{"id":3937,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/fibromyalgia\/"},"modified":"2024-05-16T10:14:09","modified_gmt":"2024-05-16T09:14:09","slug":"fibromyalgia","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/fibromyalgia\/","title":{"rendered":"Fibromyalgia"},"content":{"rendered":"\n<h3 class=\"wp-block-heading has-alert-red-color has-text-color\"><strong>This page is currently under review &#8211; Nov 23<\/strong><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">History<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Generalised musculoskeletal pains<\/li>\n\n\n\n<li>Tired all the time and poor sleep<\/li>\n\n\n\n<li>Fatigue and poor concentration<\/li>\n\n\n\n<li>Associated with facial pain, irritable bowel syndrome, tension headaches<\/li>\n\n\n\n<li>History of stressful life events often dating back to childhood.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Examination<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Multiple tender spots on palpation (figure). Tender spots are also typical on the anterior trunk<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Investigations<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Routine bloods (normal)<\/li>\n\n\n\n<li>Anti-CCP antibodies (negative)<\/li>\n\n\n\n<li>X-rays and other imaging are unhelpful except to exclude other diseases.<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">\u200bReferral<\/h3>\n\n\n\n<p>Patients with fibromyalgia should not normally be referred to rheumatology unless you are uncertain about the diagnosis. Referral to the pain clinic may be appropriate if the patient&#8217;s symptoms don&#8217;t respond to the measures outlined in Primary Care Management.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Management<\/h3>\n\n\n\n<p>Treatment is symptomatic. Associated depression may also require treatment<\/p>\n\n\n\n<p><strong>Education:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Explain that they have fibromyalgia and it&#8217;s a condition where the perception of pain is abnormal.<\/li>\n\n\n\n<li>Explain that there is no cure but treatments are available to help control pain. Explain the importance of pacing activities<\/li>\n<\/ul>\n\n\n\n<p><strong>Pain control:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Analgesics and NSAIDs are seldom helpful<\/li>\n\n\n\n<li>Gabapentin<\/li>\n\n\n\n<li>Amitriptyline<\/li>\n\n\n\n<li>Nortriptyline<\/li>\n\n\n\n<li>Fluoxetine<\/li>\n<\/ul>\n\n\n\n<p><strong>Sleep disturbance:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>General advice on sleep hygiene<\/li>\n<\/ul>\n\n\n\n<p><strong>Physiotherapy:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Graded exercise programme<\/li>\n<\/ul>\n\n\n\n<p><strong>Clinical psychology:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cognitive behaviour therapy<\/li>\n<\/ul>\n\n\n\n<p><strong>Please see Resources and links tab for additional information<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This page is currently under review &ndash; Nov 23 History Examination Investigations<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4395,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[616],"class_list":["post-3937","page","type-page","status-publish","hentry","category-fibromyalgia"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/rheumatology\/fibromyalgia\/\" rel=\"tag\">Fibromyalgia<\/a>","rttpg_excerpt":"This page is currently under review &ndash; Nov 23 History Examination Investigations","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3937","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3937"}],"version-history":[{"count":11,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3937\/revisions"}],"predecessor-version":[{"id":19384,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3937\/revisions\/19384"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4395"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3937"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3937"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}