Fibromyalgia Flashcards
What is the definition of Fibromyalgia?
Form of nonarticular (not joints) rheumatism characterized by widespread chronic musculoskeletal pain for >3 months
What are the common symptoms of FM?
- Fatigue
- Nonrestorative Sleep
- Cognitive Dysfunction
- Mood Distubrance
What is Hyperalgesia?
Increased response to painful stimuli
What is Allodynia?
Pain from stimuli that is not usually painful
What is the 2nd most common rheumatologic disorder?
Fibromyalgia
What are common etiologies of FM?
- Non-REM Sleep Disturbances
- Neurotransmitter abnormalities
- Neurotransmitter imbalance
- Pyschological abnormalities
What are some neurotransmitter abnormalities?
- Decrease NE and Serotonin
- Increase Substance P and Glutamate
- Increase CNS Endogenous Opioids
What are clinical characteristics of FM?
- Widespread pain
- Fatigue
- Nonrestorative sleep
- Morning stiffness
- Cognitive dysfunction
What is Fibro Fog and how many patients with FM are affected?
50-80% patients with FM
1. Learning, retaining, processing info
2. Recall
3. Finding the right word
1990 ACR Criteria for FM
- 11/28 tender points sites (allodynia)
- Widespreading pain >3 months
- Axial skeletal pain
2016 Update to 2010/2011 ACR Criteria
- Generalized pain >4 body regions
- Symptoms present >3 months
- Widespread pain index WPI and Symptom severity scale SSS
- No other disorder explains pain
What is the WPI and SSS Score for 2016 ACR Update?
WPI >7 and SSS >5 OR
WPI 4-6 and SSS>9
What is included in the SSS?
- Severity over past week on 0-3 scale
- Number of following symptoms in the past 6 months
FM diagnosis is valid regardless of other diagnoses meaning
May coexist with other diseases
2019 AAPT Diagnostic Criteria
- Multisite pain in >6 of 9 pain sites
- Moderate to severe sleep problems/fatigue
- MSP + fatigue/sleep >3 months
FM is more common in what gender?
Females
What is defined as effective treatment in FM?
Sustained improvement of >20%
In terms of exercise and FM, which one is superior?
Aerobic exercise, superior to flexibility with relaxation or stretching
What is Balenotherapy?
Warm mineral baths
Cognitive Behavioral Therapy is most successful in what type of FM patients?
- High level distress
- High FM impact on daily life
Acupunture in FM Non-drug treatment can what?
- Increase serotonin
- Can increase FM pain
What is the MOA of Anticonvulsants?
Bind to alpha-2 delta protein = decrease NT release = decrease substance P and glutamate
What is the schedule of Lyrica?
Schedule V
What are the side effects of Lyrica?
Dizzy
Sommolence
Is Neurontin approved for FM treatment?
NO
What is the MOA of Tricyclics?
Inhibit reuptake of serotonin and NE, affect other NTs
What do you do with the tricyclic dose to decrease sedation?
Increase dose
Dual Serotonin and NE Reuptake Inhibitors Counseling Points
- Do not stop abruptly
- Avoid alcohol
- Serotonin Syndrome
What is the Black Box Warning for Tricyclics?
Increased suicide risk
What is the CIs for tricyclics?
- MAOI
- Uncontrolled Glaucoma
What are the side effects of Cymbalta?
- Nausea
- Somnolence
- Fatigue
What are the pearls of Cymbalta?
- Dose adjust CrCl <30
- Take in AM
What are Savella indicated for?
Approved ONLY for FM
What are the side effects of Savella?
- Nausea
- Headache
- HTN
- Palpitations
SSRIs Selective Serotonin Reuptake Inhibitors when used alone for FM are?
No better than placebo for pain, fatigue, or sleep
Prozac is best combined with what, and when should it be given?
Amitriptyline or Cyclobenzaprine
Give AM
Are benzos effective in FM?
NO
What is preferred over opioids for pain in FM?
Ultram
What are the risks of Ultram?
Serotonin Syndrome or Seizures
What is the MOA of Ultram?
Inhibits serotonin and NE uptake
Should NSAIDs and APAP be used in FM?
NO, not effective
Should Opioids be used in FM?
NO, avoid can cause hyperalgesia, abuse potential
Is Prednisone effective for FM?
NO
What are the FM treatment goals?
- Decrease pain
- Improve function
- Increase restorative sleep
When should non-drug therapy for FM be initiated?
Early before maladaptive behaviors develop
1. Aerobic exercise (aka increase sedentary time = increased pain)
2. Cognitive behavioral therapy
What is EXPRESS?
EX: Exervise
P: Pyschiatric Comorbidity
R: Regaining Function
E: Education
S: Slepp Hygiene
S: Stress Management
What are the FDA Approved drugs for FM?
- Lyrica
- Cymbalta
- Savella
Pain and Sleep issues while on Amitriptyline, should add on what drug?
Fluoxetine
Severe Pain, consider what drugs?
- Cymbalta
- Lyrica
- Ultram +/- APAP
- Amitriptyline
Sleep Complaint, consider what drugs?
- Amitriptyline
- Cyclobenzaprine
- Lyrica
Fatigue Complaint, consider what drugs?
- Milnacipran
- Amitriptyline
FM Benefits take how long to be seen?
Weeks
Strong Recommendations to FM in the 2016 EULAR are what?
- Aerobic and Strengthening Exercise
Strong Against Recommendations to FM in the 2016 EULAR are what?
- Growth Hormone
- Sodium Oxybate
- Strong Opioids
- Glucocorticoids
