Fibromyalgia syndrome

The main diagnostic features are:

1. a history of widespread pain (neck to low back)

2. pain in 11 of 18 tender points on digital palpation

These points must be painful, not tender. Smythe and Moldofsky have recommended 14 of these points on a map as a guide for management 9 (see Fig. 34.10).

recommended for use as a standard for diagnostic or therapeutic studies)

Other features

• poor sleep pattern

• fatigue (similar to chronic fatigue syndrome)

• psychological disorders, e.g. anxiety, depression, tension headache, irritable digestive system.

This disorder is very difficult to treat and is usually unresponsive in the long term to passive physical therapy or injections. 10 Patients require considerable explanation, support and reassurance.

Treatment

• explanation, reassurance and counselling

• attention to sleep disorders, stress factors and physical factors

• relaxation program

• rehabilitation exercise program, e.g. walking, swimming or cycling Medication (often disappointing)

• antidepressants (of proven value) e.g. amitriptyline 10-75 mg (o) nocte or prothiaden 25-100 mg (o) nocte or

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