Fibromyalgia

Question 1

Describe the classical signs and symptoms of fibromyalgia?

Answer 1

>3m widespread pain
11/18 tender point sites
Stiffness 
Subjective swelling (fingers)
Paraesthesiae (tingling in fingers)

Symptoms fluctuate

Fatigue (worse in the morning)
Non-restorative sleep
Poor concentration
Irritability/weepiness

Cold insensitivity

May also have: IBS, tension headaches, irritable bladderi, allodynia, chronic fatigue

Question 2

What other differentials should be considered and tested for in a patient with suspected fibromyalgia?

Answer 2

• Hypothyroidism (TFTs)
• Hyperparathyroidism (Ca)
• CTD e.g. sle, pmr (ANF, FBC, ESR)
• Osteomalacia (Vit D, ALP)
• Myositis (CK)
• Anaemia (FBC)

Malingering

Question 3

What is the approximate prevalence of fibromyalgia and is there a gender variance?

Answer 3

Approximately 2% of the population

Women:Men 7:1

Question 4

What are the recognised associations with fibromyalgia?

Answer 4

Anxiety and depression.
Somatisation

Poor education + low income
Divorce
Childhood trauma

Other disease
FH

Question 5

What are the abnormalities in sleep and pain pathology in fibromyalgia?

Answer 5

Reduced amount of delta sleep

Abnormal pain processing with: allodynia & hyperalgesia:

• augmented pain processing on fMRI studies
• increased concentrations of the pain-transmitting neuropeptide substance P in the CSF

Question 6

How should fibromyalgia be managed?

Answer 6

Acknowledge symptoms

Patient education: no inflammation or damage, cycle of loss of sleep and pain

Lifestyle changes: sleep hygiene and exercise, graded exercise therapy

Medication review:

• Stop ineffective medications.
• Treat pain generators (amitryptyline at night +/- fluoxetine) may intolerant to amitryptyline

CBT, relaxation techniques, coping strategies encouraged