Muscle Disease: Fibromyalgia

Question 1

fibromyalgia

Answer 1

unexplained condiiton that causes widespread muscle pain and fatigue

Question 2

what are the chronic symptoms

Answer 2

fatigue and widespread pain

Question 3

who is it most common in

how can it occur

Answer 3

middle aged women, but can affect anyone

may begin after physical or emotional trauma

Question 4

aetiology

Answer 4

thought to be a disorder of central pain processing or a syndrome of central sensitivity

patients tend to have a lower threshold for pain and other stimuli (heat, sound, strong odours)

Question 5

what conditions is it seen in

Answer 5

RA and SLE

Question 6

presentation

Answer 6

persistent and widespread pain that varies in intensity (and is associated with allodynia and hyperaesthesia)

fatigue, distrubed and unrefreshing sleep

morning stiffness

swelling sensation

cognitive difficulties - poor concentration and low mood

Question 7

what is it associated with

Answer 7

other somatic syndromes:

• IBS
• depression/anxiety
• headache
• pins and needles/ tingling that doesnt follow dermatomal distribution
• Raynaud’s

Question 8

diagnosis

Answer 8

• depends on pain that is chronic (>3months) and widespread in the absence of inflammation
• there must be presence of pain in at least 11/18 tender points
• diagnosis of exclusion

Question 9

tender points

Answer 9

need at least 11/18

Question 10

management

Answer 10

• patient and family education is primary
• advice regarding grading exercise and acitivity pacing
• pain control with analgesia
• CBT

Question 11

yellow flags

Answer 11

Question 12

pain control

Answer 12

• Patients will rarely respond to NSAIDs and steroids as there is no inflammation - if they do reconsider your diagnosis!!
• Atypical analgesia including tricyclics (e.g. amitriptyline), gabapentin and pregabalin may be of benefit.