Chronic Diffuse pain

Question 1

What is fibromyalgia

Answer 1

Pain and aching all-over body thought to be due to brain changes but unclear pathology

Question 2

Fibromyalgia presentation

Answer 2

Typically female, middle age, low-income, following emotional trauma
Universal fatigue
Widespread tenderness
Unrefreshing sleep

Question 3

Fibromyalgia diagnosis

Answer 3

Chronic pain >3mths and widespread with fatigue

Question 4

Fibromyalgia management

Answer 4

Full engagement of pt, encourage to remain as active as possible
Alternative diagnoses excluded
Gradually progressing exercise
CBT

Question 5

Fibromyalgia pharmacotherapy

Answer 5

Low-dose amitriptyline (10-20mg at night) helps pain + sleep
Pregabalin (150-300mg/12h PO) if amitriptyline ineffective
SSRI e.g. duloxetine if anxiety + depression accompanies

Question 6

What is Chronic fatigue syndrome

Answer 6

Persistent disabling fatigue >6mths, present >50% of time + 4 from (myalgia, polyarthralgia, dec memory, unrefreshing sleep, fatigue after exertion >24h, persistent sore throat, tender cervical/axillary lymph nodes)

Question 7

Chronic fatigue syndrome management

Answer 7

Similar to fibromyalgia but no pharmacotherapy shown to be effective