Fibromyalgia

Question 1

How common is Fibromyalgia?

Answer 1

2-3% prevalence

• 7% in females >70yrs
• 10:1 female preponderance

Question 2

What are the risk factors for Fibromyalgia?

Answer 2

Life events associated w/ life distress

• divorce
• alcoholism in the family
• traumatic injury
• low income

Question 3

How is Fibromyalgia diagnosed?

Answer 3

Diagnosis of exclusion

Question 4

What are the diagnostic criteria for Fibromyalgia?

Answer 4

Widespread pain >3mo
Pain elicited by digital pressure at 11 or more defined pressure points
Hyperalgesic withdrawal response in all 4 quadrants

Question 5

What causes Fibromyalgia?

Answer 5

Sleep abnormalities
-reduced delta sleep
Abnormal pain processing
-reduced pain tolerance at characteristic sites

Question 6

What are the common sx of Fibromyalgia?

Answer 6

Multiple regional pain
Marked fatigability
Low affect, irritability, weepiness
Poor concentration, forgetfulness
Non-restorative sleep

Question 7

What are the variable locomotor sx of Fibromyalgia?

Answer 7

Early morning stiffness
Subjective swelling of fingers only
Numbness, tingling of all fingers

Question 8

What are the additional non-locomotor sx of Fibromyalgia?

Answer 8

Non-throbbing bifrontal headache (tension)
Colicky abdo pain, bloating, variable bowel habit (IBS)
Bladder fullness, nocturnal freq (irritable bladder)
Hyperacusis, dyspareunia, discomfort when touched (allodynia)
Common s/e w/ drugs (chemical sensitivity)

Question 9

What is Chronic Fatigue Syndrome?

Answer 9

Chronic fatigue made worse by minimal exertion

• fatigue both physical & mental
• occurs in same conditions as Fibromyalgia

Question 10

What bloods must be taken in Fibromyalgia to rule out alternative, treatable conditions?

Answer 10

FBC (anaemia, lymphopenia)
ESR, CRP (inflam disease)
TFTs (hypothyroidism)
Ca, Alk Phos (hyperparathyroidism, osteomalacia)

Question 11

What key information should be given to Fibromyalgia pts as part of pt education?

Answer 11

Individual’s disease does not reflect inflammation/damage

Self-perpetuating cycle involving loss of sleep & pain

Question 12

What lifestyle advice should be given to Fibromyalgia pts?

Answer 12

Sensible increases in activity help to improve sleep/have beneficial impact on sx
-formalised as graded exercise therapy

Question 13

What is the medical management of Fibromyalgia?

Answer 13

Low-dose Amitryptyline (10-75mg nocte)

• reduces excess transmission of sleep
• increases restorative sleep
• v. effective but Fibro pts often intolerant

Question 14

What self-help strategies can be used in the management of Fibromyalgia?

Answer 14

CBT
Relaxation techniques
Coping strategies