FIBROMYALGIAAREALDISEASE

KHAIRULPUTRASURBAKTI

DEPARTMENT OFNEUROLOGY, FACULTY OFMEDICINE,

UNIVERSITASSUMATERA UTARA, 2019
 INTRODUCTION

DEFINITION:
A chronic pain characterized by widespread
pain , tenderness and stiffness of muscle and
associated connective tissue structures that is
typically accompanied by fatigue, headache
and sleep disturbances.
• Previous terms
– Fibrositis (Gowers, 1904)
– Pain Syndrome ( Graham, 1950)
– Fibromyalgia ( Smythe & Muldowsky,
1970)
• IS FIBROMYALGIA A REAL DISEASE ?

• FM: Changes in the level of neurotransmitters

that cause augmented CNS pain
processing. (Claw, 2011)

• Rheumatologist do not believe that the

disease exists (Wallace, 1995)
Why the controversy?
• FM can not be found on an objective
examination such as radiograph or laboratory
test.
• FM is more a mind/brain disease than
musculoskeletal disease.
• Fibromyalgia is real  FM has an entry in the
ICD-10
2019 ICD-10-CM Diagnosis Code M79.7
EPIDEMIOLOGY
PATHOPHYSIOLOGY
 DIAGNOSIS

Basedon ACR1990
– Diagnosis ismade byevaluation of symptomsand presence of
tender points
– Must have at least 11 pointsout of 18points
FIBROMYALGIA CRITERIA
1. 1977- Smythe and Moldofsky- non refreshing sleep, tender
point count, and ”widespread aching pain”
2. 1981- Yunus, et al – tender points and presence of
generalized aches and pains involving 3 or more anatomic
sites
3. 1990 – Wolfe, et al – ACR’s standardized classification criteria
4. 2010/2011 - Wolfe, et al – ACR preliminary classification
criteria
5. 2016 – Wolfe et al – Revisions to 2010/2011 criteria
TREATMENT
 CONCLUSION
• Fibromyalgia isareal disease
• Wide range of data support the notion that FM is a chronic pain disorder
characterized byaugmentedcentral painprocessing
• Three main symptoms of fibromyalgia are referred by almost every patient :
pain, fatigueandsleepdisturbance.
• Diagnosis should be based on ACR criteria, comprehensive assessment,
exclusion of other potential disorders associated with widespread pain, and
evaluation of therangeof symptomology
• To address pain and relevant comorbidities, treatment should include both
pharmacologic andnon pharmacologic modalities
• Currently duloxetine, milnacipran and pregabalin are the only drugs that
havebeenapprovedbytheUSFDAfor thetreatment of fibromyalgia