Diffuse Musculoskeletal Pain Research Articles

Effects of music on pain in patients with fibromyalgia.

Fibromyalgia syndrome (FMS) is a chronic syndrome characterized by diffuse musculoskeletal system pain and painful tender points in certain areas of the body. The aim of the investigation was to determine the effects of music on pain in fibromyalgia patients. This randomized clinical trial was carried out with 37 fibromyalgia outpatients as an experimental group (n = 21) and control group (n = 16) at a University Hospital Internal Medicine and Rheumatology Clinic between 1 June and 1 December 2014. The research instruments used were descriptive characteristics questionnaire, Visual Analogue Scale (VAS), music CD which includes water and wave sounds recommended by the Turkish Psychological Association for psychological relaxation, and pain evaluation form. According to the findings, the average age of patients was 43.59years ± 10.30, 94.6% were women and 81.1% were married. The fibromyalgia patients had the disease ranged from 1month to 20years, the average of disease duration was 23.6 ± 45.5months, and the average of pain intensity was 6.89 ± 1.64 on the VAS. Average pain was reported in the experimental group in VAS on day 1 (5.45 ± 2.73), day 7 (4.57 ± 2.71), and day 14 (4.14 ± 2.45), and significant reduction in pain in the listening music group was seen (p = 0.026). A repeated measure analysis of variance controlling for differences between days demonstrated a significant decrease in pain between day 1 and day 14 (p = 0.022). There was no significant decrease in pain among control group participants. The effect of music has been found to control pain in fibromyalgia patients. Music therapy should be suggested in pain management for fibromyalgia patients as an non-pharmacologic nursing intervention.

Heart rate turbulence analysis in female patients with fibromyalgia

OBJECTIVE:Fibromyalgia is characterized by diffuse musculoskeletal pain and discomfort. There are several reports regarding autonomic nervous system dysfunction in patients with fibromyalgia. Heart rate turbulence is expressed as ventriculophasic sinus arrhythmia and has been considered to reflect cardiac autonomic activity. Heart rate turbulence has been shown to be an independent and powerful predictor of sudden cardiac death in various cardiac abnormalities. The aim of this study is to determine whether heart rate turbulence is changed in female patients with fibromyalgia compared with healthy controls.METHODS:Thirty-seven female patients (mean age, 40±11 years) with fibromyalgia, and 35 age- and sex-matched healthy female control subjects (mean age, 42±9 years) were included. Twenty-four hours of ambulatory electrocardiography recordings were collected for all subjects, and turbulence onset and turbulence slope values were automatically calculated.RESULTS:The baseline clinical characteristics of the two groups were similar. There were no significant differences in turbulence onset and turbulence slope measures between patients and control subjects (turbulence onset: −1.648±1.568% vs. −1.582±1.436%, p ϝ 0.853; turbulence slope: 12.933±5.693 ms/RR vs. 13.639±2.505 ms/RR, p ϝ 0.508). Although body mass index was negatively correlated with turbulence slope (r ϝ −0.258, p ϝ 0.046), no significant correlation was found between body mass index and turbulence onset (r ϝ 0.228, p ϝ 0.054).CONCLUSION:To the best of our knowledge, this is the first study to evaluate heart rate turbulence in patients with fibromyalgia. It appears that heart rate turbulence parameters reflecting cardiac autonomic activity are not changed in female patients with fibromyalgia.

44-Year-Old Man With Exertional Dyspnea, Weight Loss, and Palpitations

44-Year-Old Man With Exertional Dyspnea, Weight Loss, and Palpitations

Characterization of the pain, sleep and alexithymia patterns of patients with fibromyalgia treated in a Brazilian tertiary center

ObjectivesFibromyalgia (FM) is a complex syndrome that is characterized by lasting and diffuse chronic musculoskeletal pain, derived from non-inflammatory causes and classically associated with the presence of specific tender points. However, studies have highlighted other important symptoms associated with a lower quality of life (QOL) in FM, such as sleep disturbances and alexithymia. This study aimed to investigate the pain, sleep and alexithymia patterns of FM patients treated in a Brazilian tertiary center. Methods20 patients with FM who were followed-up in the Rheumatology outpatient clinic of a Brazilian tertiary center (Faculdade de Medicina de São José do Rio Preto – FAMERP, São Paulo, Brazil) and 20 patients without FM from other outpatient services of the FAMERP completed a clinical and socio-demographic questionnaire, the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), the Toronto Alexithymia Scale (TAS-20) and the SF-36 (WHOQOL). ResultsThe patients with FM presented worse performances in all QOL dimensions of the SF-36 and higher scores on the PSQI (p=0.01), and the TAS-20 (p=0.02). Patients with FM also scored significantly higher in all specific domains of PSQI and TAS-20. DiscussionThe present data were in accordance with literature, disclosing a worse performance of patients with FM on pain impact, sleep complains and more presence of alexithymia. ConclusionStudies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients’ approach and treatment.

