Fibromyalgia

Question 1

History of fibromyalgia

Answer 1

-Generalised musculoskeletal pains- chronic, sometimes pain all over, multiple sites, widespread
-Tired all the time and poor sleep
-Fatigue and poor concentration= lethargy, dizziness, mood disturbance
-Associated with facial pain and tension headache (extend to neck and shoulders), irritable bowel syndrome
-History of stressful life events often dating back to childhood
-Cognitive impairment: fibro fog

Question 2

Examination in fibromyalgia

Answer 2

Multiple tender spots on palpation- diffuse. Tender spots are also typical on the anterior trunk
-American College of Rheumatology classification criteria: 9 pairs of tender points on the body (11/18 makes diagnosis of fibromyalgia)

Question 3

Investigations in fibromyalgia

Answer 3

-Routine bloods (normal)
-Anti-CCP antibodies (negative)
-X-rays and other imaging are unhelpful except to exclude other diseases

Question 4

Non-pharmacological treatment of fibromyalgia

Answer 4

-Education
=Explain that they have fibromyalgia and it’s a condition where the perception of pain is abnormal.
=Explain that there is no cure but treatments are available to help control pain. Explain the importance of pacing activities
-Sleep disturbance
=General advice on sleep hygiene
-Physiotherapy
=Graded exercise programme, aerobic exercise
-Clinical psychology
=Cognitive behaviour therapy

Question 5

Pain control in fibromyalgia

Answer 5

-Analgesics and NSAIDs are seldom helpful
-Gabapentin, pregabalin
-Duloxetine
-Amitriptyline- tricyclic antidepressants
-Nortryptilene
-Fluoxetine

Question 6

What is fibromyalgia?

Answer 6

Fibromyalgia is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites. The cause of fibromyalgia is unknown

Question 7

Epidemiology of fibromyalgia

Answer 7

-Women are around 5 times more likely to be affected
-Typically presents between 30-50 years old