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Last Updated: 5/17/2013  

Fibromyalgia Syndrome

Diagnosis
  • Musculoskeletal pain with tenderness at specific locations is the hallmark of FMS.

  • Apply the American College of Rheumatology criteria in diagnosing FMS.

  • Patients may have other symptoms such as fatigue, difficulty sleeping, and feeling of swelling, as well as symptoms associated with disorders that are associated with FMS.

  • Ask about aggravating factors and triggering factors.

  • There is no objective swelling on exam and no laboratory abnormalities.

  • Take a careful history of psychiatric symptoms and assess the patient's psychological/psychiatric status, as psychological distress occurs in 20% to 40% of patients with FMS and may trigger or perpetuate symptoms.

  • Use clinical evaluation and selected laboratory studies to separate FMS from other diseases with similar presentation.

  • Consider screening patients with RA, SLE, and PSS for concomitant FMS as the occurrence of FMS in the patients is much higher than expected in a general population.

Therapy
  • Adopt a patient-centered approach in managing patients with FMS.

  • Emphasize the importance of physical exercise and physical therapy.

  • Use serotonin-norepinephrine reuptake inhibitors (duloxetine and milnacipran are FDA approved for use in fibromyalgia) or tricyclic agents as initial therapy.

  • Consider cognitive behavioral therapy, hypnotherapy, or multidisciplinary rehabilitation.

  • Avoid systemic corticosteroids, NSAIDs, and antiviral agents for treatment of FMS.

DOI: 10.7326/d207
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Muhammad B. Yunus, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Donald Miller, PharmD, FASHP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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