What is fibromyalgia?
Fibromyalgia is a chronic pain syndrome diagnosed by the presence of widespread body pain.
What are the risk factors for fibromyalgia?
- Family history of fibromyalgia
- Rheumatological conditions
- Age 20-60
- Female sex
What are the symptoms of fibromyalgia?
- Chronic pain
- Fatigue unrelieved by rest
- Sleep disturbance
- Mood disturbance
- Cognitive dysfunction
- Headaches
- Numbness and tingling sensations
What are the signs of fibromyalgia?
- Diffuse tenderness of examination
What investigations should be ordered for fibromyalgia?
- Clinical diagnosis
- ESR/ CRP
- Thyroid function test
- FBC
- Rh factor
- Anti-CCP antibody
- ANA antibody
Breifly describe how fibromyalgia is a clinical diagnosis
There is no x-ray or laboratory testing for fibromyalgia; the diagnosis is strictly clinical. If the patient does not meet clinical criteria for a diagnosis of fibromyalgia, then some further tests may help explain the patient’s musculoskeletal pain or fatigue.
Presence of chronic (>3 months), widespread body pain and associated symptoms such as fatigue and sleep disturbance.
Why investigate ESR/ CRP? And what may this show?
- To exclude inflammatory cause of muscular pain or fatigue.
- May be normal.
Why investigate thryoid function test? And what may this show?
- To exclude hypothyroidism.
- Likely to be normal.
Why investigate FBC? And what may this show?
- To exclude anaemia as a cause for fatigue or iron deficiency as a cause for muscle pain and fatigue.
- Likely to be normal.
Why investigate Rh factor? And what may this show?
- To exclude rheumatoid arthritis; indicated only if true arthritis is present.
- Likely to be normal.
Why investigate anti-CCP factor? And what may this show?
- To exclude rheumatoid arthritis; indicted only if true arthritis is present.
- Likely to be normal.
Why investigate ANA antibody? And what may this show?
- To exclude systemic lupus erythematosus (SLE). Indicated only if true arthritis or other signs or symptoms of SLE are present.
- Likely to be normal.
Briefly describe the treatment for fibromyalgia
- Pharmacotherapy including tricyclic antidepressants (TCAs), serotonin-noradrenaline reuptake inhibitors (SNRIs), and gabapentinoids.Often patients benefit from two or three drug classes used together, whereas other patients respond to (or need) only one class.
- Non-pharmacological therapies, such as education, exercise, and cognitive behavioural approaches.
What is the role of tricyclic antidepressants (TCAs) in fibromyalgia?
Give examples of TCAs used in fibromyalgia
- Improve sleep and visceral motility as well as pain.
- Amitriptyline and cyclobenzaprine.
What is the role of serotonin-noradrenaline reuptake inhibitors (SNRIs) in fibromyalgia?
Give examples of SNRIs used in fibromyalgia
- First choice for patients with comorbid depression or fatigue.
- Duloxetine and milnacipran.
What is the role of gabapentinoids in the treatment of fibromyalgia?
Give examples of gabapentinoids in fibromyalgia
- First choice for a patient with significant comorbid sleep issues.
- Pregabalin and gabapentin.
What differentials should be considered for fibromyalgia?
- Myofascial pain syndrom (MPS)
- Vitamin D deficiency
- Chronic fatigue syndrome (CFS)
How does fibromyalgia and myofascial pain syndrome (MPS) differ?
- Differentiaing signs and symptoms: myalgia is localised, typically to an extremity and the attached truncal musculature. In contrast to the tender points of fibromyalgia, trigger points are the hallmark of MPS, with pressure over these areas not only reported as tender but causing radiation and reproduction of the pain.
- Diffentiating investigations: patients with localised MPS do not have evidence of widespread central sensitisation.
How does fibromyalgia and vitamin D deficiency differ?
- Differentiating signs and symptoms: low vitamin D levels are associated with widespread body pain; however, this may not be causal but may instead be due to low outdoor activity and sunlight exposure in people with chronic pain.
- Differentiating investigations: serum 25-hydroxyvitamin D level is low.
How does fibromyagia and chronic fatigue syndrome (CFS)?
- Differentiating signs and symptoms: considerable overlap between fibromyalgia and CFS, with most patients with fibromyalgia meeting criteria for CFS, and most CFS patients reporting widespread body pain.
- Differentiating investigations: no differentiating tests.
