Fibromyalgia

Question 1

What is fibromyalgia?

Answer 1

This is a neurosensory disorder characterised by chronic MSK pain

Question 2

Who is most likely to develop fibromyalgia?

Answer 2

Females (6:1)
Aged 22-50

Question 3

What are some predisposing factors of fibromyalgia?

Answer 3

Emotional trauma
Physical trauma
Rheumatoid arthritis
SLE

Question 4

Describe the physiology of fibromyalgia

Answer 4

Pre-existing factors such as seretonin receptors and endorphins, alongside precipitating factors such as muscle micro-trauma and sleep disturbances

These, with pain, fatigue and depression lead to skin hyperactivity, muscle contraction and decondition (Rapid decrease in muscle strength)

Hyperactivity of cutaneous nociceptors, sympathetic outflow and muscle nociceptors (Tactile allodynia) can then occur as a result

This activates the ascending and descending pathways to the somatosensory cortex and hypothalamus of the brain

Question 5

How will fibromyalgia present?

Answer 5

• Widespread pain
• Intense fatigue
• Hypersensitivity to normal stimuli
• Poor concentration
• Brian fog
• Poor refreshment from rest

Question 6

Where are the main points of hypersensitivity in fibromyalgia?

Answer 6

Question 7

How is diagnosis of fibromyalgia made?

Answer 7

Clinical examination and history
Diagnosis of exclusion
The patient should have had symptoms present at the same level for ≥3 months

Question 8

What treatments are available in fibromyalgia?

Answer 8

• Education
• MDT
• CBT
• Graded exercise programme
• Complementary medicine (e.g. acupuncture)
• Antidepressants (Tricyclics - Amitriptyline)
• Atypical analgesia (Gabapentin, Pregabalin)