Fibromyalgia (FM) is a neurosensory disorder characterized by chronic

musculocutaneous pain
characterized by the combination of ill-defined symptoms including chronic widespread pain,
with fatigue, sleeping disorders and cognitive disturbances

Etiology
• Genetic predisposition
• Environmental triggers (e.g., physical or psychosocial stress)
• Dysregulation of the neuroendocrine and autonomic nervous systems
CLINICAL FEATURES
presenting complains of patients with fibromyalgia include:

• chronic widespread pain (also called multisite pain),

• fatigue and
• Poor sleep.
• pain is initially localized, but eventually it involves many muscle groups. (persistent
with varying intensity)
• Excessive sensitivity to normally painful stimuli, such as pressure or heat (hyperalgesia)
• painful sensation to normally non-painful stimuli, such as touch (allodynia)
• frequent awakening during the night and difficulty falling back to sleep.
• Light-headedness,
• dizziness, and
• Faintness.
• Headaches, either muscular or migraine type, are also commonly present

ASSESSMENT
Patient self-reporting using the fibromyalgia score :

• Widespread pain or tenderness in up to 19 different regions of the body (widespread

pain index; WPI)
Tender-point examination was performed based on the 1990 ACR diagnostic criteria :

• Symptom duration of at least 3 months

• Tender points: ≥ 11 of 18 FM-associated localized areas of pain
• Pain-affected areas: all four quadrants of the body
• Pain intensity can be assessed using visual analog scale
• ”Tenderness can be measured by evaluating the alteration of the severity of pain at the
tender points, using visual or analog scales
• Fatigue can be evaluated by the Fatigue Severity Scale (FSS), which measures the
functional outcomes related to
• Cognitive dysfunction can be evaluated by the Multiple Ability Self-report Questionnaire
(MASQ), which is a self-report questionnaire measuring language, visuoperception,
verbal memory and attention
• Sleep disturbance in fibromyalgia patients has been evaluated by the Medical Outcome
Studies (MOS) sleep scale
MANAGEMENT
• Patient education: Explain that the condition, though painful, is benign, and recommend
coping strategies such as relaxation exercises.
• Lifestyle changes: dietary recommendations, sleep hygiene, regular physical activity
• Medication: antidepressants, sedatives, muscle relaxants and antiepileptic drugs.
• electro-acupuncture significantly improved pain, stiffness and global well-being when
compared to non-acupuncture.
Exercise in fibromyalgia patients should have two major components:

• strengthening to increase soft-tissue length and joint mobility, and

• aerobic conditioning to increase fitness and function, reduce fibromyalgia symptoms
and improve quality of life.

Role of physiotherapy in fibromyalgia:

Physical exercise strongly beneficial for fibromyalgia:

➢ Low-impact aerobic conditioning (water aerobics)

➢ Pain relief exercise
➢ Stretching and strengthening exercises
➢ TENS units (transcutaneous electrical nerve stimulation)
➢ Ultrasound
➢ Other modalities

▪ Heat Therapy: reduces chronic aches and pains, blood delivers extra oxygen and nutrients.
Blood also removes waste byproducts from muscle spasms
▪ Electric Muscle Stimulation: reduces muscle spasms.
▪ Ultrasound: helps reduce muscle spasms, inflammation, stiffness, and pain and is most
effective in relieving range of motion limitations in chronic pain sufferers, release of endorphins,
which are your body’s natural pain killers.
▪ Type of aerobic exercises—include walking, running, cycling, dance, and water exercises
▪ Flexibility exercises: are indicated for the purposes of relieving muscle tension and increasing
muscle length and are effective for reducing pain,
▪ Hydrotherapy: Hydrodynamic properties of water, such as buoyancy, density, viscosity, and
hydrostatic pressure, provide resistance to movement, leading to muscle strengthening and
causing muscle relaxation, low joint impact, and better venous return

https://www.ncbi.nlm.nih.gov/books/NBK279092/#!po=11.9718
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662432/