Fibromyalgia profoma Flashcards
What is fibromyalgia?
Chronic widespread MSK/muscle pain associated w/ stiffness & localised tenderness.
Disorder of sensory processing of non-nociceptive input.
Differs from arthritis which is specific to joints.
Overlap between fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, post-traumatic syndrome, migraines, myofascial pain syndromes.
Seen in rheumatic conditions
Epidemiology of fibromyalgia
- Common: 2-5%
- x3 more common in women than men.
- Rises w/ age to a maximum in 60s
Aetiology of fibromyalgia
Poorly understood
Often associated with a FH of fibromyalgia
Theories:
- Post viral trigger & then up-regulation of pain receptor sensitivity.
- Genetic - familial clustering, HLA associations.
- Trauma - leg fracture, hyper-mobility, neck trauma.
- CNS/Autonomic- Altered pain threshold, Increased heart rate
Risk factors for fibromyalgia
Women
Middle age
Stressful & traumatic life events
psychiatric illness
Obesity
Family history
Clinical features of fibromyalgia
- Fatigue - both physical & mental
- Sleep disturbance - light sleep 8-10 hrs = unrefreshed. Slow wave disruption triggers fibromyalgia.
- Stiffness & morning stiffness
- Poor concentration
- Paraesthesia - tingling
- Anxiety/depression - greater prevalence if familial.
- Altered bowel habit
- Widespread pain!
- Hyperalgesia & allodynia - extreme sensitivity to pain & extreme sensitivity to touch. Allodynia is a type of neuropathic pain (nerve pain).
- Cold hands
Description of Pain in Fibromyalgia
- “It hurts all over”
- May have a focus, but shifts
- Burning, radiating, gnawing
- Worse than that of RA
- Cold damp weather makes it worse
- Exhibit hyperalgesia & allodynia
Examinations will ONLY show soft-tissue tenderness:
- Tender points are the only reliable physical finding
- No muscle weakness
- Widespread myofacial tenderness
- No synovial inflammation
Classification criteria for fibromyalgia
- Pain for at least 3 months
- Upper & lower body
- Right & left sides
- Axial skeleton involvement - Widespread pain (index)
- 11 out of 18 tender points
- Suboccipital
- Lower cervical
- Trapezius
- Supraspinatus
- 2nd rib
- Lateral spicondyle
- Gluteal
- Greater trochanter
- Knee (medial fat pad) - Symptom severity score
- A: fatigue, waking unrefreshed, cognitive symptoms.
- B: List of 40 other wide ranging symptoms (headache, itching, change in taste, hair loss) - Symptoms have no other explanation
Investigations for fibromyalgia
These are used to exclude other conditions, should be normal in fibromyalgia!
Blood tests:
- ESR & CRP- elevated in PMR, SLE or inflammatory arthritis.
- Calcium levels - high in bony metastases or low in osteomalacia
- PTH- exclude hyperparathyroidism.
- Vitamin D - low in osteomalacia
- Serum alkaline phosphatase - elevated in Paget disease.
- Immune screening for antibodies e.g. anti-CCP (ANA, anti-dsDNA, complement) - abnormal in SLE
Radiology:
- Erosive changes - arthritis
- Long bones - looser zones seen in osteomalacia
- Suspection of malignancy
Diagnosis is clinical
often co-morbid w/ rheumatological condition
Management for fibromyalgia: conservative
Patient education
- Inform of condition - it is not all in their head
- Reassure that there is not destructive arthritis
- Explain why further investigations are not useful
- Emphasise that exercise will not cause joint harm
Psychological management
- CBT - helps develop coping mechanisms to deal w/ symptoms.
- Biofeedback - mind-body technique that teaches people to recognise the physical signs & symptoms of stress e.g. increased heart rate, muscle tension.
- Meditation - about stress relief.
Physio & exercise - Improves fitness & reduces pain & fatigue
Management for fibromyalgia: pharmacological
Tricyclic antidepressants e.g. amitriptyline.
Selective serotonin reuptake inhibitors
DO NOT GIVE STEROIDS!
Prognosis for fibromyalgia
(better)
- Young age
- Lower pain score
- Better outcome in community studies, where (at best) 25% remit at 2 years.
