Fibromyalgia

Question 1

What is fibromyalgia?

Answer 1

A chronic disorder characterised by widespread musculoskeletal pain, fatigue, sleep issues, and cognitive/mood disturbances.

Question 2

What type of pain is associated with fibromyalgia?

Answer 2

Nociplastic pain, which is more widespread/intense than expected given the amount of identifiable tissue or nerve damage.

Question 3

What is the most common age range for fibromyalgia diagnosis?

Answer 3

30-50 years old.

Question 4

Which gender is more commonly affected by fibromyalgia?

Answer 4

Females are more commonly affected than males.

Question 5

What phenomenon describes the amplified response of the CNS to sensory input in fibromyalgia?

Answer 5

Central sensitisation.

Question 6

What are common risk factors for developing fibromyalgia?

Answer 6

• Family history
• Environmental factors (stress, trauma, chronic illness/pain conditions)

Question 7

List some common symptoms of fibromyalgia.

Answer 7

• Widespread pain (persistent, dull ache)
• Tender points (sensitive areas)
• Fatigue and sleep disturbances
• Musculoskeletal stiffness
• Cognitive difficulties (memory, concentration)
• Irritable bowel syndrome

Question 8

Name three differential diagnoses for fibromyalgia.

Answer 8

• Rheumatoid arthritis
• Systemic lupus erythematous
• Multiple sclerosis

Question 9

What types of blood tests may be used in the investigation of fibromyalgia?

Answer 9

• FBC
• LFT
• U&Es
• ESR and CRP
• Creatine kinase (CK)
• TSH
• HbA1c
• Rheumatoid factor (RF) and anti-CCP
• Autoimmune screen

Question 10

What are the American College of Rheumatologists (ACR) 2016 diagnostic criteria for fibromyalgia?

Answer 10

• Generalised pain in at least 4 of 5 regions
• Symptoms present at a similar level for at least 3 months
• Widespread pain index (WPI) ≥7 and symptom severity scale (SSS) score ≥5 (or WPI 4-6 and SSS ≥9)

Question 11

List some non-pharmacological management strategies for fibromyalgia.

Answer 11

• Self-management (exercise, pain diary)
• Health promotion (healthy diet, managing drugs, alcohol, smoking)
• Physiotherapy (massage, acupuncture, exercises)
• Psychological interventions (CBT, support groups)
• Sleep management (sleep hygiene advice)

Question 12

What types of medications are commonly used to manage fibromyalgia?

Answer 12

Antidepressants such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, and sertraline, often prescribed off-label.