Chronic musculoskeletal neck and back pain under the mask of fibromyalgia

Fibromyalgia manifests as chronic widespread pain combined with fatigue, sleep disturbance, cognitive impairment ("fibro fog"), various somatic complaints, and anxiety-depressive symptoms. Chronic nonspecific musculoskeletal pain (CNSMP) in the neck and back may present under the mask of fibromyalgia. The approaches to managing patients with fibromyalgia and CNSMP in the neck and back differ. In fibromyalgia, antidepressants and anticonvulsants are effective as pharmacological agents, whereas in CNSMP of the neck and back, non-steroidal antiinflammatory drugs (NSAIDs) are effective. We present the observation of a female patient who, before seeking care at the Clinic of Nervous Diseases (CND) of Sechenov University, had been followed up with a diagnosis of fibromyalgia and had not responded to the prescribed pharmacotherapy (an antidepressant). At the CND, the patient was diagnosed with CNSMP of several localizations (cervicobrachialgia, lumboischialgia with myofascial pain syndrome) and concomitant episodic migraine. The patient's treatment was carried out in accordance with the established diagnoses and included optimal pharmacotherapy with NSAIDs (stepwise therapy with Dexalgin and a short course of Dexalgin 25 for the treatment of CNSMP, eletriptan for the relief of migraine), kinesiotherapy, training in ergonomic principles, optimal physical activity and correct postures in daily life, and cognitive-behavioral therapy for pain. The comprehensive therapy allowed the patient to cope with the pain syndromes relatively quickly and for a long period.