Fibromyalgia

Question 1

What is fibromyalgia?

Answer 1

A complex syndrome characterised by chronic pain & fatigue with multiple areas of tenderness
It has no definitive aetiology or pathophysiology therefore most clinicians agree that it is a biopsychosocial disease
Comprises around 10% of all rheum referrals

Question 2

What are the faces of fibromyalgia

Answer 2

Insomnia
Brain fog (fibrofog)
Fatigue 
Widespread pain 
Morning stiffness

Question 3

Risk factors of fibromyalgia

Answer 3

Female (10:1 predominance)
Middle age
Divorce
Low education/socioeconomic status
Commonly linked with a stressful event e.g. death of a loved one, physical trauma, operation etc.

Question 4

Signs and symptoms of fibromyalgia

Answer 4

Multiple tender points 
Chronic pain >3 months
Fatigue
Morning stiffness (90%)
Poor concentration
Fibrofog – lose memory or fact retention issues
Low mood 
Sleep disturbance

Question 5

Diagnostic features of fibromyalgia

Answer 5

Fibromyalgia is difficult to diagnose – no single specific test to diagnose
Usually lab based investigations are normal – be wary of over investigating as can often make disease worse

Question 6

What is the key difference between fibromyalgia and other rheum conditions?

Answer 6

NO SYNOVITIS - joint swelling - in fibromyalgia

Question 7

What are the 3 American College of Rheum (2010) diagnostic criteria for fibromyalgia?

Answer 7

1. Pain and symptoms over the last week, based on total number of painful areas on the body PLUS severity of:
   o Fatigue
   o Waking unrefreshed
   o Cognitive (memory or thought problems)
2. Symptoms lasting >3 months on a similar level
3. No other health problem to explain symptoms

Question 8

What type of condition could fibromyalgia be considered as?

Answer 8

Biopsychosocial disease
Somatoform condition - physical manifestation of psychological/psychiatric disease
(don’t say either of these to patients!!!)

Question 9

What are the non pharmacological management methods of fibromyalgia?

Answer 9

Patient education and family 
Explanation and reassurance 
CBT/counselling 
Activity pacing 
Support groups

Question 10

What are the pharmacological management methods of fibromyalgia?

Answer 10

Anti-depressants - SSRIs e.g. duloxetine & amitriptyline (because this is also used to treat neuropathic pain)
Gabapentin/ pregabalin
Opioids – which aren’t that useful so tend not to prescribe