Soft tissue pain disorder

defining characteristics

Widespread and migratory pain/tenderness; waxes & wanes, other nonspecifc MSK sx (IBS, headaches), fatigue, weight change, night sweats, weakness, SLEEP PROBLEMS, trouble concentrating, TMJ, ENT sx, nondermatomal parasthesias
Chronic widespread pain involving ALL 4 quadrants and axial skeleton; Presence of 11/18 tender points

disease development

No inflammation or tissue pathology!
Abnl neurochemistry affects pain perception; mood & sleep disturbance along w/ changes in HPA axis causes decreased blood flow to thalamus (pain perception center), resulting in decreased pain thresholds

potential causes

Pain perception thresholds decreased (abnl neurochem)
Physical/emotional triggers can precede or aggravate sx (virus, trauma, dep/anx)


Prev? 4% of population F>>M (10:1)
Peak onset 30-55y.o.

risk factors

First degree relatives w/ FM (8x higher risk!)
Mutations in serotonin gene


Clinical? Should not see weakness! Dramatic pain/tenderness at pressure points
No anemia
Nl CPK, aldolase Nl ESR/CRP
Nl thyroid studies Negative ANA, RF

conventional treatment

Pt education
Anti-inflammatory/ analgesic meds (not better than placebo)
tricyclics (muscle relaxant, antidep)
Serotonin reuptake inh
Lyrica (decrease perception of pain) FITNESS TRAINING! (low impact aerobics and muscle strength)