Caracterização dos padrões de dor, sono e alexitimia em pacientes com fibromialgia atendidos em um centro terciário brasileiro

ObjectivesFibromyalgia (FM) is a complex syndrome that is characterized by lasting and diffuse chronic musculoskeletal pain, derived from non‐inflammatory causes and classically associated with the presence of specific tender points. However, studies have highlighted other important symptoms associated with a lower quality of life (QOL) in FM, such as sleep disturbances and alexithymia. This study aimed to investigate the pain, sleep and alexithymia patterns of FM patients treated in a Brazilian tertiary center. Methods20 patients with FM who were followed‐up in the Rheumatology outpatient clinic of a Brazilian tertiary center (Faculdade de Medicina de São José do Rio Preto – FAMERP, São Paulo, Brazil) and 20 patients without FM from other outpatient services of the FAMERP completed a clinical and socio‐demographic questionnaire, the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), the Toronto Alexithymia Scale (TAS‐20) and the SF‐36 (WHOQOL). ResultsThe patients with FM presented worse performances in all QOL dimensions of the SF‐36 and higher scores on the PSQI (p=0.01), and the TAS‐20 (p=0.02). Patients with FM also scored significantly higher in all specific domains of PSQI and TAS‐20. DiscussionThe present data were in accordance with literature, disclosing a worse performance of patients with FM on pain impact, sleep complains and more presence of alexithymia. ConclusionStudies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients’ approach and treatment.

A Rare Presentation of Adrenal Insufficiency: Isolated Adrenocorticotropic Hormone Deficiency and Miyelofibrosis

have been estimated to afflict 3% of the population (2). Therefore, clinical presentation of the autoimmune diseases may have a wide spectrum. For example, celiac disease is said to be a clinical chameleon that may be presented with osteoporosis, anemia, growth retardation, fatty liver, etc. (3). Similarly, the less prevalent lymphocytic hypophysitis (LYH) is probably underestimated rather than being a rare disease (4). It has to be suspected when other Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare cause of hypocortisolism, mostly associated with lymphocytic hypophisitis (LYH). Autoimmune miyelofibrosis is another rare autoimmune disease causing bone marrow fibrosis. Here, we report the case of a patient who presented with common symptoms (weakness, fatigue, weight loss, vague pain) and anemia and was diagnosed with both rare autoimmune disorders (lymphocytic hypophisitis and autoimmune myelofibrosis). A 34-year-old male presented with weakness, fatigue, weight loss, and diffuse musculoskeletal pain. He had mild normochromic normocytic anemia. Further investigations revealed bone marrow fibrosis. The World Health Organization criteria were not fulfilled for the diagnosis of primary myelofibrosis. Since his symptoms could not be explained by mild anemia, a thorough evaluation was performed which revealed hypocortisolism associated with undetectable ACTH. Insulin-induced hypoglycemia test yielded insufficient response of ACTH and cortisol. Sellar MRI demonstrated typical features of LYH. Resolution of all the symptoms and anemia was achieved with low-dose glucocorticoid replacement therapy. In conclusion, when evaluating a patient presenting with fatigue, weight loss, vague pain, backache, and mild anemia, hypocortisolism also should be kept in mind in the differential diagnosis. If the case is isolated ACTH deficiency, the most probable cause is LYH. In such a case, additional endocrinological or non-endocrinological autoimmune disorders are likely to be present. We report the first case of lymphocytic hypophysitis coexisting with autoimmune myelofibrosis. Turk Jem 2014; 2: 47-51

THU0327 Efficacy of Vitamin D Supplementation in the Treatment of Fibromyalgia: Randomized Controlled Trial

BackgroundFibromyalgia (FM) is a condition characterized by chronic widespread musculoskeletal pain (MSK), fatigue and muscle tenderness. In addition, many patients have mood disturbances, report fatigue, disrupted sleep, balance disorders and...

