Fibromyalgia

Question 1

What is fibromyalgia?

Answer 1

1. A condition associated with chronic widespread pain and tenderness
2. Pain for >3 months
   *pain above and below the waist
   *pain on left and right sides of the body and axial skeleton
   *pain at >11 of 18 tender points when palpated with 4 kg of digital pressure

Question 2

What is the cause of fibromyalgia?

Answer 2

1. Unknown
   *Maybe genetic factors

Question 3

What demographic is fibromyalgia most common in?

Answer 3

1. Females 20-50

Question 4

What is fibromyalgia similar to?

Answer 4

1. Chronic fatigue syndrome
   *CFS is more associated with lassitude (lack of energy, mental weariness)
   *fibromyalgia is associated with M/S pain and tenderness

Question 5

What are some clinical findings of fibromyalgia

Answer 5

1. Chronic pain and stiffness
   *neck, shoulder, low back, and hips MC
2. Fatigue and sleep disorders
3. Chronic headaches
4. Trigger points

Question 6

What are the control and tender points for fibromyalgia?

Answer 6

Control: Forehead, right forearm, left thumb
Tender points: Low cervical, second rib space, elbow, knee, trapezius, occipital, Supraspinatus, gluteal, greater trochanter

Question 7

What type of diagnosis is fibromyalgia?

Answer 7

Diagnosis of exclusion

Question 8

How to tell the difference between RA, SLE, and Fibromyalgia

Answer 8

1. RA and SLE will have something on the imaging and labs
2. Fibromyalgia is not a cause of fever, weight loss, or other objective findings

Question 9

What is the first line treatment of fibromyalgia?

Answer 9

1. Amitriptyline 10mg then
2. Fluoxetine
3. Duloxetine
4. Cyclobenzaprine (muscle relaxant)

Question 10

What is the evidence about opioids, NSAIDs, or hypothyroid drugs when treating fibromyalgia?

Answer 10

1. There isn’t any evidence that they will be effective

Question 11

What are the hallmark signs of fibromyalgia?

Answer 11

1. Hyperalgesia
   *amplified response to painful stimuli
   *pinprick causes and intense stabbing sensation
2. Allodynia
   *pain resulting form normal stimuli
   *hugs that feel painful

Question 12

What pain neurotransmitters are elevated in people with fibromyalgia compared to people without it?

Answer 12

1. Glutamate
2. Substance P
   *these will be at an increased level
   *minimal stimuli cause an increased pain perception due to the increased levels of glutamate and substance P