Fibromyalgia
What Is It?
Chronic widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive dysfunction (fibro fog). Central sensitization disorder - not inflammatory or structural.
How Is It Diagnosed?
2010 ACR criteria: widespread pain index >=7 and symptom severity score >=5 (or WPI 3-6 with SS >=9). Exclude inflammatory arthritis, hypothyroidism, and other causes.
How Is It Treated?
Multimodal: exercise (most effective), CBT, sleep optimization. Medications: duloxetine, milnacipran, pregabalin, cyclobenzaprine, low-dose amitriptyline. Avoid opioids.
Tests and Imaging Typically Needed
CBC, BMP, TSH, ANA, RF, anti-CCP, CK, ESR, CRP (to rule out inflammatory causes). Vitamin D, B12.
Approximate Self-Pay Costs
Office visit: $95-$150. Lab panel: $80-$130. Medications: $10-$100/month.