Centralized pain & fibromyalgia

Question 1

What are the dx criteria centralized pain?

Answer 1

Dx of exclusion 
3 mo widespread pain
allodynia, hyperalgesia
no obvious cause (inflammatory, neuropathic, structural) 
coexisting symptoms
normal phase reactants

Question 2

what are the definitions of allodynia and hyperalgesia

Answer 2

allodynia = pain following minimal stimuli

hyperalgesia = increased pain w/ stimuli or increased sensitivity

Question 3

what is the definition of central sensitization?

Answer 3

an amplification of neural signalling within the CNS that elicits pain hypersensitivity

Question 4

what are some hypersensitivity syndromes?

Answer 4

fibromyalgia
IBS 
TTH
interstitial cystitis 
TMJ 
neck and back pain 
chronic fatigue 
restless leg

Question 5

What are risk factors for chronic pain?

Answer 5

biologic (surgery, disease, trauma)
psychological (PTSD, ACE, depression/anxiety)
substance use
social
repeated surgeries
pre-existing wide-spread pain (fibromyalgia)

Question 6

Patho of centralization of pain per Huether

Answer 6

progressive repeated stimulation of group C neurons in the dorsal horn –> sensitivity of central pain signalling neurons –> pathologicla changes in the CNS (neural plasticity) that cause persistanet pain (increase membrane excitability, synapse efficiency, overactivation of ascending pathway, etc)

Question 7

P/E for centralized pain

Answer 7

diffuse non-anatomical areas of pain, allodynia, hyperalgesia, no redness/swelling/inflammation, normal neuro exam

Question 8

What is fibromyalgia?

Answer 8

generalized aching and stiffness with characteristic pain at specific sites for > 3 mo

may also have issues w/ cognition, sleep, fatigue, HA…

Question 9

Age and sex: fibromyalgia

Answer 9

20-50, female

Question 10

S/S fibromyagia

Answer 10

multifocal soft tissue pain, CWP to muscles, ligaments, tendons, joints, often neck and shoulders, might “feel like the flu”. AM stiffness, triggered by cold, inactivity or overactivity, weather…. reactive hyperemia… moderate to severe fatigue, anxiety/depression, cognitive disturbance “firbo fog”, multipla somatic symptoms (bladder, pelvic, IBS, GERD, raynaulds, etc)

Question 11

Pharm tx options for FM

Answer 11

anticonvulsants
antidepressants (amitriptyline common)
cyclobenzaprine