What you can do for your fibromyalgia patient

Article Figures & Data

TABLE 1

Distinguishing inflammatory pain from centralized pain

Feature	Inflammatory pain	Centralized pain
Location	Hands, wrists, cervical spine, knees, hips, ankles, feet	More diffuse, “all over,” tender points
Relationship to time of day	Nocturnal, with rest, early morning	Nocturnal, with rest, early morning
Relationship to exertion	Better with exertion	Better during exertion, worse after
Character of pain	Constant, dull, achy	Intermittent, stabbing, burning, “like being hit by a truck,” “unbearable”
Duration	Variable	Often many years
General associated symptoms and signs	Fatigue, fever, other organ signs and symptoms	Fatigue, weakness, headaches, irritable bowel syndrome symptoms, cognitive impairment, disturbed sleep, mood disorders, dry eyes and mouth, light sensitivity, difficulty swallowing, sensation of swollen glands in neck, urinary frequency, feeling faint after hot shower or in hot weather
Localized associated symptoms and signs	Stiffness ≥ 60 minutes Objective swelling	Stiffness ≥ 60 minutes Lack of objective findings Tender points Allodynia (pain from normally nonpainful stimuli), hyperalgesia (increased sensitivity to pain) Acrocyanosis (bluish coloring of hands and feet) Brisk reflexes
Laboratory results	Inflammatory picture: elevated C-reactive protein and Westergren sedimentation rate, anemia, occasionally elevated platelet count, positive serologies (rheumatoid factor, anti-cyclic citrullinated peptide, extractable nuclear antigen panel)	Normal

TABLE 2

Significance of ANA immunofluorescence patterns

Associated with autoimmune disease

Nuclear homogeneous

Nuclear coarse-speckled

Nuclear centromeric

Associated with healthy individuals

Nuclear dense fine-speckled

Most common, found in both groups

Nuclear fine-speckled

TABLE 3

Evaluating fibromyalgia for management

Domains	Key questions and characteristics	Tests
Mood	Ever diagnosed with depression, anxiety, or other psychiatric condition?	Depression (PHQ-9) Anxiety (GAD-7) Bipolar screen (MDQ)
Sleep	Difficulty falling or staying asleep? Average hours slept, daytime sleepiness, snoring, apnea? Prior diagnosis of narcolepsy, sleep apnea, or restless leg syndrome?
Physical conditioning	Moderate aerobic exercise at least 30 minutes 3 times a week?
Stressful life events	Past stressors: born premature, unhappy childhood, history of mental, physical, or sexual abuse? Current stressors: financial, family, health, social?
Maladaptive pain responses, catastrophizing	Does patient use a lot of drama to describe symptoms?	Pain Catastrophizing Scale
Function	Are you working? Have you applied for disability benefits?