Fibromyalgia Flashcards
There are 2 mechanisms of pain. What are they?
Peripheral (nociceptive)
Central (non-nociceptive)
What is the difference between peripheral and central pain?
Peripheral pain occurs due to actual inflammation or damage stimulating nociceptors
Central pain does not involve nociceptors, it is a central disturbance in the processing of pain, not a result of damage
Which type of pain, peripheral or central, is responsive to analgesics?
Peripheral
Central is not as responsive
Give some examples of peripheral pain?
Osteoarthritis
Pain post-surgery
Cancer pain
Give some examples of central pain?
Fibromyalgia
IBS
Which type of pain, peripheral or central, is responsive to biopsychosocial factors?
Central
We all have a ‘thermostat’ that determines how we feel pain.
What controls the thermostat (turns it up and down)?
Genes
The environment we grow up in and live in
What is fibromyalgia?
A rheumatic condition characterized by musculoskeletal pain with stiffness and localized tenderness at specific points on the body
Widespread pain after other diseases have been excluded
How can you diagnose pain as being caused by fibromyalgia?
Symptoms present for at least 3 months
Pain at 11 of 18 defined tender sites on digital palpation
When palpating the tender sites during examination of patient with suspected fibromyalgia, how hard should you do it?
Hard enough that your nailbed goes white
What are the risk factors of developing fibromyalgia?
Female gender Middle age Low household income Low educational status Divorced
Psychosocial factors
What are the psychosocial risk factors of fibromyalgia?
Belief that pain + activity are harmful
Sickness behaviour, such as extended rest
Social withdrawal
Emotional problems: low mood, stress, anxiety
Problems at work
Lack of support
List some disorders closely related to fibromyalgia?
Depression
Chronic headache
IBS
Chronic fatigue syndrome
Who gets fibromyalgia?
Women more than men
Often middle age + over 60
What sort of pain is experienced in fibromyalgia?
All over, but predominantly neck and back
Generalised morning stiffness
Paraesthesia of hands + feet
Pain is aggravated by stress, cold, activity
What are the clinical features of fibromyalgia?
Pain
Fatigue
Non-restorative sleep:
- frequent waking
- waking unrefreshed
Headache, diffuse abdominal pain
Depressive symptoms
What depressive symptoms do you see in fibromyalgia?
Apathy: lack of emotion
Agitated, irritable, tearful
Low mood
Poor concentration
Why does frequent waking in the night cause people to wake up unrefreshed?
Frequent waking means you never get to the stage of sleep involving REM and non-REM patterns
Without these you wake up unrefreshed
What triggers fibromyalgia?
Peripheral pain syndromes
Infection
Physical trauma
Psychological stress, PTSD
Hormonal alterations
Catastrophic events like war
Investigation of fibromyalgia?
To diagnose fibromyalgia you need to rule out every other possible cause
If it is fibromyalgia most tests will be normal
Blood:
- ESR/CRP normal
- creatinine levels normal
- no serum autoantibodies
- Vit D levels normal
Management of fibromyalgia?
Education
Help them gain coping strategies
Explain there is no actual damage happening to the body when they feel pain
Explain the importance of exercise, they will feel pain initially but exercise will make it go in the long run
Reset the pain thermostat
Pain management programmes
Drugs: low dose amitriptyline (an antidepressant) helps with sleep
Why is exercise a vital part of managing fibromyalgia?
Although it will cause pain initially, exercise helps with sleep
Getting better sleep helps with mood
Also helps to reset the pain thermostat
What is joint hypermobility?
Joints that move easily beyond their expected range
Can cause widespread joint pain in young people
Joint hypermobility is very rare.
True or false?
False
It’s really common in children
Who gets painful joints caused by hypermobility?
Common in people between age 10 and 20
What is benign joint hypermobility?
A condition that affects joints and soft tissue
Hypermobile joints
Hyper-extensible skin
Tendency to recurrent sprain or dislocation
What genetic conditions have benign joint hypermobility as a feature?
Ehlers Danlos syndrome
Marfan’s syndrome
