Fibromyalgia

Question 1

How common in fibromyalgia?

Answer 1

-Between 0.5 and 4% prevalence
-6x more common in women

Question 2

What risk factors are there for fibromyalgia?

Answer 2

Mostly psychosocial RFs
-Belief that pain and activity are harmful
-Sickness behaviours eg extended rest
-Social withdrawal
-Emotional, financial and occupational problems
-Low educational status

Question 3

What is fibromyalgia usually associated with?

Answer 3

Other somatic syndromes eg
-Chronic fatigue syndrome
-IBS
-Chronic headaches

Question 4

How does fibromyalgia present?

Answer 4

-Chronic, widespread pain
-Profound fatigue (unrefreshing sleep and disproportionate increase in symptoms with a small increase in physical activity)
-Morning stiffness
-Paraesthesia
-Headaches
-Poor concentration
-Low mood
-Sleep disturbance

Question 5

How would you investigate a patient with fibromyalgia?

Answer 5

-Clinical diagnosis
-Important to rule out organic cause eg RA, SLE
-Over-investigation may exacerbate patient’s experience

Question 6

What treatment would you consider for someone with fibromyalgia?

Answer 6

-Patient involvement and encouragement is crucial
-MDT approach to encourage movement and continuing occupation
-Graded exercise programmes to improve function and reduce pain
-Low-dose amitriptyline can improve sleep and relieve pain