Impact of vitamin D supplementation on health-care use in a 25-hydroxyvitamin D-tested population in France: a population-based descriptive cohort study.

Chronic vitamin D deficiency has been associated in some patients with diffuse musculoskeletal pain. These unspecific symptoms may partly explain why vitamin D deficiency is often diagnosed late. Our aim was to analyse health-care claims after vitamin D supplementation in patients likely to have vitamin D deficiency. Ambulatory health-care claims were compared before and after a vitamin D supplementation prescribed following a 25-hydroxyvitamin D assay. Health Insurance Fund (FHIF) database of the Rhône-Alpes area, France. Among patients reimbursed for a 25-hydroxyvitamin D assay between 1 December 2008 and 31 January 2009, those supplemented with vitamin D after the assay were matched on the date of assay to patients who did not receive vitamin D. Among the 3023 patients who had a 25-hydroxyvitamin D assay, 935 were consequently supplemented and matched to 935 patients not supplemented. Their median age was 50·0 and 49·5 years, respectively. Patients supplemented decreased their muscle relaxant consumption whereas no change was observed in the reference group, the difference between the two groups was significant (P=0·03). Second and third Pain Relief Ladder prescriptions decreased in both groups but not significantly differently between groups (P=0·58). There was a decrease in prescriptions of biological examination in both groups with no significant difference. Besides a decrease in muscle relaxant prescriptions in the supplemented group, it was difficult to assess the impact of vitamin D supplementation in patients likely to have vitamin D deficiency. Prospective cohort studies and randomized trials are needed to assess the efficiency of screening and supplementing vitamin D deficiency.

Kinesiophobia, adherence to treatment, pain and quality of life in fibromyalgia syndrome patients

BACKGROUND AND OBJECTIVES: Fibromyalgia syndrome is characterized by diffuse and chronic musculoskeletal pain, which is difficult to handle and negatively affects patients' quality of life. This study aimed at measuring fear of movement, adherence to treatment and at evaluating health-related quality of life of fibromyalgia syndrome patients. METHODS: This is a prospective study in convenience sample made up of individuals with fibromyalgia syndrome and treated in a Pain Outpatient Clinic. Tools used were: identification protocol, Fibromyalgia Impact Questionnaire, generic quality of life questionnaire World Health Organization's Quality of Life Instrument, visual analog scale, Tampa Scale for Kinesiophobia and treatment adherence measurement. Participated in the study 65 individuals being 35 with fibromyalgia syndrome called test group and 30 without diagnostic of musculoskeletal and neurological systems diseases called control group. RESULTS: The test group had predominance of females, mean age of 42.5±4.3 years, 53% were married and mean education was 9±2.5 years. Mean pain duration was 3.5±1.2 years and mean of two years for fibromyalgia syndrome diagnostic. There has been poorer quality of life, more severe pain and acknowledgment of the importance of physical activities, in spite of referring fear. In addition, adherence to pharmacological treatment was lower than that observed in the control group. CONCLUSION: Fibromyalgia patients had more severe pain, more fear of movement and poorer quality of life in physical an social domains. Adherence to treatment level was medium and there has been decreased functional capacity.

Fibromyalgia and the old dilemma: Theory vs. practice.

The objective of this article is to review some aspects of the fibromyalgia syndrome and its mechanisms of development. We also discuss how to go from preclinical research to clinical practice. Fibromyalgia is a clinical syndrome whose main features include diffuse musculoskeletal pain, fatigue, sleep disturbances, and cognitive disorders. Russell & Larsson (2009) proposed pronociceptive and antinociceptive systems under normal conditions. Functional pain states such as fibromyalgia are derived from central disturbances in pain processing. The association with anxiety and depression is a negative prognostic factor. Distress is an important part of its physiopathology. The concomitance of other functional syndromes is a rule. The already known etiopathogenic mechanisms of fibromyalgia can be applied in clinical practice for diagnosis and rational therapeutic approaches. Pharmacological but mainly nonpharmacological measures must be applied. Although much information still needs to be obtained, the clinician presently has sufficient tools for efficiently treating fibromyalgia patients. An important aspect is that such knowledge needs to reach primary care physicians because the prevalence of fibromyalgia does not allow all patients to be treated by specialists.

