Fibromyalgia

Question 1

What is fibromyalgia?

Answer 1

• Disorder of central pain processing
• Chronic widespread pain in all 4 quadrants of body (both sides above and below waist)
• Allodynia present often

Question 2

Whats allodynia?

Answer 2

• Heightened and painful response to harmless stimuli
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Question 3

What can induce fibromyalgia?

Answer 3

• Sleep deprivation
• EEG studies show reduced REM and delta wave sleep
• = hyperactivation to harmful stimuli and neural activation of braig regions associated with pain perception and response to non-painful stimuli

Question 4

Fibromylagia symptoms other than pain

Answer 4

• Joint/muscle stiffness
• Profound fatigue
• Unrefreshed sleep
• Numbness
• Headaches
• Irritable bowel/bladder
• Depression and anxiety
• Poor concentration and memory ‘fibrofog’

Question 5

Examination of fibromyalgia

Answer 5

• No physical abnormalities with MSK
• No abnormal neurological examinations
• May have tender points on palpation of muscles
• These are present if palpating with pressure sufficient to blanch fingernails

Question 6

Risk factors fibromyalgia

Answer 6

• 5% population
• Female 9x
• Peak onset 40-50
• Onset may have obvious trigger emotional or physical

Question 7

Treatment for fibromyalgia - non-pharmacological

Answer 7

• Tailored based on pain intensity, function and associated symptoms
• Simple measures to improve sleep and physical activity levels
• Cognitive behavioural therapy

Question 8

Pharmacological management

Answer 8

• Lose dose amitrypytline
• Pregabalin can be effective
• Opiates not recommended

Question 9

Investigations to exclude other causes than fibromyalgia

Answer 9

• ESR
• CRP
• FBC
• U&Es
• LFT
• Ca
• CK
• TFT