Fibromyalgia Flashcards
What should be asked when a patient presents with widespread pain and fatigue?
Exacerbating/relieving factors
Variability during day
Systemic features e.g. weight loss night sweats - malignancy
Weight gain, reduced appetite, hair loss - hypothyroidism
Sleep - unrefreshing sleep = fibromyalgia
What is needed for a diagnosis of fibromyalgia?
Chronic widespread pain (over 3 months), both sides of the body, above and below the waist and along the axial spine
Poor sleep
Poor concentration
What are the differentials for fibromyalgia?
Endocrine - Addison’s, hypothyroid, vitamin D deficiency
Infection - Hep C, HIV
Rheum - RA, SLE, PR
Malignancy - lymphoma
What is needed on examination for a diagnosis of fibromyalgia?
11 or more tender points out of 18
Where are the 18 fibromyalgia tender points?
Occiput at nuchal ridge Trapezius Supraspinatus Gluteal Low cervical Second rib Lateral epicondyle Greater trochanter Medial knee
What can be used to score fibromyalgia?
Widespread pain index
Symptom severity score
What are the ACR criteria for diagnosing fibromyalgia?
WPI of 7 and SS score of 5 OR WPI 3-6 and SS 9 Symptoms at same intensity for 3 months No other disorder explains the pain
What investigations should be done for fibromyalgia?
TFTs Vitamin D Vitamin B12 Iron studies Magnesium ESR/CRP
How can fibromyalgia be explained to patients?
A pain condition, not due to inflammation, may be due to chemical changes in the body’s pain pathways
What is the treatment for fibromyalgia?
Patient education
Exercise
Screen for anxiety and depression
Hydrotherapy, acupuncture
How is severe pain in fibromyalgia treated?
Duloxetine
Pregabalin
Tramadol
How is severe sleep disturbance in fibromyalgia treated?
Low dose amitriptyline
Cyclobenzapine
Pregabalin
What is prognosis in fibromyalgia based on?
Yellow flags - biopsychosocial indicators
What are the risk factors for fibromyalgia?
Low household income Lack of further education Female FH Traumatic events
