4- Fibromyalgia (Sandhouse) Flashcards
A 35 year old female patient presents with chronic aching pain in her cervical, shoulder, pectoral and lumbosacral regions. She also complains of chronic headache, disturbed sleep and generalized fatigue. When questioned, she describes swelling, numbness and morning stiffness. On examination you find no evidence of joint swelling, warmth or deformity. You find multiple tender areas over her neck, back and upper extremities. What could she have?
Fibromyalgia
define fibromyalgia
A common syndrome in which a person (usually women) has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues.
What is the etiology (cause) of fibromyalgia
Unknown, though evidence points towards dysregulation of pain processing in CNS
What are the primary symptoms of fibromyalgia?
- Widespread pain
- Fatigue
- Sleep Disturbances
- Difficulty with Memory
- Morning stiffness
In fibromyalgia, what are the key areas for pain?
neck shoulders elbows hips knees back
In fibromyalgia, how does fatigue present?
begins on rising from bed, feeling more tired when they wake up than when going to bed
What type of sleep do patients with fibromyalgia have?
Does not reach stage 4 for prolonged periods (AKA “alpha delta sleep”)
Constant interruptions of sleep with awake-like brain activity
How does morning stiffness present for patients with fibromyalgia?
- lasts all day long
- Limits activities, but does not diminish with activity
What are aggravating factors for fibromyalgia?
- changes in temperature/weather
- non-restorative sleep
- physical and mental fatigue
- excessive physical activity
- physical inactivity
- anxiety
- stress
What are the specific point criteria necessary for the diagnosis of fibromyalgia?
Widespread pain in all four quadrants of the body (minimum of 3 months) w/ tenderness in 11 of 18 standard tenderpoints on palpation
What are the two main types of fibromyalgia?
Primary and secondary fibromyalgia
What characterizes primary fibromyalgia?
fibromyalgia w/ no coexisting disease/disorders
What characterizes secondary fibromyalgia?
fibromyalgia w/ present coexisting disorder
What is the differential diagnosis for fibromyalgia? (i.e. what other diseases need to be ruled out)
Chronic Fatigue Syndrome Hypothyroidism Lyme Disease SLE RA HIV
What are the lab findings of fibromyalgia?
Negative in primary FMS
True or False: Fibromyalgia is a diagnosis of exclusion
False.
Fibromyalgia is NOT a diagnosis of exclusion
A patient presents with diabetes and widespread sprain. You treat the patient for diabetes, and the widespread pain still exists. What is the patient presenting with?
Secondary fibromyalgia
Besides FMS, what are other screening labs that should be asked for when contemplating fibromyalgia?
CBC with diff
Chem profile
ESR (Erythroid sedimentation rate)
ANA (antinuclear antibodies) [determines autoimmune disorder]
RF (Rheumatoid factor) [determines rhumatory arthritis]
Thyroid profile [checks for hyothyroidism]
How do you treat fibromyalgia?
Diagnose first! then Treatment is management of the pain, sleep, psychological support, and OMT
What are possible treatments that can be used for pain management?
Drugs (Analgesics, low dose antidepresseants, specific FDA approved drugs for FMS), local anesthetic injections, acupuncture, exercise
What are the three medications that are FDA approved for FMS?
Pregabalin (brand name: Lyrica)
Duloxetine (brand name: Cymbalta)
Milnapracin (Brand name: Savella) [3x as selective for norepinephrine (NE) vs. seratonin], note: can increase BP due to effect of NE, induce HTN
What are possible treatments to be used for sleep management?
Improved sleep hygiene
Medications
What OMT may help treat fibromyalgia?
Counterstrain (correlation of tenderpoints)
Myofascial release
Lymphatic techniques
Stretching
Which form of OMT does not directly effective in treating myalgia?
HVLA
