Clinical features

Symptoms of fibromyalgia are vague and generalized and usually wax and wane over time, but seldom disappear (1).

Pain is the primary complaint in a patient.

• should have been present for at least 3 months
• onset is usually insidious and may initiate in a localized area
• pain may be intermittent initially which will progress and become more persistent
• location and intensity of pain may vary from day to day
• factors such as weather or stress may modify the pain e.g. – symptoms are increased with cold and humid weather conditions

Other associated symptoms are also common in FM and can contribute to one third of the global suffering

• fatigue
  • most common associated complaint and seen in over 90% of the patients
  • in some patients fatigue could be more disabling than pain and contributes to subjective report of functional impairment
  • may overlap with chronic fatigue syndrome (but pain is more prominent in patients with FM than in chronic fatigue syndrome)
• non-restorative sleep
  • impaired daytime function due to sleep latency, sleep disturbance, and fragmented sleep
  • negatively impacts fatigue, and pain
  • other sleep disorders like restless leg syndrome or sleep apnoea can be seen as well
• cognitive dysfunction
  • poor working memory, spatial memory alterations, free recall, and verbal fluency associates with pain in FM as well as other pain patients
• mood disorder
  • seen in up to three quarters of persons with the disease (including depression and/or anxiety)
• pain related somatic symptoms
  • somatic symptoms, including irritable bowel syndrome, migraine headaches, severe menstrual pain, lower urinary tract symptoms, myofascial facial pain, and temporomandibular pain are seen in FM
• non pain related symptoms
  • e.g. – sexual dysfunction (reported to occur in 97% of FM patients),posttraumatic stress disorder (PTSD) (1)

Cold and humid weather, poor sleep, and physical or mental stress may aggravate symptoms while warm and dry weather, moderate physical activity, adequate sleep, and relaxation usually improves symptoms (2)

Reference:

• (1) Fitzcharles MA et al. 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Res Manag. 2013;18(3):119-26.
• (2) Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician. 2007;76(2):247-54.