Vitamin D supplementation for diffuse musculoskeletal pain: Results of a before-and-after study

Background: Several studies have shown that vitamin D supplementation could be useful for treating diffuse musculoskeletal (DMS) pain in adults.Objectives: The aim of this study was to evaluate the effects of correcting a vitamin D deficiency (≤ 50 nmol/l) on DMS pain and quality of life in adults.Methods: A pragmatic prospective study was conducted in a general practice setting in the Rhone-Alps area between 1 February and 30 April 2009. Patients between the ages of 18 and 50 years old who consulted their general practitioner (GP) for DMS pain or chronic unexplained asthenia and had a deficient serum 25 (OH) D level with no signs of any other disease were enrolled in this study. The patients received high doses of vitamin D supplements (400 000 to 600 000 units). Mean pain evaluation scores were evaluated before and after vitamin D supplementation using mixed models and accounting for repeated measures.Results: Before vitamin D supplementation, the adult study cohort (n = 49) had an adjusted mean serum 25 (OH) D level of 23.7 nmol/l, a mean pain evaluation score of 5.07 and a mean quality of life score of 3.55. After vitamin D supplementation, the adjusted mean serum 25 (OH) D level increased to 118.8 nmol/l (P < 0.001), the mean quality of life score increased to 2.8 nmol/l (P < 0.001) and the mean pain evaluation score decreased to 2.8 (P < 0.001).Conclusion: In this small before-and-after study, vitamin D supplementation decreased pain scores in adult patients with diffuse musculoskeletal pain and vitamin D deficiency. These results must be confirmed by further studies.

Low-dose adefovir-induced hypophosphatemic osteomalacia on whole-body bone scintigraphy.

While adefovir dipivoxil (ADV) effectively suppresses the hepatitis B virus, it can cause proximal renal tubular dysfunction leading to phosphate wasting [1, 2]. The safety of low-dose ADV (a dose of 10 mg/day), which does not induce clinically significant nephrotoxicity, is well recognized, but a few cases of hypophosphatemic osteomalacia (HO) caused by low-dose ADV therapy have recently been reported [3–6]. Although HO induced by low-dose ADV therapy is rare, the presence of bone pain in patients treated with ADV should be monitored. Bone scintigraphy can be performed to confirm the occurrence of osteomalacia and to determine the disease extent. Bone scintigraphic and radiological image findings with a brief review of the literature are presented in this article. We report two cases of HO induced by low-dose ADV therapy that showed multifocal increased radiotracer uptakes in the bilateral bony ribs, spines, pelvic bones and lower extremities on whole-body bone scintigraphy (Figs. 1 and ​and2).2). Bone pain gradually improved after phosphate supplementation and by changing the antiviral agent. Fig. 1 A 44-year-old man presented with a 6-month history of diffuse musculoskeletal pain in the chest, back and both knees without antecedent trauma. The patient had a history of chronic hepatitis B infection and had received adefovir dipivoxil (ADV) (10 mg/day) ... Fig. 2 A 42-year-old man who had taken adefovir dipivoxil (ADV) (10 mg/day) for 7 years for treatment of chronic hepatitis B complained of a 2-year history of diffuse musculoskeletal pain in the anterior chest area with absence of antecedent ... Whole-body bone scintigraphy is a highly sensitive imaging tool and can show disease extent at once in the setting of the wide range of the clinical spectrum with nonspecific radiological findings [5]. Furthermore, frequent involvement of the lower extremities, as a result of maximum weight bearing, could be an additional scintigraphic clue for the diagnosis of HO [6, 7]. These cases could be helpful for both clinicians prescribing ADV and nuclear physicians to prevent delayed diagnosis and plan further appropriate treatment.

AB0658 Low dose naltrexone in the treatment of fibromyalgia

BackgroundFibromyalgia is a chronic pain disorder characterized by diffuse musculoskeletal pain, fatigue, sleep disturbance and cognitive impairment. A significant number of fibromyalgia patients do not respond adequately to the current...

AB1096 Overactive lifestyle in patients with fibromyalgia as a core feature of bipolar spectrum disorder

BackgroundFibromyalgia syndrome (FMS) is a diffuse musculoskeletal pain disorder, accompanied by tenderness on examination at specific anatomic sites known as tender points (TP), fatigue and non-restorative sleep.ObjectivesWe tested the hypothesis...

