Fibromyaglia

Question 1

What is Fibromyalgia?

Answer 1

Disorder characterised by widespread MSK pain and fatigue

Question 2

What are the causes?

Answer 2

Idiopathic
Thought to be due to sleep disturbance, genetic factors and psychological input

Thought sufferers have reduced delta sleep (non-REM)
AND
Abnormal pain processing- reduced pain tolerance at characteristic sites of the body- allodynia can occur

Question 3

What are the risk factors?

Answer 3

Women
Life events with distress e.g. divorce
FH
Poor sleep
Middle aged

Question 4

What are the symptoms?

Answer 4

Multiple regional pain
Muscle pain and aching
Pain begins localised and becomes more generalised
Intermittent at first and becomes constant
Early morning stiffness
Subjective finger swelling
Numbness/tingling of fingers
Tension headache

Question 5

What are non MSK related symptoms?

Answer 5

Fatigue
Low affect
Poor concentration and forgetfulness
Day time sleepiness
Poor sleep
IBS
Irritable bladder
Sexual dysfunction

Question 6

What is found on examination?

Answer 6

Tender/trigger points

• total of 18 tender points
• normally needs this in all 4 quadrants

Consider in patients

• who fail to respond to analgesia
• marked discordance between signs and symptoms
• marked discordance between disability and clinical findings

Question 7

How is it diagnosed?

Answer 7

Diagnosis of exclusion
Symptoms must be present for 3 months
Painful at 11/18 tender points under 4kg pressure
Clinical Diagnosis

Must rule out other differentials

Question 8

What are the differentials to fibromyalgia?

Answer 8

Anaemia
Polymyalgia Rheumatic
Hypothyroidism 
Hyperparathyroidism
Cancer
Psychiatric conditions 
Sleep disorders
Chronic fatigue Syndrome

Question 9

What investigations are needed?

Answer 9

Thorough history and check red flags

Bloods

• FBC- anaemia
• ESR/CRP-inflammatory disease
• TFTs- hypothyroidism
• Calcium- hyperparathyroidism, osteomalacia
• LFTs- osteomalacia
• ANA- SLE
• CK- muscle problems

Want to rule out any potential underlying cause

Question 10

What is the management?

Answer 10

Patient Education

• disease does not reflect inflammation or damage
• caused by loss of sleep and this leads to amplified pain
• stress can make it worse

Lifestyle advice

• graded exercise to improve sleep and therefore symptoms
• self help CBT for symptoms
• relaxation

Simple analgesia e.g. paracetamol

Low dose amitriptyline
-helps pain, sleep and mood