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Clinical lectures > Fibromyalgia > Flashcards

Fibromyalgia Flashcards

1
Q

How was fibromyalgia discovered?

A

Fibromyalgia was discovered by analysing pattern of symptoms over the years

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2
Q

In 1876, Balfour made a connection between which 2 symptoms, which eventually led to discovery of fibromyalgia?

A

Balfour 1876: Connection between muscular rheumatism and tender points

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3
Q

In the discovery of fibromyalgia, who initially named it fibrositis and what was their reasoning?

A

William Gowers 1904: definition needed for inflammation of fibrous tissue, so should follow cellulitis analogy and call it fibrositis

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4
Q

What 2 symptoms of fibromyalgia were discovered in 1977, and by which 2 scientists?

A

Smythe and Moldofsky 1977: multiple tender points and disturbed sleep

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5
Q

What 2 discoveries did Yunnus make in 1981 regarding fibromyalgia?

A

Yunnus 1981: found that tender point examination is useful and found common comorbidities

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6
Q

What organisation adopted the term ‘fibromyalgia’ and why, and in what year did this happen?

A

American College of Rheumatology 1990: ‘Fibromyalgia’ term adopted as it has respectability and causes acceptance of the condition

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7
Q

What is the percentage worldwide prevalence of fibromyalgia?

A

1-10%

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8
Q

Is the incidence of fibromyalgia equal in men and women?

A

3x more common in women than men

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9
Q

Is prevalence of fibromyalgia equal at all ages?

A

Prevalence increases with age to maximum in 60s

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10
Q

What is the definition of fibromyalgia?

A

Widespread musculoskeletal pain for which no alternative cause can be identified, that is accompanied by fatigue, unrefreshing sleep, memory, mood issues

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11
Q

In the ACR classification criteria 1990 for fibromyalgia, what is the duration of the pain and what 4 body areas must the pain occur in, and what must this be combined with?

A

Pain for minimum 3 months in left, right, upper, lower body combined with 11/18 tender points

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12
Q

What is meant by a tender point?

A

Small area near joint that is painful when pressed on

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13
Q

Where are the 18 tender points in the fibromyalgia criteria 1990?

A

9 bilateral tender points, making 18 in total:
Suboccipital (back of neck)

Lower cervical

Trapezius

Supraspinatus

2nd rib (upper chest under clavicle)

Lateral epicondyle

Gluteal muscle

Greater trochanter

infrapatellar fat pad

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14
Q

Give 3 critiques of the America College of Rheumatology Fibromyalgia classification criteria 1990?

A

No gold standard pathology as it isn’t grounded in any clear pathological process

Doesn’t consider related clinical features

Fibromyalgia doesn’t encompass all chronic pain as tender points present in other conditions

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15
Q

From 2010-2016, give 3 ways in which the fibromyalgia classification criteria has changed from the 1990 criteria?

A

doesn’t use tender points

combination of physician/diagnostic and classification criteria

valid irrespective of other diseases

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16
Q

What are the 3 requirements that need to be met in order to fulfil the 2016 fibromyalgia classification criteria and confirm the validity of the diagnosis?

A

Pain in 4 out of 5 regions, not including jaw, chest, abdomen

WPI > 7 and SSS 5 or more, or WPI 4/5/6 and SSS > 9 or more

Symptoms present for at least 3 months

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17
Q

What is the Widespread Pain Index used to calculate in the 2016 fibromyalgia classification criteria?

A

Numbers of areas which contain pain for minimum 3 months

Maximum 19 areas which are split into 5 regions

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18
Q

What is the Symptom Severity Score used to calculate in the 2016 fibromyalgia classification criteria?

A

Total score is calculated, maximum is 12 points

Symptoms experienced in last week are individually rated from 0-3: fatigue, cognitive symptoms, waking up unrefreshed

Symptoms experienced in last 6 months are individually rated from 0-1: abdominal pain/cramps, depression, headache

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19
Q

Describe a later modification to the 2016 fibromyalgia classification criteria?

A

Fibromyalgia scale and questionnaire that will consider psychological, social, cultural, biological aspects

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20
Q

Is there a main site of pain in fibromyalgia?

