Fibromyalgia

Overview – Fibromyalgia

Fibromyalgia is a chronic pain disorder characterised by widespread musculoskeletal discomfort, heightened pain sensitivity, fatigue, and psychosomatic symptoms. It primarily affects middle-aged women and is often associated with psychiatric comorbidities such as anxiety and depression. Despite its impact on quality of life, fibromyalgia presents with no objective pathology on examination or investigation, making it a diagnosis of exclusion. Effective management focuses on stress reduction and pharmacological symptom control.

Definition

Fibromyalgia is a psychosomatic disorder marked by widespread pain, fatigue, and tender points in the absence of underlying organic pathology.

Aetiology

• Psychosomatic origin
• Strong association with:
  • Chronic fatigue syndrome
  • Depression, anxiety
  • Irritable bowel syndrome (IBS)
  • Migraines
  • Obesity

Morphology / Pathophysiology

• No identifiable pathology
• Normal joint and musculoskeletal examination
• No structural or inflammatory changes detected
• Pathogenesis remains unclear

Clinical Features

• Demographics:
  • Most common in females aged 25–45 (female:male ratio = 3:1)
• Symptoms:
  • Widespread musculoskeletal pain and stiffness
  • Chronic fatigue
  • Tender points reproducible on examination
  • Symptoms worsened by:
    • Physical exertion
    • Sleep disturbances
    • Stress
  • Neurological features:
    • Hyperalgesia
    • Paresthesias

Investigations

• Diagnosis of exclusion
• Criteria:
  • Pain present in multiple regions for >3 months
• Lab results: Normal inflammatory markers and imaging

Management

• Non-pharmacological:
  • Stress reduction (e.g. CBT, mindfulness, exercise)
  • Sleep hygiene
  • Lifestyle optimisation
• Pharmacological:
  • Tricyclic antidepressants (e.g. amitriptyline)
  • Other options (not listed in original notes but worth noting):
    • SNRIs (e.g. duloxetine)
    • Anticonvulsants (e.g. pregabalin)

Summary – Fibromyalgia

Fibromyalgia is a chronic pain syndrome with no identifiable structural pathology, predominantly affecting women aged 25–45. It is marked by widespread pain, fatigue, and associated psychosomatic conditions. Diagnosis is clinical and by exclusion, with treatment focused on symptom control, stress management, and tricyclic antidepressants. For broader context, see our Musculoskeletal Overview page.