chronic pain syndrome consisting of a constellation of symptoms with no clear pathophysiological explanation

common cuase of myalgia

2-5% of population

• can affect anyone

• most common young - middle aged females

• cardinal features

  • chronic widespreada musculoskeltal pain with:

    • tendernss on exam

    • poor and unrefreshing sleep

    • fatigue

    • cognitive effects on short-term memory and concentration

• pathophysiology uncelar

  • long term psychological or physical stress

    • CNS alter processing of afferent sensory input

    • normally non-painful stimuli may become amplified and experienced as pain

• American college of rheymatology criteria

  • recording pain during previous week at different locations on body

  • sleep quality and cognitive symptoms are assessed as improtant features

    • headache

    • abdominal pain

    • depression

• regular exercise

  • improve pain

  • fatigue

  • and sleep disturbance in those with fibromyalgia

  • especially aerobic resistance training

  • introduced slowly

  • yoga, Qi Gong, Tai Chi

• psychological input

• pharmacological treatment not routinely helpfull

  • paracetamol/NSAID

  • TCA used off-label

    • Amitriptyline = best evidence base

    • 10-30mg an hour before going to bed

  • opioids not recommended

    • howver, Tramadol may be of some benefit

      • atypical pathways compared to classs effect