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Fibromyalgia is a complex syndrome of persistent widespread pain, fatigue, disrupted sleep, cognitive difficulties, and anxiety/depression, which typically affects young or middle-aged women. It is thought to be multifactorial in nature, and may be caused by a combination of environmental and genetic factors, as well as possibly being a functional disorder of central pain processing or a syndrome of central sensitivity.


The symptoms of fibromyalgia include chronic widespread pain lasting for more than three months, accompanied by fatigue, poor sleep, stiffness, cognitive difficulties, anxiety and/or depression. Physical examinations are often normal, except for the presence of multiple tender points.

Criteria for Diagnosis:

  • Widespread pain in all four quadrants of the body
  • Present for at least three months
  • Eleven out of eighteen tender points


Additional signs of fibromyalgia include anxiety, depression, and tender joints.


Blood tests are often normal.


Conservative management of fibromyalgia involves education about the condition, graded exercise over several sessions, relaxation techniques, and medications such as antidepressants, muscle relaxants, and gabapentin.


Complications of fibromyalgia can include marked functional impairment, severe depression, and anxiety.


Those with fibromyalgia are at risk for developing chronic pain and long-term disability due to psychosocial risk factors.

Rectangle: Rounded Corners: NOTE FOR PUBLISHERS –     Image Of 18 tender points for assessment

Figure 8.7 Tender Points for Diagnosis of Fibromyalgia

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