Fibromyalgia

Question 1

What is fibromyalgia?

Answer 1

Fibromyalgia is a syndrome characterised by widespread pain throughout the body, with tender points at specific anatomical sites

Question 2

What are the risk factors for fibromyalgia?

Answer 2

Female
Family history of fibromyalgia
30-50 years olf

Question 3

What are the features of fibromyalgia?

Answer 3

Chronic pain
Lethargy
Cognitive impairment
Sleep disturbance
Headaches
Dizziness

Question 4

Where are the specific tender points in fibromyalgia?

Answer 4

Occiput
Low cervical region
Trapezius
Supraspinatus
Second rib
Lateral epicondyle
Gluteal region
Greater trochanter
Knees

Question 5

What clinical tools are used to assess for fibromyalgia?

Answer 5

Widespread pain index - divides the body into 19 regions and patient reports which ones are painful

Symptom severity score - assesses fatigue, sleep and cognitive symptoms

Question 6

What are the score thresholds for diagnosis of fibromyalgia?

Answer 6

Widespread pain index more than 7, symptom severity >5

Symptoms have been present at a similar level for at least 3 months

Patient does not have a disorder that would otherwise explain the pain

Question 7

What investigations can be performed to exclude other conditions in suspected fibromyalgia?

Answer 7

TFTs
ESR
Autoimmune screen
Creatinine kinase
Bone profile
LFTs

Question 8

What is the first line management of fibromyalgia?

Answer 8

Patient education and explanation of the condition
Physical therapy - aerobic exercise

Question 9

What are the second line management options of fibromyalgia?

Answer 9

Psychological therapies - CBT, antidepressants
Pain medications
- Duloxetine
- Pregabalin
- Amitriptyline
Multimodal rehabilitation programs