Fibromyalgia Flashcards
Define fibromyalgia
Acquired disorder of pain/sensory processing (nociplastic pain) characterised by widespread musculoskeletal pain, sleep disturbance, multiple somatic and cognitive symptoms
Chronic pain syndrome diagnosed by presence of widespread body pain >3 months
Aetiology of fibromyalgia
A type of chronic primary pain = no clear underlying condition or impact of pain is out of proportion to any observable injury or disease
May be secondary to inciting events e.g. infection, injury. trauma, emotional trauma, surgery, pain syndromes
Risk factors for fibromyalgia
Family history
Rheumatological conditions
Age 20-60
Female sex
Presence of associated conditions e.g. IBS, chronic fatigue syndrome, chronic headache syndromes
Mood disorders e.g. depression, anxiety, stress
Work dissatisfaction
Overprotective family/lack of support
Epidemiology of fibromyalgia
Affects 2% of the population
F > M (10:1)
Age of onset typically 20-60, average age 35
Prevalence increases with age
Symptoms of fibromyalgia
Chronic, widespread pain
Fatigue unrelieved by rest
Sleep disturbance
Mood disturbance e.g. depression, anxiety
Cognitive dysfunction
Change in bowel habit in the day only (IBS)
Urinary symptoms: frequency
Dizziness
Palpitations
Heat or cold intolerance
Headaches (Axial in nature, May extend into the neck and shoulders)
Numbness/tingling sensation
Stiffness
Sensitivity to sensory stimuli e.g. bright lights, odours, noises
Signs of fibromyalgia on examination
Diffuse tenderness (BUT there is no evidence for a systemic disease (e.g., joint inflammation or muscle weakness) causing the widespread pain)
Stiffness
Investigations for fibromyalgia
Clinical diagnosis (not of exclusion)
Calculate symptoms severity index (SSI) and widespread pain index score (WPI)
Urine dip
FBC, U&Es, ESR, bone profile, TFTs, HbA1c
Management for fibromyalgia
MDT management
Always ask what their goal of treatment is and tailor accordingly
Conservative:
- Education and information
- Exercises: graded exercise programme
- CBT/ACT
Medical:
- Antidepressants e.g. amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, sertraline - NO gabapentin/opioids/benzos/NSAIDs
Other: Acupuncture
Complications of fibromyalgia
Disability
Psychological distress
Medicine misuse (25-30% taking opioids)
Sleep impairment
Reduced QOL
Prognosis for fibromyalgia
People with chronic pain usually experience symptoms lasting several months to years
Complete remission rarely occurs, although most people experience substantial symptomatic improvement and reduced reliance on medicines when followed over 3 years.
It is unusual for any analgesic, including strong analgesics like opioids, to completely eliminate chronic pain
