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At the heart of general practice since 1960

Standard treatment options for fibromyalgia

Both 1 and 2 must be present

1. A history of widespread pain for at least three months

Definition: Pain is considered when all the following are present: pain on both sides of the body; pain above and below the waist. In addition, axial skeleton pain (cervical spine, anterior chest, thoracic spine or low back pain) must be present. In this definition, shoulder and buttock pains are considered as pain for each involved side. Low back pain is considered lower segment pain.

2. Pain in at least 11 of 18 tender point sites

on digital palpation

Location of tender points:

 · Occiput: bilateral at suboccipital muscle insertions

 · Lower cervical: bilateral at anterior aspects of the intertransverse spaces at C5-7

 · Trapezius: bilateral at mid point of upper border

 · Supraspinatus: bilateral and origins above scapular spine near medial border

 · Second rib: bilateral, at second costochondral junctions, just lateral to junctions on upper surfaces

 · Lateral epicondyle: bilateral 2cm distal to the epicondyles

 · Gluteal: bilateral in upper outer quadrants of buttocks in anterior fold of muscle

 · Greater trochanter: bilateral, posterior to trochanteric prominence

 · Knees: bilateral, at medial fat pad proximal to joint line

Digital palpation should be performed with manual pressure of approximately 4kg/cm2

For a tender point to be considered positive, a patient must state the palpation was painful: a reply of tender is not considered to be painful

 · Education and reassurance about the diagnosis

 · Graded exercise

 · Antidepressants

 · Cognitive behaviour therapy

Analgesia is not as effective as in acute pain and benefits tend to be temporary

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