Fibromyalgia

Question 1

prevalence

Answer 1

2-3%
affects women more
20-50 years

Question 2

aetiology

Answer 2

genetic predisposition
environmental triggers eg stress
dysregulation of ANS and neuroendocrine

Question 3

common symptoms

Answer 3

chronic, widespread pain 
where muscles and tendons attach to bone 
fatigue 
headache 
unrefreshing sleep 
paresthesias
cognitive dysfunction 
ANS - bowel, weight, palpitations

Question 4

common associations

Answer 4

functional somatic syndromes eg chronic fatigue, IBS
depression/GAD
restless leg
rheumatoid, SLE

Question 5

How is fibromyalgia diagnosed?

Answer 5

clinical

Question 6

criteria used

Answer 6

2010 american college rheumatology - ACR

Question 7

criteria to diagnose

Answer 7

atleast 3 months
pain/tenderness up to 19 places
fatigue, sleep, depression
tender point examination

Question 8

differentials

Answer 8

myofascial pain syndrome
PMR
rheumatoid arthritis/SLE
malignancy

Question 9

initial treatment

Answer 9

patient education
graded exercise programmes/strength training
lifestyle - sleep hygiene, physical activity

Question 10

medications

Answer 10

low dose TCA
SNRI eg duloxetine
anticonvulsants eg gabapentin

Question 11

other non-pharmacological treatments

Answer 11

CBT

physio = hydrotherapy, heat

Question 12

yellow flag risk factors

Answer 12

female, age, low household income
emotional problems eg low mood, stress
lack of support, problems at work
social withdrawl

Question 13

What medication should be avoided?

Answer 13

NSAIDs and steroids as no inflammation

Question 14

allodynia

Answer 14

pain in response to non-painful stimulus

Question 15

hyperaesthesia

Answer 15

exaggerated perception of pain in response to a mildly painful stimulus