FIBROMYALGIA

Question 1

Fibromyalgia

Answer 1

Fibromyalgia is a disorder of chronic, widespread pain and tenderness.

Question 2

Which sex is mostly affected by fibromyalgia

Answer 2

Women

Question 3

Symptoms of fibromyalgia

Answer 3

Chronic widespread pain
Unrefreshing sleep and tiredness
Anxiety
Depression
Migraine or tension headaches
Numbness or tingling of different parts of the body
Abdominal pain
Constipation or diarrhoea
Irritable bladder

Question 4

Signs of fibromyalgia

Answer 4

Tender points (commonly found around the elbows, shoulders, knees, hips, back of the head, and the sides of the breastbone)
Myalgia for more than 3 months

Question 5

Investigations for fibromyalgia

Answer 5

FBC, ESR
BUE and creatinine
Urinalysis
Thyroid stimulating hormone level
25-hydroxy vitamin D level
Vitamin B12 level
Iron studies
Magnesium level

Question 6

Treatment objectives for fibromyalgia

Answer 6

To reduce pain
To aggressively treat co-morbid depression
To improve sleep
To reduce fatigue

Question 7

Non-pharmacological intervention for fibromyalgia

Answer 7

Stress management
Exercise
Balanced diet
Sleep therapy
Psychologic/behavioural therapy

Question 8

First line Treatment for fibromyalgia with mild symptoms

Answer 8

PO Paracetamol or PO/Recta Diclofenac

Question 9

Second line Treatment for fibromyalgia with mild symptoms

Answer 9

PO Tramadol 25mg stat then increase by 25-50mg daily up to 50-100mg 6hourly (max. 400mg per day)
and
PO Amitriptyline 10mg nocte

Question 10

Additional treatment for fibromyalgia presenting with chronic or severe symptoms with depression

Answer 10

Add
Fluoxetine 20mg (max. 80mg) daily
or
Amitriptyline PO 25-50mg daily max. 150mg
or
Duoloxetine

Question 11

Additional treatment of chronic or severe symptoms of fibromyalgia with myalgia

Answer 11

Tizanidine, oral,
Adults
2 mg 8 hourly
May increase to 4 mg 8 hourly after 7 days
Children
Not recommended

Or

Cyclobenzaprine, oral,
Adults
5-10 mg 8 hourly as required
Children
5 mg 8 hourly as required

Question 12

Additional treatment of chronic or severe fibryomyalgia symptoms with neuropathic
pain

Answer 12

Pregabalin, oral,
Adults
50-75 mg 12 hourly till resolution (max. 300 mg per day)
Children
Not recommended

Or

Gabapentin, oral,
Adults
300 mg daily
Then
Increase by 300 mg daily to a max. of 600 mg 8 hourly
Children
Not recommended

Question 13

additional treatment of chronic or severe fibromyalgia symptoms with migraine

Answer 13

Clonidine, oral,
Adults
50-75 microgram 12 hourly
Children
Not recommended

Question 14

Fibromyalgia tender points

Answer 14

Occiput
Trapezius
Supraspinatus
Gluteal
Greater trochanter

Low cervical
Second rib
Lateral epicondyle
Knee