Fibromyalgia

Question 1

Presentation

Answer 1

2/3 WOMEN

• Chronic, widespread MSK pain (esp central)
• Associated w/ severe fatigue, unrefreshing sleep, cog complaints, depression and anxiety
• Usually MSK pain but can be headaches, sore throat, ab pain, pelvic pain
• Often chronic - ask about childhood pain
• Discomfort w/ touch and tight clothing
• Abnormal sensation or numbness/tingling
• Non-pain complaints … fatigue, sleep prob, weakness, memory/attention prob, wt fluctuation, heat or cold intolerance, allergies (inc sensitivity not IgE-mediated), non-allergic rhinitis/URIs, syncope, dizziness

Question 2

Pathogenesis

Answer 2

• Normal detection threshold for pain but inc sensitivity to many stimuli (pressure, heat, noise, electrical)
• In normal ppl … when pain sensed we activate descending path of analgesic effect via endogenous opioids (anti-nociceptive path)
• In fibromyalgia … descending path is attenuated
• There is an altered pain threshold so same stimulus will activate pain centers in fibromyalgia pt but not in normal pt; this same level of pain imaging will show up w/ much harder stimulus in normal pt
  
  • Objective evidence in fMRI studies

Question 3

Tx

Answer 3

NO NSAIDS OR OPIOIDS

• Tricyclics (help sleep) - amitriptyline, cyclobenzaprine
• Serotonin and NE reuptake inhibitors - duloxetine, milnacipran
• Selective SSRIs - (treat pain and depression) - sertraline, fluoxetine, venlafaxine, paroxetene
• Gabapentinoids - (treat central paths) - gabapentin, pre-gabalin
  
  • BUT Side effects = sedation, wt gain, peripheral edema

Question 4

Dx

Answer 4

Must r/ other causes

• Should be no inflammatory markers, thyroid labs and no synovitis
• Normal imaging