Fibromyalgia

Question 1

What is fibromyalgia?

Answer 1

A syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites; the cause is unknown.

Question 2

Which sex is more commonly affected by fibromyalgia?

Answer 2

Women, who are around 5 times more likely to be affected.

Question 3

What age group most commonly presents with fibromyalgia?

Answer 3

Typically between ages 30–50.

Question 4

What are the core features of fibromyalgia?

Answer 4

Chronic widespread pain, lethargy, cognitive impairment (‘fibro fog’), sleep disturbance, headaches and dizziness.

Question 5

How is fibromyalgia diagnosed?

Answer 5

Diagnosis is clinical; the American College of Rheumatology criteria may be used to support diagnosis.

Question 6

What do the ACR tender point criteria state?

Answer 6

Tenderness in at least 11 of the 18 paired tender points makes fibromyalgia more likely.

Question 7

What are the ACR diagnostic requirements using WPI and SSS?

Answer 7

Symptoms for ≥3 months plus: WPI ≥7 and SSS ≥5 OR WPI 4–6 and SSS ≥9.

Question 8

What is the WPI in fibromyalgia assessment?

Answer 8

The Widespread Pain Index, measuring the number of painful body sites.

Question 9

What is the SSS in fibromyalgia assessment?

Answer 9

The Symptom Severity Scale, measuring severity of associated symptoms.

Question 10

Why must baseline investigations be performed before diagnosing fibromyalgia?

Answer 10

To rule out alternative causes of pain, fatigue or cognitive impairment.

Question 11

Which baseline blood tests should be done in suspected fibromyalgia?

Answer 11

FBC, ESR, CRP, CK, LFTs, U&Es, bone profile, TFTs and blood glucose.

Question 12

Why is CK checked in suspected fibromyalgia?

Answer 12

To exclude muscle damage (e.g. myositis), which raises CK.

Question 13

Why are ESR and CRP checked in suspected fibromyalgia?

Answer 13

To rule out inflammatory conditions such as RA or SLE.

Question 14

Why are thyroid function tests important in suspected fibromyalgia?

Answer 14

Hypothyroidism can mimic fibromyalgia symptoms.

Question 15

Which imaging may be indicated if features suggest multiple sclerosis?

Answer 15

MRI brain and spine.

Question 16

What is the general approach to fibromyalgia management?

Answer 16

A psychosocial, multidisciplinary, individualised approach.

Question 17

Which lifestyle advice should be given to patients with fibromyalgia?

Answer 17

Maintain healthy weight and diet, stop smoking, limit alcohol intake.

Question 18

Which form of exercise has the strongest evidence for fibromyalgia?

Answer 18

Aerobic exercise.

Question 19

What does NICE recommend regarding exercise for fibromyalgia?

Answer 19

Group exercise is recommended; some patients may benefit from individual specialist physiotherapy.

Question 20

What psychological therapies may benefit patients with fibromyalgia?

Answer 20

Cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT).

Question 21

Are conventional analgesics recommended for fibromyalgia?

Answer 21

No; NICE recommends they should NOT be used as they are usually ineffective.

Question 22

Which medications may be considered in fibromyalgia?

Answer 22

Amitriptyline, fluoxetine, pregabalin and duloxetine.

Question 23

When should patients with fibromyalgia be referred to specialist services?

Answer 23

If management is complex, comorbidities are present or there is diagnostic uncertainty.

Question 24

What may multimodal rehabilitation programmes be used for in fibromyalgia?

Answer 24

Severe disability.

Question 25

Why is patient education important in fibromyalgia?

Answer 25

Understanding the condition enables self-management and reduces distress.

Question 26

What are typical cognitive symptoms in fibromyalgia?

Answer 26

Poor concentration, memory problems and 'fibro fog'.

Question 27

What sleep disturbances occur in fibromyalgia?

Answer 27

Unrefreshing sleep, insomnia and disrupted sleep patterns.

Question 28

What is the hallmark characteristic of fibromyalgia pain?

Answer 28

Chronic widespread pain at multiple sites, sometimes described as 'pain all over'.