Fibromyalgia Flashcards
Define fibromyalgia
chronic (>3 mo), widespread (axial, left- and right-sided, upper and lower segment), nonarticular pain with characteristic tender points
Dx of fibromyalgia
- Widespread pain index (WPI) ≥7 (out of 19) and symptom severity score (SS) ≥5 or WPI 3-6 and SS ≥92. Symptoms have been present at a similar level for ≥3 mo3. The patient does not have a disorder that would otherwise explain the pain
Epidemiology of fibromyalgia
• F:M = 3:1• primarily ages 25-45, some adolescents• prevalence of 2-5% in general population• overlaps with chronic fatigue syndrome and myofascial pain syndrome• strong association with psychiatric illness!!
Px of fibromyalgia
• widespread aching, stiffness• easy fatiguability• sleep disturbance: non-restorative sleep, difficulty falling asleep, and frequent wakening• symptoms aggravated by physical activity, poor sleep, emotional stress• patient feels that joints are diffusely swollen although joint examination is NORMAL• neurologic symptoms of hyperalgesia, paresthesias• associated with irritable bowel or bladder syndrome, migraines, tension headaches, restless legs syndrome, obesity, DEPRESSION & ANXIETY
Ix of fibromyalgia
• bloodwork: includes TSH and ESR; all typically NORMAL unless unrelated, underlying illness present• serology: do not order ANA or RF unless there is clinical suspicion for a connective tissue disease• laboratory sleep assessment
DDx of fibromyalgia
• diagnosis of exclusion• rule out other disorders by history and physical exam
Rx of fibromyalgia
Conservative- Education- Exercise program- Stress reduction, Cognitive behavioural therapy- MeditationMedical- low dose tricyclic antidepressants (e.g. amitriptyline)- SRI: duloxetine, milnacipra- anticonvulsant: pregabalin, gabapentin- analgesics (NSAIDs)
Prognosis of fibromyalgia
variable; usually chronic, unless diagnosed and treated early
