Fibromyalgia. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307227/all/Fibromyalgia. Accessed April 25, 2019.
Fibromyalgia. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307227/all/Fibromyalgia
Fibromyalgia [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307227/all/Fibromyalgia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Fibromyalgia ID - 307227 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307227/all/Fibromyalgia PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -