#7: Fibromyalgia

Question 1

1st line TX for fibromyalgia:

Answer 1

TCA:

• Amitriptyline (elavil) 25mg QD PM
• preferred with sleep issues

Question 2

2nd line TX for fibromyalgia:

Answer 2

Sleep issues?-Pregabalin (Lyrica) qd PM

Depression?-Duoloxetine (Cymbalta) qd AM

Question 3

3rd line TX for fibromyalgia:

Answer 3

Sleep issues?-Gabapentin (Neurotin) qd PM

Depression?-Milnicipran (savella) qd AM

Question 4

Worst outcomes indicators with fibromyalgia prognosis: (4)

Answer 4

1- Work unemployment
2- obesity
3- Low SES
4- Female

Question 5

Describe the pain and duration associated with fibromyalgia:

Answer 5

• widespread pain
• at least 3 months
• above and below the waist B/L

Question 6

Describe how to calculate a severity score (SS):

Answer 6

As pt about SXS of:
1- fatigue
2- waking unrested
3- cognitive
--assign low (1), mod (2), high (3) severity to HX 
--max of 12

Question 7

Fibromyalgia DX is made with these 3 components:

Answer 7

1- SXS >3 mos.
2- r/o other psych DZ to otherwise explain pain
3- SS>/= 5 and WPI>/=7 OR SS>/=9 and WPI>/= 3-6

Question 8

Non-pharm tx should always preclude pharm tx and these include: (3)

Answer 8

1- exercise program (aerobic, stretch and strengthen)
2- referral to specialists: PT/OT or counselors
3- education: sleep hygiene and tx for underlying psych dz