fibromyalgia

Question 1

what is fibromyalgia syndrome?

Answer 1

a chronic pain disorder
also presents with fatigue

Question 2

is fibromyalgia more common in females or males?

Answer 2

-females
-3:1 ratio

Question 3

what are the common symptoms of fibromyalgia syndrome?

Answer 3

-widespread pain
-fatigue
-poor sleep
-low mood

Question 4

what are the risk factors of fibromyalgia?

Answer 4

-childhood trauma
-past trauma
-female
-stress
-genetics
-can be secondary to other auto-immune rheumatology conditions eg RA

Question 5

describe the pathophysiology of fibromyalgia

Answer 5

-not fully understood
-now considered to be related to altered CNS processing

Question 6

define allodynia

Answer 6

pain due to a stimulus which is not normally painful eg light touch, pressure

Question 7

define hyperalgesia

Answer 7

increased response to a normally painful stimulus ie feels more painful than normal

Question 8

what is central sensitisation?

Answer 8

Central sensitisation is defined as an increased responsiveness of nociceptors in the central nervous system
-ie hypersensitivity to pain, pain with non - noxious stimuli

Question 9

what are the main features of central sensitisation?

Answer 9

-wide spread distribution of stimuli
-inconsistent aggs and eases
-allodynia
-hyperalgesia
-pain has a mind of its own

Question 10

what are examples of other fibromyalgia other than pain, fatigue etc?

Answer 10

-sleep disturbance
-chemical sensitivities
-dysmenorrhea (painful periods)
-numbness or pins and needles
-depression / anxiety
-cognitive impairment

Question 11

what does the ACR fibromyalgia diagnostic criteria involve?

Answer 11

-generalised pain,
-widespread pain index of greater than 7
-symptoms being present for at least 3 months

Question 12

what are other conditions that can also cause central sensitisation?

Answer 12

-chronic fatigue syndrome
-tension type headache
-migraines
-TMJ disorders
-restless leg syndrome
-primary dysmenorrhea (cramping that comes before and during period)

Question 13

What are examples of differential diagnosis to FM?

Answer 13

-RA
-lupus
-Polymyositis
-AS - spondyloartropathies
-hypothyroidism

Question 14

should blood tests be normal with FM?

Answer 14

yes

Question 15

how do we manage FM?

Answer 15

-multi modal approach
-stress management eg CBT
-pharmacological
-exercise
-lifestyle modification

Question 16

what is involved in non-pharmacological management of FM?

Answer 16

-education / self management
-exercise / physical activity
-physical therapies
-psychological therapies

Question 17

how is FM managed with drugs?

Answer 17

-centrally acting drugs - affecting the CNS
-eg anti-depressants such as amitryptiline
-eg 2) anti-seizure meds

Question 18

how do we assess subjectively and physically for FM?

Answer 18

-subjective - pain locations, symptoms, medical history, mood, hobbies etc
-physical - pressure pain threshold, posture, ROM, strength , functional ability

Question 19

what is an example of a good outcome measure for fibromyalgia?

Answer 19

-fibromyalgia impact questionnaire

Question 20

what is pressure pain threshold?

Answer 20

the minimum force applied that causes pain

Question 21

what are examples of lifestyle modification that is recommended for FM pts?

Answer 21

-planning the week
-reducing the length of working day
-pacing activity and work
-allowing time for exercise
-energy conservation

Question 22

how can CBT help with FM patients?

Answer 22

-help them to realise its a manageable condition
-recognise that they are not helpless
-break the vicious cycle
-goal setting
-allows pt to identify triggering events and moods