Effect of Acupuncture at Tender Points for the Management of Fibromyalgia Syndrome: A Case Series

BackgroundAffecting more women than men, fibromyalgia syndrome (FMS) is a rheumatic disorder characterized by chronic, diffuse and widespread musculoskeletal pain, and its pathogenesis is still unknown. Among the recommended treatments, acupuncture (for its analgesic effects) is an effective option for reducing the pain sensitivity and improving quality of life. Therefore, this study aimed to investigate whether acupuncture at tender points could effectively manage FMS. MethodsEight female patients, with a previous diagnosis of fibromyalgia, underwent an initial assessment involving pressure algometer measurements for pain tolerance and questionnaires [Fibromyalgia Impact Questionnaire (FIQ), Heath Assessment Questionnaire (HAQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI)], followed by treatment. Over a 2-month period, acupuncture was performed once per week at five tender points, located bilaterally at the occipital bone, trapezius, rhomboid, upper chest and lateral epicondyle. At the end of treatment, the participants underwent a reassessment for a final review of the applied methods. ResultsWe observed a reduction in the pain threshold and sensitivity and improvement in the areas of anxiety and depression and quality of life, which were demonstrated using the FIQ, BDI and BAI but not the HAQ. ConclusionThe results demonstrated the effectiveness of tender-point acupuncture treatment on the patients' overall well-being, not only by improving quality of life, but also by reducing the pain sensitivity of FMS.

Douleurs musculo-squelettiques non systématisées diffuses et déficit sévère en vitamine D. Étude avant-après en médecine générale

The objective of this study was to evaluate the effect of the correction of vitamin D deficiency (defined by a rate≤50 nmol/l) on the pain, fatigue and quality of life. A pragmatic prospective study was conducted in Rhone-Alpes area, in general practices between February 1 and April 30, 2009. All patients aged 18 to 50 years consulting for diffuse musculoskeletal pain and/or chronic unexplained fatigue, with the only abnormality deficient serum vitamin D were enrolled in this study. They might agree to complete questionnaires on quality of life, pain assessment and control their vitamin D levels after treatment. Forty-nine complete records were analyzed. The deficiency was severe (mean 26 nmol/l). High doses of vitamin were necessary to correct deficiency, between 400,000 to 600,000 units. The correction of vitamin D deficiency resulted in a significant decrease in the level of pain intensity according to verbal rating scale (P=0.034) and the Digital Scale (P<0.001), consumption of analgesics (P=0.002) and discomfort in carrying out activities of daily living following: the shopping, cleaning, walking for more than a kilometer (P<0.001) and dressing (P=0.012). The correction has had a positive impact both physical, mental and social activities. Non-specific musculoskeletal pain or unexplained asthenia are common in primary care. Make a dosage of vitamin D and correct deficits is a necessity before performing complex and expensive examinations.

Is there a relationship between fibromyalgia and rhinitis?

Fibromyalgia (FM) is a common chronic pain disorder characterized by diffuse musculoskeletal pain and stiffness. It is recognized as a common syndrome affecting 2-4% of the population that may present with several ambiguous and seemingly unrelated symptoms. A broad variety of complaints and lack of tests to accurately identify the disease challenges physicians with confirming this elusive diagnosis. FM has significant overlap with several other systemic diseases including those of sensory hypersensitivity, autonomic deregulation, neurological dysfunction, migraine, and related chronic rhinitis. Current research suggests a relationship between allergic disease especially allergic and NAR and sinusitis. The pathogenesis of FM is related to aberrant pain processing and immunoregulatory abnormalities that may occur in autoimmune disorders with increases in immunologic signaling molecules such as ILs, cytokines, nerve growth factor, which is linked with rhinitis, TNF-alpha, and L-selectin suggesting that pathophysiology is a product of the inflammatory response system. Central nervous system cytokine activation through viral neurotropism and subsequent glial activation is speculated as a possible mechanism. Allergists-immunologists and other specialists such as rheumatologists and rehabilitation and psychiatric physicians may be able to more accurately diagnose and treat these debilitated and often stigmatized patients. The complexity of this disorder must be tackled by a multidisciplinary approach to ensure the successful management of this multifaceted syndrome.

