Ortho week 2 - widespread pain and fatigue Flashcards
What are the main symptoms of fibromyalgia?
- chronic widespread pain (>3months)
- extreme fatigue
- difficulty sleeping
- poor concentration
- poor memory
What are the top differentials for a presentation of widespread pain and fatigue ?
- fibromyalgia
- cancer mets
- anaemia
- viral infection (HIV, Hep C)
- rheumatoid arthritis
- SLE
- blood cancers
- lymphoma
- addisons disease
- hypothyroid myopathy
- vit D deficiency
- hyperparathyroidism
what are the symptoms of myositis ?
- muscle weakness in limbs
- skin rash (heliotrope)
presents quite similar to lupus
How to you examine for fibromyalgia ?
Assess the 18 pressure points on the body by pressing thumb into each one until nail blanches
*pain in 11+ suggests fibromyalgia**
Where are the 18 pressure points associated with fibromyalgia ?
they are 9 points symmetrically paired on each side of body:
front of body:
- side of thyroid
- under clavicle at side of sternum
- lateral inner elbow
- medial knee
back:
- base of skull
- traps at base of neck
- superior angle of scapula
- posterior sacroiliac joint
- lateral bum (near greater trochanter of femur)
What causes fibromyalgia?
it is unclear, maybe:
- stress
- injury
- illness
- death of loved one
…
What is needed for a diagnosis of fibromyalgia ?
- widespread pain (11+ of the 18 points)
- chronic symptoms (>3 months)
Is fibromyalgia a deforming or debilitating condition ?
no!
treatment is just about managing symptoms and the condition can sometimes go through remission periods.
What are the treatment options for fibromyalgia ?
- exercise
- CBT
- acupuncture
- hydrotherapy
- screen for mental health impacts
or meds
- duloxetine (pain)
- tramadol (pain)
- pregabalin (pain and sleep)
- low dose amitriptyline (sleep)
strong evidence to avoid NSAIDs
What medication is used in fibromyalgia where there is severe pain and severe sleep problems ?
pregabalin - helps with both issues
What is the prognosis for fibromyalgia ?
- no cure
- most patients are able to maintain good quality of life with support/treatment
can get an indication of likelihood it progresses to long term distress/disability/pain via use of ‘yellow flags’
What are some of the biomedical ‘yellow flags’ that a persons fibromyalgia may develop into a long term disability/pain ?
- severe pain or increased disability at presentation
- previous significant pain episodes
- multiple site pain
What are some of the psychological ‘yellow flags’ that a persons fibromyalgia may develop into a long term disability/pain ?
- belief that pain = harm
- belief that meds are better than all other treatments
- avoidance behaviour
- catastrophic thinking
- atypical health beliefs
- high levels of distress
What are some of the social ‘yellow flags’ that a persons fibromyalgia may develop into a long term disability/pain ?
- lack of self confidence at completing work tasks
- low expectation of returning to work
- low level of control over rate of work
- heavier work load
- poor work relationships
- social dysfunction
What are some risk factors for developing fibromyalgia?
- female
- Fx of fibromyalgia
- traumatic events (e.g car crash..)
- PMHx of rheumatoid arthritis
- low household income
- lack of further education
