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Fibromyalgia is a disorder of chronic, widespread pain and tenderness (see the image below). It typically presents in young or middle-aged women but can affect patients of either sex and at any age.

Tender points in fibromyalgia.

Signs and symptoms

Fibromyalgia is a syndrome that consists of the following signs and symptoms

Persistent (≥3 mo) widespread pain (pain/tenderness on both sides of the body, above and below the waist, including the axial spine [usually the paraspinus, scapular, and trapezius muscles])
Stiffness
Fatigue; disrupted and unrefreshing sleep
Cognitive difficulties
Multiple other unexplained symptoms, anxiety and/or depression, and functional impairment of activities of daily living (ADLs)

Diagnosis

Fibromyalgia is a diagnosis of exclusion and patients must be thoroughly evaluated for the presence of other disorders that could be the cause of symptoms before a diagnosis of fibromyalgia is made. The clinical assessment may reveal objective evidence for a discrete or comorbid illness, such as the following:

Hypothyroidism
Rheumatoid arthritis
Systemic lupus erythematosus
Polymyalgia rheumatic
Other inflammatory or autoimmune disorders
Serious cardiac conditions in those with chest pain, dyspnea, and palpitations

Social Support Questionnaire
Sickness Impact Profile
Multidimensional Pain Inventory

See Workup for more detail.

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Management

There is no cure for fibromyalgia, but education, lifestyle changes, and proper medications can help the individual to regain control and achieve significant improvement.
Models of pain behavior that interrelate biologic, cognitive, emotional, and behavioral variables form the basis for cognitive-behavioral and operant behavioral approaches to adult pain management. Fibromyalgia in children responds to a combination of psychotherapy, exercise, relaxation techniques, and education. Pharmacotherapy is generally not indicated in children.
Nonpharmacotherapy

Diet (eg, promote good nutrition, vitamin supplementation, bone health, weight loss)
Stress management
Aerobic exercise (eg, low-impact aerobics, walking, water aerobics, stationary bicycle)
Sleep therapy (eg, education/instruction on sleep hygiene)
Psychologic/behavioral therapy (eg, cognitive-behavioral, operant-behavioral)

Other agents used in fibromyalgia may include the following:

Vitamins and minerals
Malic acid and magnesium combination
Antioxidants
Amino acids
Herbs and supplements

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5 ways you are harming your gut bacteria

Our society has adopted some very unhealthy activities and lifestyles that affect our microbes in a variety of ways. Most are difficult to avoid, but it's critical to spread awareness if we want to protect our microbiome.

A microbiota is an "ecological community of commensal, symbiotic and pathogenic microorganisms" found in and on all multi cellular organisms studied to date from plants to animals. A microbiota includes bacteria, archaea, protists, fungi and viruses. Here are just a few easy ways you can understand how bacteria works.

Wine and beer. Alcohol consumption can alter your microbial balance