Fibromyalgia

Question 1

A 45-year-old female presents to the pain clinic with a 4 month history of widespread body pain. She has a history of asthma, for which she takes regular inhalers, and depression, for which she takes fluoxetine.

What is pain?

Answer 1

• As defined by the International Association for the Study of Pain (IASP) in 2020, pain is “an unpleasant sensory or emotional experience associated with, or resembling that associated with, actual or potential tissue damage”.

Question 2

When assessing patients with chronic pain, what are yellow flags?

Answer 2

• Yellow flags are used in patients with pain. They indicate the presence of psychological risk factors for the development of chronic pain. These include:
• Anxiety and/or depression.
• The patient favours passive treatment e.g. analgesia and ice packs over active treatment such as physiotherapy.
• The patient does not carry out usual activities due to fear of exacerbating the pain.
• Catastrophising of symptoms.

Question 3

What is fibromyalgia?

Answer 3

• Fibromyalgia is a syndrome characterised by generalised pain and tenderness, together with non-specific symptoms such as fatigue and difficulty sleeping.
• The criteria for a diagnosis of fibromyalgia have been specified by the American College of Rheumatology, to include the following three factors:

1. Widespread pain index (WPI) ≥7 and symptom severity (SS) scale score ≥5 or WPI 3–6 and SS scale score ≥9 (from a defined scoring system).
2. Symptoms have been present at a similar level for at least 3 months.
3. The patient does not have a disorder that would otherwise explain the pain.

Question 4

What is allodynia?

Answer 4

• Allodynia is the sensation of pain in response to a non-painful stimulus.

Question 5

What is hyperpathia?

Vs Hyperalgesia?

Answer 5

• Hyperpathia is an exaggerated painful response to a stimulus, with an increased threshold for the said response.
• Hyperalgesia is an increased response to a stimulus which is normally painful

Question 6

What are the risk factors associated with fibromyalgia?

Answer 6

• There are no specific or defined causes for fibromyalgia, but it is associated with a number of different conditions and risk factors, including:
• Chronic fatigue syndrome.
• Irritable bowel syndrome.
• Interstitial cystitis.
• Temporomandibular joint dysfunction.
• Family history of fibromyalgia.
• Rheumatoid arthritis.
• Systemic lupus erythematosus.
• Anxiety, stress and depression.
• Female gender.

Question 7

A diagnosis of fibromyalgia is made in this patient after a thorough history and examination are carried out. What are the initial treatment options for her?

Answer 7

Physical
* Physiotherapy.
* Graded exercise therapy.
* Acupuncture.
* TENS.

Psychological
* Cognitive behavioural therapy.
* Pain management programme.
* Acceptance commitment therapy.

Pharmacological
* Antidepressants.
* Simple analgesic agents.