Fibromyalgia

Question 1

Fibromyalgia is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites. What is the estimated prevalence of fibromyalgia?

1 - 2-3%
2 - 10-20%
3 - 30-40%
4 - >50%

Answer 1

1 - 2-3%

Question 2

Does Fibromyalgia, a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites affect men or women more?

Answer 2

• women
• 10:1

Question 3

What age does fibromyalgia typically occur?

1 - 5-15
2 - 15-30
3 - 20-50
4 - 40-70

Answer 3

3 - 20-50

Question 4

Which of the following conditions has been linked with a higher prevalence of fibromyalgia?

1 - RA
2 - OA
3 - Psoriasis
4 - Septic arthritis

Answer 4

1 - RA

Question 5

Although the exact cause of fibromyalgia is unknown, dysfunction of which receptors is linked with fibromyalgia?

1 - ruffini endings
2 - nociceptors
3 - pacinian corpuscle
4 - meissners corpuscle

Answer 5

2 - nociceptors
- also called free nerve endings

Question 6

When a pain sensation is detected by nociceptors (free nerve endings) it is transmitted into an electrical signal in the dendrite of the nociceptor and travels to the 1st order cell body located where?

1 - ventral root ganglion
2 - dorsal root ganglion
3 - posterior grey matter
4 - anterior grey matter

Answer 6

2 - dorsal root ganglion

Question 7

Once a nociceptors (free nerve endings) transmits its signal to the cell body located in the dorsal root ganglion, it then releases what at the dorsal horn that then binds with the 2nd order cell body?

1 - GABA
2 - substance P
3 - acetylcholine
4 - adrenalin

Answer 7

2 - substance P
- 2nd order neuron transmits pain to CNS
- inhibitory neurons present in dorsal horn next to where 1st order and 2nd order neurons meet
- inhibitory neurons dampen the sensation of pain

Question 8

Inhibitory neurons are present in dorsal horn next to where 1st order and 2nd order neurons meet. The inhibitory neurons dampen the sensation of pain by releasing which 2 of the following?

1 - GABA
2 - serotonin
3 - acetylcholine
4 - noradrenaline

Answer 8

2 - serotonin
4 - noradrenaline

• if substance P signal is greater than inhibitory neurons then action potential (pain) travels up 2nd order neuron to the brain

Question 9

When the nociceptors (nerve free endings) located in the skin are stimulated a growth factor is released causing:

• growth of nociceptors
• increased sensitivity of nociceptors
• increased release of substance P

What growth factor is released here?

1 - epidermal growth factor
2 - transforming growth factor
3 - epidermal growth factor
4 - nerve growth factor

Answer 9

4 - nerve growth factor

Question 10

Although the exact cause of fibromyalgia is unknown, suggestion are that it may be a hypersensitivity to pain. Which of the following has been reported to be low in patients with fibromyalgia?

1 - noradrenaline
2 - nerve growth factor
3 - serotonin
4 - substance P

Answer 10

3 - serotonin
- this inhibits pain, so if levels are low, pain may not be inhibited as well

Question 11

Although the exact cause of fibromyalgia is unknown, suggestion are that it may be a hypersensitivity to pain. Which 2 of the following has been reported to be high in patients with fibromyalgia?

1 - noradrenaline
2 - nerve growth factor
3 - serotonin
4 - substance P

Answer 11

2 - nerve growth factor
4 - substance P

Both are linked with causing pain, so if higher levels then may cause more pain

Question 12

All of the following are clinical presentations of fibromyalgia, but which is the most common clinical presentation?

1 - chronic pain at multiple site, sometimes ‘pain all over’
2 - lethargy and fatigue
3 - cognitive impairment: ‘fibro fog’
4 - sleep disturbance
5 - headaches
6 - dizziness
7 - depression/anxiety

Answer 12

1 - chronic pain at multiple site, sometimes ‘pain all over’

Question 13

How long must pain associated with fibromyalgia be present for that is not associated with another disorder for a diagnosis of fibromyalgia to be made?

1 - >1 week
2 - >2 weeks
3 - >3 weeks
4 - >3 months

Answer 13

4 - >3 months

Question 14

In the image below we can see all the 9 paired (18 in total) fibromyalgia points based on the American College of Rheumatology classification. How many of these are needed to make a diagnosis of fibromyalgia?

1 - >6
2 - >11
3 - >14
4 - all 18

Answer 14

2 - >11

• fibromyalgia is more likely if they have >11 of these points

Question 15

Which of the following non-pharmacological approaches are often used when treating fibromyalgia?

1 - exercise
2 - cognitive therapy
3 - relation
4 - sleep therapy
5 - all of the above

Answer 15

5 - all of the above

Question 16

Although medications are typically not always prescribed, which 2 of the following may be prescribed that can increase serotonin and noradrenalin levels, which may be low in fibromyalgia?

1 - amitriptyline
2 - sertraline
3 - gabapentin
4 -pregabalin

Answer 16

1 - amitriptyline
2 - sertraline

Question 17

Although medications are typically not always prescribed, which 2 of the following may be prescribed to slow nerve conduction, and potentially dampen pain sensations and help with sleep?

1 - amitriptyline
2 - sertraline
3 - gabapentin
4 -pregabalin

Answer 17

3 - gabapentin
4 -pregabalin

• inhibit pre-synaptic voltage-gated calcium channels and subsequent release of excitatory neurotransmitters