A

No, patient says that pain hurts all over, and that pain can have a focus but shifts

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21
Q

What are the 2 ways in which individuals with fibromyalgia describe the character of the pain?

A

Burning, gnawing pain

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22
Q

Give 7 associated symptoms of fibromyalgia

A

Hyperalgesia: abnormally heightened sensitivity to pain

Allodynia: pain due to a stimulus that usually doesn’t provoke pain

Mental and physical fatigue

Sleep disturbance, 8-10 hrs light sleep a night

EMS

Unrefreshed after waking

Psychiatric symptoms such as depression, anxiety

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23
Q

What 2 types of weather conditions exacerbate fibromyalgia?

A

Cold, damp weather

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24
Q

Describe the severity of pain caused by fibromyalgia, and how it compares to pain caused by RA?

A

Pain is moderate or severe, worse than RA

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25
Q

Give 3 characteristic findings of fibromyalgia upon physical examination?

A

Tender points

No synovial inflammation

No muscle weakness

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26
Q

In fibromyalgia, what are the results of the lab investigations typically like?

A

All lab tests are normal

27
Q

In fibromyalgia, what is the typical result of an electromyography?

A

Normal electromyography

28
Q

Is there a proven association between infection and fibromyalgia?

A

No sero-epidemiological evidence has been found

29
Q

Why 2 pieces of data suggest that there could be an association between lyme disease and fibromyalgia incidence?

A

20% individuals with lyme disease had widespread pain after infection

Antibiotics didn’t relieve widespread pain after lyme disease infection, suggesting that the pain is noninflammatory/noninfectious

30
Q

What percentage of individuals with mononucleosis infection developed widespread pain, that could be fibromyalgia?

A

20%

31
Q

Give 3 examples of trauma that fibromyalgia is associated with?

A

Leg fracture

Neck trauma

Hypermobility

32
Q

When an individual has developed fibromyalgia caused by trauma occurrence, what part of their history should you make sure to also check?

A

Psychiatric history prior to the trauma occurrence

33
Q

Give 2 ways in which genetics can cause fibromyalgia?

A

Familial clustering, as fibromyalgia tends to run in families

Pain behaviour is learnt from family, which can cause dysfunctional beliefs and mood changes in response to fibromyalgia

34
Q

Can individuals with fibromyalgia be HLA positive, if so why might this not be linked to fibromyalgia itself?

A

HLA positive suggests that there is presence of inflammatory disease, which means that patient could have another condition apart from fibromyalgia

35
Q

What is the association between catechol-O-methyltransferase (COMT) gene mutation and fibromyalgia?

A

COMT regulates nociceptive processing and inflammation, when a COMT gene mutation occurs this can cause increased pain sensitivity

36
Q

What is the association between serotonin transporter promotor gene and fibromyalgia?

A

Serotonin transporter gene polymorphism produces variants

Higher frequency of one variant was found in patients with fibromyalgia, and this group exhibited higher levels of depression and psychological distress

37
Q

Is muscle abnormality a cause of fibromyalgia?

A

Intrinsic muscle abnormality detected, but this is secondary cause to inactivity/pain

So muscle abnormality doesn’t directly cause fibromyalgia

38
Q

How can slow wave distribution in sleep abnormality trigger fibromyalgia?

A

Slow wave sleep is deep and restorative rest, so produces refreshed feeling upon waking

Alterations in slow wave sleep distribution means that individual will have less restorative rest so will wake up still feeling unrefreshed

39
Q

What percentage of fibromyalgia cases show EEG non-restorative sleep patterns?

A

75%

40
Q

How do EEG results correlate with symptom severity of fibromyalgia?

A

The more severe the symptoms the more unstable sleep patterns are shown on EEG

41
Q

Give 2 hormone levels that are increased due to CRH response to stress, which can cause fibromyalgia?

A

CRH responds to stress by increasing prolactin and stress hormone ACTH

42
Q

How can increased prolactin levels correlate with fibromyalgia symptoms?

