5.8 Clinical- Fibromyalgia Flashcards
Current theories related to fibromyalgia
Hyperexcitability of central nervous system pain receptors- central sensitization- built in pain
Abnormal central processing of nociceptive input- Skeletal muscle
Dysfunction of hypothalamic-pituitary-adrenal axis- dopaminergic neurotransmission
Explain how Fibromyalgia relates to the Generalized Pain Scheme
Pain–> Mixed
Incidence of FM
2nd most common disorder encountered by rheumatologists
Chronic, relapsing, diffuse aching pain, and tenderness
Incidence in US and Canada is 2%
Women between 20 and 60 years of age are primarily affected.
Women: 3.4%
Men: 0.5%
Signs, and symptoms for FM
Sleep disturbance Stiffness Short-term memory loss Fatigue Mood changes (Anxiety / Depression) Multiple somatic complaints Exercise intolerance Hyperesthesia Allodynia
These are constant over years
No biochemical, immunologic, or anatomic abnormalities are specifically associated with Fibromyalgia.
Diagnostic criteria for FM
- “Widespread” pain for at least 3 months
- Pain at 11 out of 18 tender point locations on palpation with force of 4 kg., in predictable and bilateral locations.
Posterior Tenderpoints: Occiput Supraspinatus Trapezius Gluteal Greater Trochanter Anterior TP: Low Cervical Second Rib Lateral Epicondyle Knee
Diagnostic findings, history, and signs and symptoms of myofascial pain syndrome
Findings: Trigger points
Prevalence Male: Female: 1:1
Sleep disturbance and fatigue: No
Pain distribution: Regional
Diagnostic findings, history, and signs and symptoms of chronic fatigue.
Preceded by Viral illness NOT widespread 11 out of 18 tenderpoints: No Fatigue and sleep disturbances: Yes Also with 4 of the following: Decreased memory, Sore throat, tender lymph nodes, multi-joint pain, headache, malaise, muscle pain
Three common causes of myofascial pain
Myofascial pain syndrome
Chronic fatigue
Fibromyalgia
Biochemical Model and FM
Somatic dysfunction likely contributes to the patient’s biomechanical stress and therefore increased nociception
Treatment focus on areas of most severe somatic dysfunction first
Exercises – to stretch and strengthen
management guidelines for fibromyalgia, and appropriate use of osteopathic manipulative treatment, relative to osteopathic treatment models.
Balancing sympathetic and parasympathetic tone – (basically this is achieved by decreasing hypertonia and somatic dysfunction in related regions.
T1-T12 – Sympathetics
OA, C1-C2, Sacrum – Parasympathetics
Support lymphatic flow and circulation of fluids in general
Light touch and gentle procedures are generally recommended.
Myofascial release
Soft Tissue Treatment
Counterstrain (significant pain relief found) (see current research on OMT for Fibromyalgia)
Palpation of FM
Tenderness, joint swelling, and temperature of the skin –best evaluated with the fingers.
Joint and muscle tenderness- nonspecific, sensitive signs.
Pressure enough to blanch the fingernail, is recommended in assessing tenderness. (adjust to patient tolerance)
Respiratory and circulatory Model and FM
Somatic dysfunction and pain can cause muscle splinting and reduced or altered movements.
This can reduce low pressure venous and lymphatic drainage, who’s functions are dependent on external forces.
Neurologic Model
Hypersensitive proprioceptors can cause structural alterations, which can lead to somatic dysfunctions
Somatic dysfunctions may lead to increased and/or sustained pain
Central sensitization – can affect 2 segments above and below the sensitized area of the cord.
Metabolic Energy
Diet
Exercise – judicious use of aerobic exercise in a graded program
Activity pacing
Decreasing somatic dysfunction load
Behavioral Model
Anxiety and depression commonly seen in fibromyalgia patients
Association between depression and pain has been established
Pain adds to overall stress levels (“allostatic load”)
