Fibromyalgia

Question 1

What is Fibromyalgia?

Answer 1

Fibromyalgia is a chronic pain disorder. The cause of fibromyalgia is unknown, but there is some evidence for a genetic predisposition, abnormalities in the stress response system or hypothalamic-pituitary axis, and possible triggering events.

Question 2

What will you find on history taking of someone with Fibromyalgia?

Answer 2

Symptoms:
Chronic widespread pain associated “pain all over”
Gnawing, lancinating type of pain or accompanied by numbness or tingling.
Unrefreshing sleep and tiredness
Memory Problems/Mood changes

Risk Factors:
Inflammatory bowel disease
Patient may have lost faith in doctors, and have anxiety

Specific Questions to ask:
Family histroy of chronic pain
How long, needs to be >3 months to be diagnostic
Where is the pain, need to be on right and left, axial and perihperal

Differentials:
Vitamin D deficiency - Can also lead to widespread pain, look for vit D levels
Chronic fatigue syndrome - Very similair conditions, commonly overlap
Rheumatoid Arthritis - Commonly Co-exist, will have signs of RA
Hypothyroidism - Commonly tired and general aches , look at TSH
Anaemia - Can have tiredness, iron defiicicney can also cause muscle pain. Look at FBC
SLE - Has similar features, but if you meet the criteria for SLE you have that aswell/instead. Also ANA test

Question 3

What will you find on examination of a patient with Fibromyalgia?

Answer 3

End of the bed:
Palpation in at least 11 of 18 defined tender points set out
Push till your nail blanches
Normal exam apart from that

Question 4

What investigations will you order in Fibromyalgia?

Answer 4

There are confirmatory tests for fibromyalgia, exclude all other causes and if they meet the criteria, they have it. All their tests should be normal!

Bloods:
ESR/CRP - Should be normal and excludes inflammatory conditions
TFT - To exclude hypothyroidism
FBC - Exclude iron deficiency anaemia
Rheumatoid Factor - To exclude rheumatoid arthritis
CCP antibody - To exclude rheumatoid arthritis
ANA - To exclude SLE
Vitamin D levels - to exclude vitamin D deficiency

Question 5

What is the treatment of Fibromyalgia?

Answer 5

Lifestyle:
Exercise - Stuff like yoga/t’ai chi
Education - cannot be cured, but positive attitude and exercise help
CBT
Keep an eye out for depression - psychologist referral if needed

Medical:
Tricycylic Antidepressant - Amitriptyline