Fibromyalgia

Question 1

what is the pathogenesis?

Answer 1

unexplained

Question 2

what is it?

Answer 2

widespread muscle pain and fatigue
thought to be a disorder of central pain processing/syndrome of central sensitivity
biochemical, metabolic and immunoregulatory abnormalities

Question 3

how does it present?

Answer 3

persistent >3months widespread pain
- pain/tenderness on both sides of the body
- above and below the waist
- includes axial spine
fatigue - disrupted and unrefreshing sleep
cognitive difficulties
multiple other unexplained symptoms
anxiety
depression
functional impairment of activities of daily living (ADLs)

Question 4

how is it investigated?

Answer 4

no specific investigations 
diagnosis on a clinical basis 
rule out other conditions 
- hypothyroidism 
- RA
- SLE
- PMR (polymyalgia rheumatica)
- other inflammatory/AI

Question 5

how is it managed?

Answer 5

learn self-management techniques
understand the condition
validate the patients illness
graded exercise and activity pacing
atypical analgesia - tricyclis (amitriptyline), gabapentin, pregabalin
psychological input with CBT may help some patients