Fibromyalgia
Chronic widespread pain: is defined as pain in ≥4 out of 5 regions of the body and is associated
with significant emotional distress (anxiety, anger/frustration, depression) or functional
disability, for >3-6 months. Obstructive sleep apnea, hypothyroidism (TSH >20mIU/L) and vit.D
deficiency should be ruled out in all FM patients regardless of body size.
Types of pain
-Nociceptive: from actual damage to non-neural tissue, due to activation of nociceptors.
-Neuropathic: from a lesion or disease of the somatosensory nervous system.
-Nociplastic: from altered nociception without clear evidence of tissue damage or nerve injury.
Pathologic sensitivity terms
-Paresthesia = abnormal, non-painful (tingling, pins & needles, when a numb limb comes round)
-Dysesthesia = abnormal, unpleasant/painful (burning, electric, like in diabetic neuropathy)
-Allodynia = pain from a stimulus that normally isn’t painful (light tough, clothes/sheets)
-Hyperalgesia = increased pain from a normally painful stimulus
-Hyperpathia = higher pain threshold but once crossed → explosive and lingering pain (post
nerve injury neuropathic pain)
-Hyperesthesia = increased sensitivity to a not necessarily painful stimulus.
Models
-The biological model of FM states that pain is a result of altered nociception (central or
peripheral). Central is either due to overreactivity of anterior horn neurons or malfunction of
descending pain-inhibitory pathways and peripheral might be due to small-fiber neuropathy.
Also, derangement of neurotransmitters. Possible role of inflammatory cytokines.
-Biopsycosocial
Diagnosis
ACR 1990: pain for ≥3months + 11/18 tender points.
ACR 2010: pain for ≥3months + widespread pain (≥4/5 body regions) + WPI ≥7 + SSS ≥5 (or WPI
of 4-6 + SSS ≥9).
Widespread Pain Index (WPI) and the Symptom Severity Scale (SSS) do not require a
tender point examination. The WPI includes a list of 19 painful areas and the SSS assesses the
severity of i) fatigue, ii) unrefreshed awakening, iii) cognitive disturbances and iv) somatic
symptoms (a checklist of 41 symptoms; IBS, fatigue/tiredness, muscle weakness, RP, tinnitus,
etc) over the past week.
Body regions: left (upper, lower), right (upper, lower), axial. Jaw, chest and abdominal
pain are excluded from the generalized pain definition.
Treatment
1. non-pharmacological
Education
CBT psychotherapy
Exercise (cardio [>30’, 3 times per wk], strength, tai chi)
Sleep hygiene
2. pharmacological
3. TENS (transcutaneous electrical nerve stimulation) / TMS (transcranial magnetic stimulation)
4. Cannabinoids?
Chronic widespread pain: is defined as pain in ≥4 out of 5 regions of the body and is associated
with significant emotional distress (anxiety, anger/frustration, depression) or functional
disability, for >3-6 months. Obstructive sleep apnea, hypothyroidism (TSH >20mIU/L) and vit.D
deficiency should be ruled out in all FM patients regardless of body size.
Types of pain
-Nociceptive: from actual damage to non-neural tissue, due to activation of nociceptors.
-Neuropathic: from a lesion or disease of the somatosensory nervous system.
-Nociplastic: from altered nociception without clear evidence of tissue damage or nerve injury.
Pathologic sensitivity terms
-Paresthesia = abnormal, non-painful (tingling, pins & needles, when a numb limb comes round)
-Dysesthesia = abnormal, unpleasant/painful (burning, electric, like in diabetic neuropathy)
-Allodynia = pain from a stimulus that normally isn’t painful (light tough, clothes/sheets)
-Hyperalgesia = increased pain from a normally painful stimulus
-Hyperpathia = higher pain threshold but once crossed → explosive and lingering pain (post
nerve injury neuropathic pain)
-Hyperesthesia = increased sensitivity to a not necessarily painful stimulus.
Models
-The biological model of FM states that pain is a result of altered nociception (central or
peripheral). Central is either due to overreactivity of anterior horn neurons or malfunction of
descending pain-inhibitory pathways and peripheral might be due to small-fiber neuropathy.
Also, derangement of neurotransmitters. Possible role of inflammatory cytokines.
-Biopsycosocial
Diagnosis
ACR 1990: pain for ≥3months + 11/18 tender points.
ACR 2010: pain for ≥3months + widespread pain (≥4/5 body regions) + WPI ≥7 + SSS ≥5 (or WPI
of 4-6 + SSS ≥9).
Widespread Pain Index (WPI) and the Symptom Severity Scale (SSS) do not require a
tender point examination. The WPI includes a list of 19 painful areas and the SSS assesses the
severity of i) fatigue, ii) unrefreshed awakening, iii) cognitive disturbances and iv) somatic
symptoms (a checklist of 41 symptoms; IBS, fatigue/tiredness, muscle weakness, RP, tinnitus,
etc) over the past week.
Body regions: left (upper, lower), right (upper, lower), axial. Jaw, chest and abdominal
pain are excluded from the generalized pain definition.
Treatment
1. non-pharmacological
Education
CBT psychotherapy
Exercise (cardio [>30’, 3 times per wk], strength, tai chi)
Sleep hygiene
2. pharmacological
3. TENS (transcutaneous electrical nerve stimulation) / TMS (transcranial magnetic stimulation)
4. Cannabinoids?
