Quiz: What Do You Know About Fibromyalgia?

April 24, 2018

Recent studies have shed light on the pathophysiology, clinical diagnosis, and effective management of fibromyalgia. Are you up-to-date?

Recent studies have shed light on the pathophysiology, clinical diagnosis, and effective management of fibromyalgia. Are you up-to-date on the latest research? Test your knowledge with this 10-question quiz.

1. In addition to nonspecific pain, which of the following may be a symptom of fibromyalgia?

A. Headache

B. Sleep disorders

C. Fatigue

D. Depression

E. All of the above

Please click below for answer, discussion, next question.

Answer: E. All of the above

“. . . pain and fatigue emerged as the top two of six distinct clinical features of fibromyalgia in a sample of 788 people with fibromyalgia; 54% perceived pain as their primary symptom and 28% perceived fatigue as their main complaint.”1

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2. True or false? People who have fibromyalgia tend to have a higher pain threshold than people who do not.

A. True

B. False

Please click below for answer, discussion, next question.

Answer: B. False

“Fibromyalgia patients have a lower pain threshold than healthy people. Allodynia (a normally nonpainful stimulus perceived as pain) and hyperalgesia (a painful stimulus is perceived as even more painful) are common responses in these patients.”2

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3. Which of the following is not likely to contribute to the etiology of fibromyalgia?

A. Genetics

B. Viral infection

C. Organic lesion

D. Psychological trauma

Please click below for answer, discussion, next question.

Answer: C. Organic lesion

“Some patients reported the initiating event as a psychological or physical trauma, or a viral infection (hepatitis B or C, or HIV). Other patients described a slow, gradual onset of symptoms with no precipitating event. Genetics may also play a role.”1

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4. The pain of fibromyalgia is usually described as widespread, affecting:

A. The head and neck

B. The muscles and joints

C. The abdomen and lower torso

D. Any bodily region

Please click below for answer, discussion, next question.

Answer: D. Any bodily region

“Fibromyalgia is a medical condition that appears to involve disordered afferent processing and which might be associated with multiple symptoms, the hallmarks being chronic widespread pain (in any bodily region including visceral organs), fatigue, sleep disturbances, and cognitive alterations.”3

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5. The symptoms of fibromyalgia overlap most often with which of the following conditions?

A. Chronic fatigue syndrome (CFS)

B. Hypertension

C. Attention-deficit hyperactivity disorder (ADHD)

D. Multiple sclerosis (MS)

Please click below for answer, discussion, next question.

Answer: A. Chronic fatigue syndrome (CFS)

“There is significant overlap of symptoms between fibromyalgia and CFS. These include muscle pain, fatigue, sleep disturbance, cognitive dysfunction, abdominal pain, muscle weakness, migratory arthralgias and decreased activity.”2

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6. True or false? Cognitive impairment and memory dysfunction are common secondary symptoms of fibromyalgia.

A. True

B. False

Please click below for answer, discussion, next question.

Answer: A. True

“Cognitive performance is measured by verbal fluency, memory, concentration, automatic processing, and is commonly decreased in people with fibromyalgia. ‘Fibro fog’ is a subjective report of cognitive difficulties such as mental confusion, memory difficulties, memory decline or speech difficulties and could reflect both cognitive fatigue and/or cognitive performance.”4

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7. Although fibromyalgia can affect anyone, it is most commonly diagnosed in:

A. Young women under age 25

B. Male children aged 8 to 16

C. Men and women over age 60

D. Women aged 30 to 55

Please click below for answer, discussion, next question.

Answer: D. Women aged 30 to 55

“Fibromyalgia is most common in women 30 to 55 years of age at symptom onset. It also affects men and children.”2

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8. Management of fibromyalgia rests largely on which of the following therapies?

A. Exercise

B. Cognitive behavioral therapy

C. Lifestyle changes

D. Pain management

E. All of the above

Please click below for answer, discussion, next question.

Answer: E. All of the above

“Successful management incorporates education of the patient in self-management skills, cognitive behavioral therapy (CBT), exercise, and drug therapy.”5

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9. Which of the following pharmacotherapies are most effective for the management of fibromyalgia pain?

A. Tricyclic antidepressants

B. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

C. Gabapentin and pregabalin

D. A and C only

E. All of the above

Please click below for answer, discussion, next question.

Answer: E. All of the above

“Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs) (duloxetine and milnacipran), α2-δ ligands (gabapentin and pregabalin) are effective in reducing pain by ≥30%. Some success has been shown with dopamine agonists (pramipexole), tramadol, other opioids and cannabinoids (nabilone).”5

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10. Effective complementary and alternative therapies now believed to work best for fibromyalgia include:

A. Tai chi

B. Aerobic exercise

C. Acupuncture

D. A and C only

E. All of the above

Please click below for answer and discussion.

Answer: A. Tai chi

“Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement.”6

“There is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. There is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being.”7

For more information, please see our recent article: Fibromyalgia Pain: New Insights, New Hope

References:

1. Dailey DL, Frey Law LA, Vance CG, et al. Perceived function and physical performance are associated with pain and fatigue in women with fibromyalgia. Arthritis Res Ther. 2016;18:68.

2. Sumpton JE, Moulin DW. Fibromyalgia: presentation and management with a focus on pharmacological treatment.Pain Res Manag. 2008;13:477-483.

3. Smith HS, Harris R, Clauw D. Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome. Pain Physician. 2011;14:E217-E245.

4. Dailey DL, Keffala VJ, Sluka KA. Do cognitive and physical fatigue tasks enhance pain, cognitive fatigue, and physical fatigue in people with fibromyalgia?Arthritis Care Res. 2015;67:288-296.

5. Sumpton JE, Moulin DW. Fibromyalgia. Handb Clin Neurol. 2014;119:513-527.

6. Wang C, Schmid CH, Fielding RA, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. 2018;360:k851. doi: 10.1136/bmj.k851.

7. Deare JC, Zheng Z, Xue CC, et al. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev. 2013 May 31;(5):CD007070. doi: 10.1002/14651858.CD007070.pub2.