- Chronic, widespread noninflammatory musculoskeletal pain syndrome with multisystem manifestations; although the specific pathophysiology has not been fully elucidated, it is generally thought to be a disorder of altered central pain regulation.
- Synonym(s): FMS; fibrositis, fibromyositis (misnomers)
- Predominant sex: female (70–90%) > male
- Predominant age range: 20 to 65 years
2–5% of adult U.S. population (1); 8% of primary care patients
Etiology and Pathophysiology
- Idiopathic; appears to be a primary disorder of central pain processing (central sensitization) with afferent augmentation of peripheral nociceptive stimuli
- Alterations in neuroendocrine, neuromodulation, neurotransmitter, neurotransporter, biochemical, and neuroreceptor function/physiology
- Sleep abnormalities—α-wave intrusion
- Systemic inflammation is not a feature of fibromyalgia, although localized immunologic and inflammatory processes in the CNS may play a role. There may be a distinctive cytokine profile in patients with fibromyalgia.
- High familial aggregation
- Inheritance is unknown but likely polygenic.
- Odds ratio may be as high as 8.5 for a first-degree relative of a familial proband.
- Environmental—several triggers have been described:
- Physical trauma or severe illness
- Stressors (e.g., work, family, life events, and physical or sexual abuse)
- Viral and bacterial infections
- Female gender
- Poor functional status
- Negative/stressful life events
- Low socioeconomic status
No known strategies for prevention
Commonly Associated Conditions
- Often a comorbid condition with other rheumatologic or neurologic disorders
- Psychiatric comorbidities, including depression, anxiety, and posttraumatic stress disorder (PTSD) occur in two-thirds of patients—similar to findings in other chronic pain conditions.
- Obesity is common and associated with increased severity of symptoms.
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