A

Increased prolactin level correlates with more severe fibromyalgia symptoms

43
Q

How does 5HT/serotonin level change to cause fibromyalgia, and what 3 symptoms are caused?

A

Reduced 5HT/serotonin level leads to pain, depression, anxiety

44
Q

How does growth hormone level change to cause fibromyalgia, and what 4 symptoms are caused?

A

Reduced growth hormone level leads to impaired cognition, cold intolerance, low energy, reduced exercise capacity

45
Q

What does physiological testing of tender points in fibromyalgia show?

A

Detected altered pain threshold, implying CNS sensitisation

46
Q

How does the level of CSF Substance P change to cause fibromyalgia symptoms?

A

Elevated CSF Substance P levels, so more SP is released from nociceptors which increases pain sensitivity

47
Q

How can blood flow in brain regions cause fibromyalgia symptoms?

A

Brain regional blood flow abnormalities in areas related to pain processing

48
Q

What is temporal summation of pain, and how can it lead to fibromyalgia symptoms?

A

Abnormal temporal summation of pain (repeated noxious stimuli at specific frequency overall increases pain sensitivity)

49
Q

Is fibromyalgia more common in individuals with active psychological illness than without?

A

Yes, 1.5x more common in individuals with active psychological illness

50
Q

Does fibromyalgia arise from a specific personality type, and does it cause a specific personality type?

A

No specific personality type causes fibromylagia, but it causes healthcare seeking behaviour to arise

51
Q

Is history of abuse associated with fibromyalgia?

A

Fibromyalgia can arise from psychological/emotional/physical stress, which could be caused by abuse

History of abuse tends to correlate with severity of symptoms

52
Q

What is the most plausible cause of fibromyalgia?

A

Disorder of sensory processing of non-nociceptive input

53
Q

Is a specific treatment available to manage fibromyalgia?

A

No current highly effective therapy, so clinicians and patients should be willing to try different modalities

54
Q

What is the most important aspect of managing fibromyalgia?

A

Patient education

55
Q

According to the EULAR 2017 recommendations, what is the only strong management option for fibromyalgia?

A

Exercise

56
Q

What 4 fibromyalgia management aspects are the EULAR 2017 recommendations based on, and how was it developed amongst clinicians?

A

pharmacology

multimodal rehabilitation

education

nonpharmacological therapies

Developed by shared decision making

57
Q

According to the EULAR 2017 recommendations, what 3 factors need to be assessed to make a prompt diagnosis of fibromyalgia?

A

pain, function, psychological context

58
Q

According to the EULAR 2017 recommendations, in the multidisciplinary graduated approach to fibromyalgia, what kind of modality is used initially?

A

Initially non pharmacological and then pharmacological modalities

59
Q

According to EULAR 2017 recommendations, are non pharmacological or pharmacological modalities stronger for fibromyalgia management?

A

Non pharmacological modalities are strongest, pharmacological are weakest

60
Q

According to EULAR 2017 recommendations, give 4 examples of non-pharmacological therapies for fibromyalgia management?

A

Aerobic, strengthening exercise

Cognitive behavioural therapy

Physiotherapy such as acupuncture

Meditative therapy such as yoga

61
Q

Give an 2 examples of antidepressant medications that can be prescribed for fibromyalgia management, and describe their drug classes?

A

Low-dose Amitriptyline: tricyclic

Duloxetine: Serotonin-Noradrenaline Reuptake Inhibitor (SNRI)

62
Q

What drug classes does tramadol belong to, and how long can it be administered for, in treatment of fibromyalgia?

A

Tramadol is an opiate analgesic and SRNI that is used for moderate-severe pain relief

Prescribed for short period of time as it can lead to opioid addiction

63
Q

What is pregabalin used for in fibromyalgia management?

A

Pregabalin is antiepileptic, anxiolytic (reduces anxiety) medication that is used to manage pain and anxiety symptoms of fibromyalgia

64
Q

What is cyclobenzaprine used for in fibromyalgia treatment?

A

Cyclobenzaprine is a muscle relaxant drug that works by acting as a depressant in CNS (blocking nerve impulses sent to brain) and reducing muscle hyperactivity

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