Fybromyalgia

Refer only when:

1. Diagnosis unclear. It is important to exclude thyroid disease, SLE and muscle disorders. The history and examination are usually very typical of fibromyalgia. It is suggested that the following investigations are undertaken once. Please if referring patient include these results as repeat investigation enforces concerns about pathological nature of the symptoms.

   Routine investigations:

   • HB
   • WCC
   • ESR
   • CK/Aldolase
   • U and E/P5
   • Thyroid function
   • CXR
2. If results of above investigations positive, please refer.
3. Non-restorative sleep disturbance which has not responded to a trial of tricyclic anti-depressant in full therapeutic dose for 2 months.
4. Careful assessment of social and psychological factors indicates possible psychiatric or psychological problem requiring treatment.

Definition

A Spectrum of symptoms including non specific aches and pains, point tenderness in muscles at 9 or more sites, non-restorative sleep with marked fatigue. Often associated with irritable bowel syndrome, Raynauds type symptoms, dysmenmorhoea.

First line treatment

1. Reassure
2. Graded exercise
3. Amitryptiline 5-30 mg nocte initially increasing as tolerated to a dose which promotes sleep without daytime drowsiness

Document Information
Expiry Date: 11/04/04
Author: Kennedy Tom Dr
Organisation: Arrowe Park Hospital