Fibromyalgia Study Guide

• Know the four major causes of diffuse arthralgias and myalgias
  
• Recognize the “Red Flags” that differentiate patients who have inflammatory rheumatic disease
  
• Know the strategies to employ in managing Fibromyalgia: What Works?

Case History

A 48 year-old woman presents with diffuse muscle pain, weakness, and significant fatigue. She reports:

• Symptoms for over 3 years that have become slightly worse in past 6 months
• Generalized pain and fatigue that limit her ability to work
• Increasing sleep difficulty due to the pain

General physical examination is unremarkable.
Diffuse muscle tenderness is noted
Some tenderness around the joints, but not synovitis
No objective muscle weakness
Normal neurologic examination
CBC, ESR, and chem profile are normal
 
What are the major diagnostic considerations in this patient?
What if any additional tests or labs should be ordered?
What therapies are important for this patient?
 
What points should be emphasized in educating patients with fibromyalgia?
How do we differentiate Depression and Somatoform Pain disorders?
 
How Do We Explain it?
 
What is the Evidence for Dysfunction in the Hypothalamic-Pituitary Axis?
What is the Evidence for Abnormalities in Sensory Processing?
What are the Psychosocial Factors?
    
How do we fit it all together?
 
 
Barbara Segal, M.D.  December 12, 2002