Hypophosphatemic osteomalacia induced by low-dose adefovir therapy: focus on manifestations in the skeletal system and literature review

Osteomalacia is a metabolic bone disease that leads to softening of the bones and can be caused by hypophosphatemia. Large clinical studies of low-dose adefovir dipivoxil (adefovir) have found no evidence of renal tubular dysfunction leading to hypophosphatemia after 48weeks of treatment. We report two cases of low-dose adefovir-induced hypophosphatemic osteomalacia that initially presented with diffuse musculoskeletal pain. The first patient was a 62-year-old man with a 2-year history of bone pain involving the dorsal mid-thorax, lower anterior chest wall, right sacroiliac joint area, and both knees. The patient had been receiving adefovir for 5years before confirmation of hypophosphatemia and urinary phosphate wasting. Bone scintigraphy revealed multifocal lesions including multiple ribs, costochondral junctions, costovertebral junctions, sacrum, both posterior iliac bones, both proximal tibia, right calcaneus, and the left second metatarsophalangeal joint area, which were suggestive of metabolic bone disorder. Bone pain was significantly reduced within 3months after supplementation with phosphate and calcitriol. The second patient was a 54-year-old male who presented with an 18-month history of severe bone pain of the right medial knee and low back. The patient had been taking adefovir for approximately 40months before the development of bone pain. Laboratory data revealed hypophosphatemia and vitamin D deficiency. Bone scintigraphy showed increased uptake in bilateral ribs, sternum, both scapulae, both costovertebral junctions, both pelvic bones, medial cortex of the right proximal femur, right proximal tibia, and the left lateral tarsal bone. The symptoms improved by changing the antiviral agent from adefovir to entecavir. Because osteomalacia often presents with diffuse bone pain, non-specific radiologic findings and non-characteristic routine serum biochemical changes, the disease can be confused with various musculoskeletal diseases and a high index of suspicion is necessary for an early diagnosis in patients receiving adefovir therapy.

Fibromyalgia Syndrome and Chronotype

Sleep has strong links to the symptomology of fibromyalgia syndrome (FMS), a diffuse musculoskeletal pain disorder. Information about the involvement of the circadian clock is, however, sparse. In this study, 1548 individuals with FMS completed an online survey containing questions on demographics, stimulant consumption, sleep quality, well-being and subjective pain, chronotype (assessed by the Munich ChronoType Questionnaire, MCTQ), and FMS impact. Chronotype (expressed as the mid-sleep-point on free days, corrected for sleep deficit on workdays, MSF(sc)) significantly correlated with stress-ratings, so-called "memory failures in everyday life," fatigue, FMS impact, and depression but not with anxiety. When chronotypes were categorized into 3 groups (early, intermediate, late), significant group differences were found for sum scores of perceived stress, memory failures in everyday life, fatigue, FMS impact, and depression but not anxiety, with late chronotypes being more affected than early chronotypes. Sleepiness ratings were highest in early chronotypes. Challenges of sleep quality and subjective pain were significantly increased in both early and late chronotypes. The results show that according to their reports, late chronotypes are more affected by fibromyalgia.

P-907 - Escitalopram monotherapy in managing depressive and pain symptoms in patients with depression and fibromyalgia

Introduction Fibromyalgia is characterized by diffuse musculoskeletal pain, fatigue, sleep disturbance, headaches, and cognitive and affective disturbance. The aetiological pathway is not clearly understood nor is there a clearly defined pathophysiological profile for the disorder that distinguishes it as a diagnosis. Objectives To investigate the efficacy of 20 mg escitalopram monotherapy in management of depressive symptoms, pain, fatigue and sleep. Aims To demonstrate efficacy of escitalopram in improving depressive and pain symptoms as measured by primary and secondary outcome measures. Methods 60 subjects were randomized to treatment or control group and evaluated at 4,8 and 12 weeks using MADRAS, McGill pain questionnaire, fibromyalgia impact score and sleep questionnaires. Results Mean MADRAS score was significantly lower in the treatment group (14.96 ± 1.02 vs 18.12 ± 1.05; p = 0.03) as compared to the control group. When the change from baseline on MADRAS score was compared between the groups, the reduction was even more apparent in the treatment group (−12.49 ± 1.48 vs − 4.77 ± 1.54; p = 0.001).Mean FIBROMYALGIA score was significantly lower in the treatment group as compared to the control group (54.20 ± 2.09 vs 64.93 ± 2.14; p Conclusion Positive statistically significant results for treatment group on all primary outcome measures of MADRAS and fibromyalgia impact score questionnaire.