fibromyalgia Flashcards
what is fibromyalgia?
A common disorder of central pain processing characterised by chronic widespread pain in all 4 quadrants of the body (both sides and above and below the waist).
Allodynia, a heightened and painful response to innocuous stimuli, is often present.
what is the pathogenesis of fibromyalgia?
It can be induced by deliberate sleep deprivation.
Sleep disturbance is probably the trigger in most patients -EEG studies show reduced REM sleep and delta wave sleep.
This causes hyper-activation in response to noxious stimulation, and neural activation in brain regions associated with pain perception in response to non-painful stimuli.
what are the symptoms of fibromyalgia?
- pain
- joint/ muscle stiffness
- unrefreshed sleep
- numbness
- headaches
- irritable bowel/bladder syndrome
- depression and anxiety
- poor concentration and memory “fibrofog”
on examination, what will you observe in a patient with fibromyalgia?
no physical abnormalities to MSK or neurological systems
may have tender points on palpation of muscles
what are the risk factors for fibromyalgia?
- female
- 40-50
- may have a trigger, emotional or physical e.g painful arthiritis
how is fibromyalgia treated?
- tailor based on pain intensity, function and associated features e.g depression, fatigue and sleep disturbance
- many patients will improve with an explanation of their symptoms
- drug treatment is mainly with low dose amitrypytline
- pregabalin may be effective if amitrptyline is ineffective
- opiates are not reccomended
- CBT may be effective
- encourage physical activity
what blood tests can be used to exclude other pathology?
ESR, CRP, FBC, U+E, LFT, Ca, CK and TFT
otherwise diagnoisis of fibromyalgia is clinical
what are some psychosocial risk factors for developing persistant, chronic pain?
- Belief that pain and activity are harmful.
- Sickness behaviours such as extended rest.
- Social withdrawal.
- Emotional problems such as low mood, anxiety, or stress.
