July 13, 2020 CASE DISCUSSION-8

Patient 42 / F
C/o Aching pain and stiffness, frequently involving the entire body,
prominence of pain around the neck, shoulders, low back, and hips. Fatigue,
Numbness Duration 4 years
History of previous illness NO T2DM, HTN, dyslipidaemia
F/H Nothing relevant
Habits Food regular habits Smoking No Alcohol No
O/E Sleep disturbed Bowel Normal
Appetite less
Vitals Wt: 60kg BMI: 27 kg/m2 BP: 128/86
PR: 73/MT RR: 12 breaths mt
Blood investigations
TC: 10000 cells/uL HB: 13. gm%
ESR: 12 mm/hr S Creatinine: 1.1 mg/Dl
MRI whole spine, USG abdomen and other investigations done are
Within Normal

Discussion
Fibromyalgia
Fibromyalgia (FM) is characterized by chronic widespread
musculoskeletal pain and tenderness. Although it is defined
primarily as a pain syndrome, FM patients also commonly
complain of associated neuropsychological symptoms of
fatigue, unrefreshing sleep, cognitive dysfunction, anxiety, and
depression. Patients with FM have an increased prevalence of
other syndromes associated with pain and fatigue, including
chronic fatigue syndrome, temporomandibular disorder, chronic
headaches, irritable bowel syndrome, interstitial cystitis/painful
bladder syndrome, and other pelvic pain syndromes. Available
evidence implicates the central nervous system as key to
maintaining pain and other core symptoms of FM and related
conditions. The presence of FM is associated with substantial
negative consequences for physical and social functioning.

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 July 13, 2020 CASE DISCUSSION-8

 Most frequent in women aged 20–50.

 Chronic widespread musculoskeletal pain syndrome with
multiple tender points.
 Fatigue, headaches, numbness common.
 Objective signs of inflammation absent; laboratory studies
normal
The cause is unknown, but aberrant perception of painful
stimuli, sleep disorders, depression, and viral infections have all
been proposed. Fibromyalgia can be a complication of
hypothyroidism, rheumatoid arthritis or, in men, sleep apnea.
Fibromyalgia is not a diagnosis of exclusion. It can occur in
patients who have other illnesses like RA and SLE. Individuals
suffer chronic widespread pain with disrupted and unrefreshing
sleep, constant tiredness, and tender points detectable on
pressing their muscles. Multiple other symptoms, such as irritable
bowel syndrome (IBS), tension headaches, dysmenorrhoea,
atypical facial or chest pain and forgetfulness, often coexist. It

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 July 13, 2020 CASE DISCUSSION-8

occurs in about 1 in 50 people, can develop at any age and

affects women more than men (2:1). The diagnosis is clinical,
and blood tests and imaging are normal. These tests may be
requested to exclude other causes of pain.
Management
A clear explanation of the diagnosis is critically important.
While being honest about the fact that there is no cure for
fibromyalgia, it is also necessary to reassure the patient that it
is not arthritis and that the pain is not causing damage to joints
or muscles. Many patients have never had an explanation of
the cause of their symptoms, which leads to fear and doubt.

Further reading
 Davidson's Principles and Practice of Medicine - 23rd Edition
 Kumar and Clark's Clinical Medicine - 9th Edition
 2020 Current Medical diagnosis and treatment 59 th Edition

Q.
1. After reading the discussion do you think that you
can diagnose a case like this?
2. Yes or NO?
3. Why?

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