Fibromyalgia

Question 1

What is the main feature of fibromyalgia?

Answer 1

Chronic widespread pain. To be chronic it must be >3 months in duration. To be widespread it must be found on both sides of the body, above and below the waist and along the axial spine.

Question 2

What are other features of fibromyalgia?

Answer 2

• Difficulty sleeping
• Poor concentration/memory
• Extreme + constant tiredness that doesn’t improve with sleep or rest

Question 3

What are the differentials of fibromyalgia?

Answer 3

• Addison’s
• Hyperparathyroidism
• Hypothyroid myopathy
• Vit D deficiency
• Hep C
• HIV
• RA
• SLE
• Polymyalgia rheumatica

Question 4

What are the signs of fibromyalgia?

Answer 4

There are 18 well recognised ‘tender points’ that must be palpated - 4 anterior and 5 posterior. Patients reporting pain in 11 or more of these sites > fibromyalgia. Pressure should be applied with the pulp of the thumb until the examiners nail blanches.

Question 5

How do you diagnose fibromyalgia?

Answer 5

1. Widespread pain index (WPI) and symptom severity score (SSS) - WPI >/= 7 + SSS >/=5 OR WPI 4-6 + SSS >/=9
2. Generalised pain: 4/5 regions
3. Symptoms present >/= 3 months
   Do not need to rule out other conditions if criteria 1-3 are met.

Question 6

What investigations are helpful for fibromyalgia?

Answer 6

• TSH
• 25-hydroxy vit D level
• Vit B12 level
• Iron studies
• Mg
• ESR/CRP
• CK

Question 7

What is the non-pharmacological treatment for fibromyalgia?

Answer 7

• Exercise (strong evidence of benefit)
• CBT
• Acupuncture
• Hydrotherapy
• Meditative movement
• Screen for anxiety and depression and treat appropriately

Question 8

What is the pharmacological treatment for fibromyalgia?

Answer 8

• Duloxetine
• Pregabalin
• Tramadol
• Low dose amitriptyline
• Severe disability - multimodal rehab programme
  NOT NSAIDS

Question 9

What are biomedical yellow flags?

Answer 9

Severe pain or increased disability at presentation, previous significant pain episodes, multiple site pain, non-organic signs, iatrogenic factors.

Question 10

What are psychological yellow flags?

Answer 10

Belief that pain indicates harm, an expectation that passive rather than active treatments are most helpful, fear avoidance behaviour, poor problem solving ability, atypical health beliefs, high levels of distress.

Question 11

What are social yellow flags?

Answer 11

Low expectation of return to work, lack of confidence in performing work activities, low levels of control over work, poor work relationships.

Question 12

What are the risk factors for fibromyalgia?

Answer 12

• Low household income
• Lack of further education
• Female sex
• FH of fibromyalgia
• Been through a traumatic event
• Certain conditions like RA