Fibromyalgia

Question 1

A 46 yo female presents complaining of diffuse MSK pain. Exam, labs, and imaging show no obvious pathological cause. What is the most likely diagnosis? What is the pathophys behind this disorder?

Answer 1

Fibromyalgia Syndrome
Decreased descending inhibitory input from the brain and spinal interneurons
Less blood flow of pain processing areas of brain
Increased substance P
Decreased pain tolerance!!

Question 2

A 31 yo female presents complaining of dizziness, HA, cold intolerance, significant constipation, depression, anxiety, fatigue, insomnia, and stiffness. After ruling out various conditions including hypothyroidism, sleep apnea, infection, and PMR, what do you suspect? What are the 4 factors to diagnose this condition?

Answer 2

Fibromyalgia

1. widespread body pain
2. involves > 3 quadrants
3. at least 3 mo in duration
4. no other cause for pain

Question 3

A 38 yo female presents complaining of fatigue, sleep disturbances, stiffness, slight loss of sensation, HA, and IBS. She has had pain for the past 4 months on both sides of her body, and 16 out of the 18 tender points are positive on digital exam. What control points could you test?

Answer 3

Fibromyalgia

Mid-forehead, thumbnail, volar surfacce of mid-forearm, anterior mid-thigh

Question 4

A 56 yo female presents complaining of diffuse pain and stiffness for the past 5 months. She has pain all over her body a well as dizziness, HA, sensitivity, endocrine imbalance, IBS, irritable bladder, and restless legs. What work-up should you do for this pt?

Answer 4

Fibromyalgia
CBC, chemistries, ESR, TSH, CPK
Rheumatoid factor, ANA
Imaging
NCV/EMG
Sleep study!

Question 5

A 45 yo female presents with fatigue, stiffness, anxiety, esophageal dysmotility, allergies, non-cardiac chest pain, thoracic outlet syndrome, tendinitis, dizziness, and HA. All diagnostics come back negative, but the sleep study shows sleep disturbances. What do you suspect? What could you recommend?

Answer 5

Fibromyalgia
Patient Education
Antidepressants (Duloxetine, Cyclobenzaprine)
Pregabalin
Tramadol
Milnacipran
Exercise, improve sleep, treat psych distress

Question 6

How do you treat fibromyalgia?

Answer 6

Antidepressants - Duloxetine, Cyclobenzaprine
Pregabalin
Tramadol
Milnacipran
Exercise, improve sleep, treat psychological distress

Question 7

In order to Dx fibromyalgia, a pt must present with at least 3 months of…?

Answer 7

R & L sided body pain

> 11 of 18 tender points on digital exam w/ 4kg pressure