Fibromyalgia Flashcards
definition of fibromyalgia
chronic pain syndrome diagnosed by presence of widespread body pain
front and back, L and R, both sides of diaphragm for at least 3mo
tenderness at 11 out of 18 tender point sites
CNS driven pain amplification syndrome
epidemiology of fibromya;gia
10% referrals to rheumatology clinic
prev - 0.5-4%
RF for fibromyalgia
female
middle age
low household income
divorced
low educational status
yellow flags:
- belief that pain and activity are harmful
- sickness behaviour eg extended rest
- social withdrawal
- emotional problems eg low mood, anxiety, stress
- problems or dissatisfaction at work#
- problems with claims for compesnation of time off
- overprotective family or lack of support
- inappropriate expectations of treatment, eg low active participation in treatment
associations with fibromyalgia
other somatic syndromes eg chronic fatigue syndrome, IBS chronic headache syndrome
RA AS SLE
aetiology of fibromyalgia
mechanism of pain originating from the CNS is nociplastic pain - pain and sensory amplification
fundamental problem with augmented pain or sensory processing in CNS
imbalance in neurotransmitters
maybe small fibres of peripheral nerves abnormal or structural abnormalities in the brain
genetic
signs and symptoms of fibromyalgia
>3mo pain ie chronic
widespread - L and R, above and below waist, axial skeleton
profound fatigue - unrefreshing sleep
sig fatigue and pain with small increase in physical exertion
morning stiffness
paraesthesia
headache - migraine and tension
poor concentration
low mood
sleep disturbance
widespread and severe tender points
investigations for fibromyalgia
all normal
dx is clinical
over investigation can consolidate illness behaviour - but exclude other causes of pain/fatigue
mx of fibromyalgia
Meds
* TCAs eg amitriptyline
* SNRI
* pregabalin
education, exercise, CBT
consider referral to a psychologist
patient education for fibromyalgia
chronic condition
with good exercise, CBT - can expect to improve over time
