Fibromyalgia Flashcards
What is fibromyalgia?
Common disorder of central pain processing characterised by chronic widespread pain in all 4 quadrants of the body.
Allodynia is often present - a non-pain associated stimulus leading to pain.
Pathogenesis of fibromyalgia.
Can be induced by deliberate sleep deprivation.
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.
Explain the sleep deprivation in fibromyalgia.
Sleep disturbance is probably the trigger in most patients.
EEG studies show reduced REM sleep and delta wave sleep.
Symptoms and signs of fibromyalgia.
Pain
Joint/muscle stiffness
Profound fatigue
Unrefreshed sleep
Numbness
Headaches
Irritable bowel/bladder syndrome
Depression and anxiety
Poor concentration and memory (fibrofog)
Examination findings in fibromyalgia.
No physical abnormalities to MSK or neurological systems.
Patient’s may have “tender points” on palpation of their muscles.
There is no specific diagnostic test.
Explain tender points.
Present if the patient experiences excess discomfort when palpating with just sufficient pressure to blanch your finger nails.
Risk factors of fibromyalgia.
Affects 5% of pop.
Female 9:1 male
Middle age 40-50
Low housefold income
Divorced
Low educational status
Triggers such as emotional or physical like painful arthritis.
Diagnostic criteria of fibromyalgia.
Revised 2016 ACR criteria;
Generalised pain, defined as pain in at least 4 of 5 regions.
Symptoms have been present at a similar level for at least 3 months.
Widespread Pain Index (WPI) ≥7 and symptom severity scale (SSS) score ≥ 5 or WPI 4-6 and SSS score ≥ 9.
A diagnosis of fibromyalgia is valid irrespective of other diagnosis. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses.
AAPT criteria;
Multi-site pain defined as 6 or more pain sites from a total of 9 possible sites
Moderate to severe sleep problems OR fatigue
Multi-site pain plus fatigue or sleep problems must have been present for at least 3 months.
Treatment of fibromyalgia.
Education, pharmacological, CBT and physical.
Need to mind depression, fatigue and sleep disturbance and improve one those.
Many patients will improve with an explanation of their symptoms, improvement of sleep and increased physical activity levels.
Pharma includes low dose amitrypytiline, pregabalin may also be effective.
CBT can help as well.
Opiates are not recommended.
Why is it important to make investigations when diagnosing fibromyalgia?
ESR, CRP, FBC, U&Es, LFTs, Ca, CK and TFT should all be normal to exclude differentials.
