FUNCTIONAL

Question 1

What is fibromyalgia?

Answer 1

A condition characterised by chronic widespread pain with multiple muscular tender points or associated fatigue, sleep disturbance, cognitive dysfunction. All in the absence of a well-defined underlying organic disease
The cause is unknown

Question 2

Epidemiology of fibromyalgia?

Answer 2

Women are 5 times more likely to be affected by
30-50 year olds
More common in people with stress or traumatic events, repetitive injuries or FHx

Question 3

Features of fibromyalgia?

Answer 3

chronic pain: at multiple site, sometimes ‘pain all over’
lethargy
cognitive impairment: ‘fibro fog’
sleep disturbance, headaches, dizziness are common

Question 4

Diagnosing fibromyalgia?

Answer 4

A clinical diagnosis and often uses the American College of Rheumatology
There must be a Hx of widespread pain for >3 months
Pt must be tender in at least 11 of the 18 tender points (occipital, low cervical trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter and knee)

Question 5

Management of fibromyalgia?

Answer 5

explanation
aerobic and strengthening exercise in supervised exercise programmes: has the strongest evidence base
CBT and acceptance & commitment therapy - weak evidence
Acupuncture - weak evidence
Meds: pregabalin, duloxetine, amitriptyline - weak evidence
Arrange referral to a specialist pain centre if necessary

Question 6

What is complex regional pain syndrome?

Answer 6

A chronic pain condition characterised by autonomic and inflamamtory features often preceded by an injury but is disproportionate to this event
Usually it only affects 1 limb
There is accompanying oedema, skin blood flow (temperature) or sudomotor abnormalities, motor symptoms, or trophic changes
Not a psychological disorder - it appears to result from an inidviudal’s abnormal response to injury

Question 7

Management of complex regional pain syndrome?

Answer 7

Education
Physical rehabilitation - PT
Pain relief
Psychological - CBT

Question 8

What is chronic fatigue syndrome AKA?

Answer 8

Myalgic encephalomyelitis
Myalgic encephalopathy

Question 9

What is chronic fatigue sundrome?

Answer 9

Persistent or recurrent debilitating fatigue that lasts at least 3 months. It is not lifelong, or the result of ongoing exertion, or alleviated by rest, or explained by other conditions, and that results in a substantial reduction in activity

Question 10

Epidemiology of chronic fatigue syndrome?

Answer 10

More common in females (2.4x more likely)
Over 250,000 people in England and Wales
25% have severe disease and are housebound or bedbound

May be an association with past psychiatric history

Question 11

Features of chronic fatigue syndrome?

Answer 11

Fatigue
Sleep disturbances e.g. insomnia, unrefreshing sleep, hypersomnia
Muscles or joint pains
Headaches
Painful lymph nodes without enlargement
Sore throat
Sognitive dysfunction
Physical/mental exertion making symptoms worse
General malaise
Dizziness
Nausea
Palpitations

Question 12

Diagnosing chronic fatigue syndrome?

Answer 12

Carry out a large number of screening blood tests to exclude other pathology e.g. FBC, U&Es, LFTs, glucose, TFTs, ESR, CRP, calcium, CK, ferritin, coeliac screen and urinalysis

Diagnose if they have symptoms that have persisted for 3 months and are not explained by another condition

Question 13

Management of chronic fatigue syndrome?

Answer 13

Refer to specialist CFS service
Enrgey management strategy
Advise pt not to undertake exercise that is not part of their programme
CBT