Common Fibromyalgia exam questions for medical finals, OSCEs and MRCP PACES
What are the management strategies in fibromyalgia?
- Patient education
- It is very important to take this seriously and have an initial positive conversation.
- Conditions involving chronic pain have a huge impact on quality of life so it is important to acknowledge this: it is a real and debilitating condition.
- Emphasise the positives: there is nothing wrong with the patient’s joints or muscles, it is an issue with the perception of pain and patients can teach their bodies to deal with this through exercise and behavioural techniques.
- Exercise programmes with a graded return to activity
- Cognitive behavioural therapy (CBT)
- Tricyclic antidepressants can improve sleep and pain
- Start with amitriptyline 10mg ON and increase as tolerated
- Antidepressants in selected cases e.g. citalopram
What are the poor prognostic features in fibromyalgia?
- High levels of distress
- Work avoidance
- Long-standing pain
- Functional impairment