title: Myalgias and Myopathies: Fibromyalgia.
abstract: Fibromyalgia is a syndrome of chronic widespread pain typically accompanied by fatigue, nonrestorative sleep, cognitive dysfunction, and mood disorders. As defined by the 2010 American College of Rheumatology criteria, fibromyalgia affects approximately 5% of the population and is the second most common disorder, after osteoarthritis, for which patients are referred to rheumatology subspecialists. These criteria provide a framework for diagnosing fibromyalgia that does not require tender points and incorporates other symptoms of the syndrome in addition to pain. Extensive laboratory tests and imaging are not required to diagnose fibromyalgia. A patient-centered, multimodal approach that includes patient education, behavioral therapy, a graded exercise program, and pharmacotherapy should be used for patients with fibromyalgia. Prescribers must be mindful of adverse drug effects and should tailor therapy to the individual patient. Strong evidence of benefit exists for tricyclic antidepressants, cyclobenzaprine, and serotonin-norepinephrine reuptake inhibitors in fibromyalgia management, whereas nonsteroidal anti-inflammatory drugs and opioids have limited proven benefit. Fibromyalgia can cause significant disability and loss of function. Family physicians are well equipped to direct the multimodal care of patients with fibromyalgia.
authors.affiliation: David Grant Medical Center Family Medicine Residency Program - Travis Air Force Base, 101 Bodin Circle, Travis AFB, California 94535.
authors.forename: Jason
authors.initials: J
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000031:analogs & derivatives / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001521:Behavior Therapy; D003131:Combined Modality Therapy; D005081:Exercise Therapy; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009135:Muscular Diseases; D063806:Myalgia; D010353:Patient Education as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
chemical_list: D000639:Amitriptyline; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors; C004704:cyclobenzaprine