Fibromylagia Flashcards
What is it?
A common disorder of central pain processing characterized by chronic widespread pain in all 4
quadrants of the body (both sides and above and below the waist).
What is allodynia?
a heightened and painful response to innocuous stimuli
Is often present in fibromyalgia
What is it caused by?
It can be induced by deliberate sleep deprivation
Sleep disturbance is probably the trigger in most patients -EEG studies show reduced REM sleep and delta wave sleep.
This causes hyper-activation in response to noxious stimulation, and neural activation in brain regions associated with pain perception in response to non-painful stimuli.
Risk factors ?
- Female sex- female : male = 9 : 1
- peak age of onset 40-50
- onset may have an obvious trigger –emotional or physical e.g. painful arthritis
- rheumatological conditions
Symptoms ? including ones not restricted to pain?
- Chronic, widespread body pain
Fibromyalgia symptoms are not restricted to pain
- depression and anxiety- mood affected
- poor concentration and memory difficulties“fibrofog”
- joint/muscle stiffness
- profound fatigue
- unrefreshed sleep
- numbness
- headaches
- irritable bowel/bladder syndrome
signs of fibromyalgia
no physical abnormalities to MSK or any neurological signs
Patients may have “tender points” on palpation of their muscles- patient experiences excess discomfort when palpating with just sufficient pressure to blanch your finger nails
what investigations used to check for differential diagnoses?
- ESR
- CRP
- FBC
- U+E
- LFT
- Ca
- CK
- TFT
Non pharmcological treatment
- patient education
- exercise
- cognitive behavioural therapy is effective too.
- simple measures to improve sleep and physical activity levels
Pharmacological management
Pain management- tailored to the patients pain intensity, function and associated features such as depression, fatigue, and sleep disturbance.
Drug treatment: often patients benefit from 2 or 3 drug classes used together
- tricyclic anti-depressants- mainly with low dose amitriptyline
- gabapentinoids- Pregabalin may be effective
- serotonin-noradrenaline (norepinephrine) reuptake inhibitors
- Opiates are not recommended
how to diagnose
clinical diagnosis
