Fibromyalgia

Question 1

What is fibromyaligia?

Answer 1

Chronic pain syndrome diagnosed by the presence of widespread body pain in all 4 quadrants of body (both sides, above and below waist).

Question 2

Allodynia is often present in pts with fibromyalgia; what is allodynia?

Answer 2

Heigtened and painful response to innocuous stimuli

Question 3

Discuss the pathogenesis of fibromyalgia

Answer 3

• Sleep deprivation is probaby the trigger in most pts
• EEG studies show reduced REM sleep and delta wave (stage 4) sleep
• This causes hyperactivation in respone to noxious stimulation and neural activation in brain regions associated with pain perception in response to non-painful stimuli

Question 4

State some risk factors for fibromyalgia

Answer 4

• Female
• 40-50yrs

Question 5

State some symptoms & signs of fibromyalgia

Answer 5

• Widespread pain (all 4 quadrants)
• Joint/muscle stiffness
• Fatigue
• Unrefreshed sleep
• Numbness
• Headaches
• Irritable bowel/bladder syndrome
• Depression & anxiety
• Poor concentration and memory “fibrofog”

Question 6

What might you find on clinical examination of a pt with fibromyalgia?

Answer 6

Shoulnd’t be any clinical findings just this idea of pain and allodynia e.g. if you palpate with just sufficient pressure to blanch your finger nails it will hurt.

HOWEVER, not all pts with fibromyalgia have tender points

Question 7

Discuss what, if any, investigations you might do if you suspect fibromyalgia

Answer 7

All investigation results in fibromyalgia will be normal hence there is no investigations you can do to ‘confirm it’ but investigations are important to rule out other causes of symptoms e.g.:

• ESR
• CRP
• FBC
• U&E
• LFT
• Ca
• CK
• TFT

Question 8

Discuss the management of fibromyalgia; think about conservative, pharmacological and psychological treatment

Answer 8

Tailor treatment to pt based on pain intensity, function and associated features e.g. anxiety & depression

• Education: many pts improve with explanation of symptoms
• Measures to improve sleep and physical activity levels
• Pharmacological:
  
  • 1st line= low dose amitryptline at night
  • 2nd line= pregabalin
  • If depression: SSRI
• Psychological: CBT