Fibromyalgia Flashcards
What is fibromyalgia
Fibromyalgia is a chronic pain syndrome characterised by the presence of widespread body pain.
Epidemiology
- 0.5-4% prevalence
- F>M
- Affects people mainly in middle age
- Can be associated with other somatic syndromes e.g. chronic fatigue syndrome, IBS, chronic headaches syndromes, RA, AS and SLE.
RFs
- Female sex
- Middle age
- Genetic association
- Environmental e.g. child abuse, low household income, divorced, low educational status, emotional problems, social withdrawal
Pathophysiology
Mechanism not well understood - there seems to be a problem with how the brain receives pain signals.
individuals have low levels of serotonin, which is involved in inhibiting pain signals, and elevated levels of substance P, and nerve growth factor, which are involved in propagating pain signals.
thought to play a role in the hypersensitivity to pain, which hints that fibromyalgiamight be a condition of central sensitization. In other words, they would perceive more pain compared to other people
What can central sensitisation mean
person might have a wide range of sensitivities- affecting everything from how they sleep to how they feel to how they think. If the person has negative emotions like depression, anxiety, and psychological factors like negative beliefs and attributions it can also amplify this sensitivity to pain.
Key presentations
- Allodynia - pain in response to non-painful stimulus
- Hyperaesthesia - exaggerated perception of pain to mildly painful stimulus
Symptoms
- Widespread pain
- Aggravated by stress, cold and activity
- Extreme tenderness
- Sleep disturbance
- Fatigue - extreme and present after minimal exertion
- Morning stiffness
- Paraesthesiae - abnormal sensation in skin
- Headaches
- Poor concentration
- Low mood
Investigations
Investigations are all normal!
Diagnosis of fibromyalgiais based on clinical features:
Clinical features
- Chronic pain that has been present for at least 3 months
- Widespread pain - involved left and right sides, above and below waist, and the axial skeleton.
- Palpate tender point sites - severe pain in 3 to 6 different areas of your body, or you have milder pain in 7 or more different areas
- No other reason for symptoms has been found
Investigations to exclude other conditions
- Thyroid function test (to exclude hypothyroidism)
- ANA’s and DsDNA (to exclude SLE)
- ESR & CRP (to exclude PMR)
- Ca2+ and electrolytes (to exclude high calcium)
- Vit D (to exclude low vitamin D)
- Examine patient and CRP (to exclude inflammatory arthritis)
DD
- Rheumatoid arthritis
- Chronic fatigue syndrome
- Hypothyroidism
- SLE
- Polymyalgia rheumatica (PMR)
- High calcium
- Low vitamin D
- Inflammatory arthritis
Non pharmacological treatment
- Regular exercise like cardiovascular fitness training which includes fast walking, biking, swimming, or water aerobics can help by reducing pain and fatigue. Grading of exercise is important to avoid over-exertion and fatigue.
- Relaxation techniques and good sleep hygiene can also help.
- Physiotherapy and rehabilitation
- CBT
Pharmacological treatment
- Amitriptyline - tricyclic antidepressant
- Serotonin-norepinephrinereuptake inhibitors (SNRIs) e.g. duloxetine
Help by elevating serotonin and norepinephrine levels.
- Anticonvulsants like pregabalin and gabapentinwhich slow nerve impulses can help with sleep problems.
Prognosis
- With good adherence to exercise, sleep, and behavioural therapy, most patients will improve over time.The goal of treatment is to decrease physical and mental symptoms and to increase functioning, not to cure.
