Fibromyalgia is a condition characterized by widespread musculoskeletal pain accompanied by other symptoms. A variety of symptoms are often present in fibromyalgia patients are fatigue, insomnia, tingling sensations, eye dryness, irritable bowel syndrome, migraine headaches, difficulties with the memory and concentration, pain in the abdomen, nervousness, dizziness, blurred vision, dry mouth, hives, ringing in the ears, heartburn, rash, loss of appetite, frequent urinations and others.

There are no obvious abnormalities on physical examination and laboratory and radiologic studies are normal in a typical fibromyalgia patient.

Ideally this condition is managed by the pain specialist along with the multidisciplinary team members at the pain clinic. The role of the rheumatologist is to make sure that patient does not have an inflammatory arthritis or connective tissues disease that can be confused with fibromyalgia. Depression and anxiety disorders are very important to exclude since they can be confused with fibromyalgia as well and if left untreated can prevent its successful management.

The evaluation of fibromyalgia started by excluding conditions that can present in a similar way. The role of family physician here is very important. It can be done by doing physical examination, screening for depression and ordering set of blood work searching for thyroid, liver, kidney dysfunction, anemia, electrolyte abnormalities and elevated inflammatory markers. There is a questionnaire (2010 fibromyalgia criteria) that can help to make a diagnosis asking patient to answer few questions without searching for tender points on physical exam.

The approach to the management of fibromyalgia as follows:

• Normalization of sleeping hygiene/treatment of insomnia
• Treatment of depression or anxiety disorders if any
• Daily exercises (start low, go slow)*
• Cognitive-behavioral psychotherapy (initial assessment by psychologist and then 16 weekly treatments is available at the psychology department of the Oshawa clinic)**
• Pain control with medications (fluoxetine, amitriptyline, tylenol, cymbalta) or injections to tender points (at the pain clinic)
• Patient is at the control with the support by family physician or other health care providers

* Arthritis society (self referring service for the physiotherapy assessment) and Durham warm water aquatic program  addresses can be found under “Useful links”.

** Psychology department, Oshawa clinic website  address can be found under “Useful links”.