• Fibromyalgia
    • History of spontaneous chronic widespread pain for 3/12 with tenderness in 11/18 defined tender points on palpation
    • Associated with pain, fatigue, headaches, morning stiffness, post exertional pain, dizziness, mood disturbances
    • Pain is deep, throbbing, aching & gnawing
    • Triggers
      • Viral
      • Trauma
      • Stress/anxiety
    • Diagnosis
      • History
      • Pain
        • Must involve all 4 limbs and trunk
      • Fatigue
      • Sleep
      • No investigations are diagnostic
    • Management
      • General measures
        • Physio, exercise, education
      • Oral Rx
        • TCA
        • SSRI/SNRI
        • Gabapentin
        • Pregabalin
        • Tramadol
        • NSAIDS
      • Trigger point injections
      • IV lignocaine
        • 3-5mg/kg over 1-2hrs
      • CBT
      • Alternative therapies
    • Biochemical factors
      • Levels of 5HT and NA which modulate pain are decreased in FM
      • 5HT works presynaptically to inhibit release of certain Neurotransmitters
      • Substance P and excitatory amino acids are increased
      • The HPA axis is abnormal
      • Behavioural and psychological factors
      • Regional changes in cerebral blood flow
      • Abnormal muscle metabolism leads to histopathological changes in muscles
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/9/5/162.full.pdf