Fibromyalgia is a disorder characterized by chronic pain in muscles, tendons, and soft tissues all over the body. There are 3 primary symptoms including: 

1. Widespread pain - particularly in the head, neck, shoulders, arms, back, buttocks and legs – typically dull and heavy, above and below the waist on both sides of the body and lasting longer than 3 months
2. Fatigue, disrupted sleep, or waking up unrefreshed despite adequate hours of sleep
3. Thinking, concentration, and memory impairment commonly referred to as “fibro fog”

Other common symptoms are headache, jaw pain, tingling or numbness of hands and feet, gastrointestinal problem as well as anxiety and depression.

Prevalence of fibromyalgia
The prevalence of fibromyalgia worldwide is 2.7%. A population survey of Bangkok in 2011 found lower prevalence at 0.6%

Causes and risk factors
Studies in the last 30 years pointed toward disordered central nervous systems processing of sensory inputs resulting in hypersensitivity to pain associated with abnormal neurochemical level in the brain and spinal cord inducing the heightened response to pain stimuli.

Risk factors: fibromyalgia occurs in all age groups and is more frequent in female than male. Patients with rheumatoid arthritis and SLE are more prone to develop fibromyalgia.

Diagnosis
Due to its protean clinical manifestations and great diversity of accompanying symptoms, delayed diagnosis is the norm. Patient may bounce from doctor to doctor and has had multiple unrevealing tests. The diagnosis of fibromyalgia requires careful history taking and physical examination, laboratory tests, and medical imaging to rule out other diseases having overlapping symptoms. After a period of care and follow-up, one can arrive at the correct diagnosis.

Treatment
The most important thing in the care of fibromyalgia is to educate and give correct information to patients to avoid confusion, fear, anxiety, or discouragement. Involve the patient in shared decision making regarding the steps of treatments with the common goal of pain alleviation, improved physical and mental health for good quality of life.

Treatment with medications
The roles of medications are to relieve pain. Depending on your predominant symptom, your doctor may prescribe pain relievers, antidepressants, or anti-seizure drugs to ameliorate central nervous system hypersensitivity. Medications include paracetamol, tramadol, gabapentin, pregabalin, amitriptyline, duloxetine, and venlafaxine.  Consult a healthcare professional for appropriate drug prescription.

Non-pharmacological treatment
Researches indicate that non-pharmacological are as important as pharmacological treatments and can be prescribed before or in concert with pharmacological treatment. Land-based and aquatic exercise, yoga, qigong, tai chi, physical therapy, massage, meditation, and psychotherapy can be used to cope with chronic pain.

The treatment of fibromyalgia is not complicated and requires no complex equiment, but rather it calls for the collaboration between doctor and patient as well as tincture of time for the condition to subside until normal daily life can resume.