04-14 L2 Fibromyalgia

Question 1

Fibromyalgia

Answer 1

• common pain disorder characterized by (chronic >3 mo) widespread pain and tenderness.
  
  • likely due to abnormal responsiveness or function of the central nervous system.
  • Familial/environmental and genetic factors are likely involved in the etiology of fibromyalgia.

Question 2

Hallmark clinical features of fibromyalgia

Question 3

Pregabalin (Lyrica)

Answer 3

• binds to alpha-2 delta subunit of VGCC of neurons
  
  • thereby reducing influx at nerve terminals, thus inhibiting the release of neurotransmitters, such as glutamate and substance P.
• inhibits glutamate and substance P (ascending pathway)
  
  • the inhibition of neurotransmitter release reduces neuronal hyperexcitability that may contribute to central pain augmentation.
  • in effect, pregabalin decreases ascending pain signals from spinal cord to brain.

Question 4

Duloxetine (Cymbalta) & Milnacipran (Savella)

Answer 4

• serotonin and norepinephrine reuptake inhibitors
  
  • increase serotonin and norepinephrine mediated neurotransmission.
  • they may correct a functional deficit of serotonin and norepinephrine mediated descending pain inhibitory pathways in brain and spinal cord.

Question 5

List 5 approaches for the management of fibromyalgia

PACE

Answer 5

• Physical therapy
• Addressing lifestyle and diet
• Congitive Behavioral therapy (CBT)
• Excercise (aerobic excercise)