Systemic (Rheumatic)
Fibromyalgia
섬유근통
Central sensitization syndrome with chronic widespread pain, fatigue, and sleep disturbance
- How common
- 2–4% of general population
- Typical age
- Ages 30–50, female predominant
What is it?
No peripheral tissue damage; CNS pain-processing dysfunction (central sensitization) lowers pain threshold so normal stimuli are perceived as painful.
Commonly affected: Widespread soft tissue including 18 classic tender points
How it develops
- TriggerTrauma, infection, or stress as trigger
- Central SensitizationAmplified pain signaling in dorsal horn and brain
- Neurotransmitter ImbalanceIncreased substance P, decreased serotonin/norepinephrine
- Sleep/Cognitive ImpairmentUnrefreshing sleep and fibro fog
Symptoms
- Widespread painBilateral, upper/lower, axial pain >3 months
- FatigueSevere fatigue unrelieved by sleep
- Sleep disturbanceUnrefreshing sleep, frequent awakening
- Cognitive dysfunctionImpaired concentration/memory
- HyperesthesiaSensitivity to light, sound, touch
How it is examined
- 18 tender pointsOcciput, low cervical, trapezius, supraspinatus, 2nd rib, lateral epicondyle, gluteal, greater trochanter, medial knee (9 bilateral pairs)
- Normal joint examNo joint swelling/warmth, no synovitis
- Normal motor/reflexNeurologic exam intact
- WPI + SSS scoreWidespread pain index ≥7 + symptom severity scale ≥5 (ACR 2016)
Imaging
Imaging typically normal — clinical diagnosis.
- Normal joints/bones
- Normal soft tissues
- Used to exclude other causes
MRI normal; functional brain imaging may show altered pain processing.
- Normal soft tissues
- Normal joints
- fMRI shows altered pain processing (research)
Non-surgical care
- Patient education + CBTUnderstanding and coping strategies are cornerstone
- Aerobic exerciseLow-intensity walking, swimming, yoga 3–5x/week
- PharmacotherapyDuloxetine, milnacipran, pregabalin; amitriptyline for sleep
- Sleep hygiene + stress managementRegular sleep schedule, relaxation, mindfulness
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
No surgical indication
Procedures that may be discussed
- Conservative and pharmacologic management only
Outlook
Chronic course; multimodal therapy improves function/QoL; cure rare.