Fibromyalgia

Question 1

Define Fibromyalgia

Answer 1

Chronic pain syndrome diagnosed by presence of widespread body pain

Question 2

Criteria for Fibromyalgia

Answer 2

Widespread pain (front and back, right and left, both sides of the diaphragm)
For at least 3 months
In addition to tenderness (digital palpation at an approximate force of 4 kg)
Of at least 11 out of 18 designated tender point sites

Question 3

Aetiology of Fibromyalgia

Answer 3

Nociplastic pain
Central sensitisation syndrome/chronic overlapping pain conditions (IBS, temperomandibular joint disorder, interstitial cystitis, vulvodynia, tension headache)

Primary: no other cause of pain (most common)
Secondary: Infections (EBV, Lyme disease) | Injury, physical trauma | emotional trauma | major surgery | peripheral pain syndrome e.g. osteoarthritis, RA

Question 4

Risk factors for Fibromyalgia

Answer 4

Family history
Rheumatological conditions
20-60
Female

Question 5

Symptoms of Fibromyalgia

Answer 5

Chronic, widespread pain
Fatigue unrelieved by rest
Sleep disturbance
Mood disturbance e.g. depression, anxiety
Cognitive dysfunction
Headaches (Axial in nature | May extend into the neck and shoulders)
Numbness/tingling sensation
Stiffness
Sensitivity to sensory stimuli e.g. bright lights, odours, noises

Question 6

Signs of Fibromyalgia on examinations

Answer 6

Diffuse tenderness (NO evidence for a systemic disease (e.g. joint inflammation or muscle weakness) causing the widespread pain.)
Stiffness

Question 7

Investigations for Fibromyalgia

Answer 7

Clinical diagnosis - Presence of chronic (>3 months), widespread body pain and associated symptoms such as fatigue and sleep disturbance

Exclusion:
ESR/CRP
TFTs
FBC
Rheumatoid factor, anti-CCP antibody 
Antinuclear antibody 
Vitamin D level