Fibromyalgia Flashcards
What is Fibromyalgia?
(Đau cơ xơ hóapain signal get send to the brain but no infection,)
FM is a painful, non-articular rheumatic condition of at least 3 months duration, characterized by widespread muscular achiness and specifically the palpation of tender points at 11 of 18 prescribed locations on the body
FM is a systemic disorder and many people state that they “hurt all over”
There is no obvious origin of the pain
There are 18 symmetrical tender points of which at least 11 need to be found on examination to confirm FM
This distinguishes FM from other conditions such as chronic fatigue syndrome myofascial pain syndrome, myalgic encephalomyelitis or various forms of arthritis and lupus
FM can occur at any age, even in children and the elderly
Most commonly it begins in young adulthood with symptoms developing slowly and gradually increasing in severity as the person reaches between 30-50 years of age
The course of FM is unpredictable-it may be chronic, go into remission or become cyclical with periods of flare-ups alternating with periods of remission (doesn’t mean worse every time flare up)
It is not life-threatening or progressive, but it can affect the person’s quality of life
For some people, they can continue working, while others become quite debilitated
Psychological factors are present in some cases of FM, with anxiety scores significantly higher for those with FM compared to control groups
Fibromyalgia-Tender Points
- Posterior View:
1,2 suboccipital muscle insertion, just inferior to the occiput
3,4 upper trapezius, just at midpoint on the upper border of the muscle
5,6 supraspinatus origin, at the medial border near the spine of the scapula
7,8 gluteus medius, at the anterior portion of the muscle
9,10 greater trochanter, at a point 2 cm posterior to it
(trochanteric prominence)
- Anterior View:
11,12 cervical region, at the anterior aspect of TVP’s C5-C7
13,14 second rib, at the costochondral junction
15,16 extensor digitorum, at the point 2 cm distal to the
lateral epicondyle
17,18 knee, at the medial collateral ligament proximal to
the joint line
Causes
Causes of FM are not clear but there seems to be a connection with immune abnormalities and a genetic predisposition which causes neuroendocrine dysfunction
There seems to be some evidence of a deficiency of serotonin due to abnormalities of serotonin binding to platelets. This results in a negative effect on the pain inhibitory pathways of the nervous system
Symptom Triggers
Symptoms can be triggered or aggravated by:
Overexertion
Lack of exercise
Stress
Anxiety
Depression
Lack of or poor quality of sleep
Trauma
Extremes of temperature or humidity no extream heat and cold for hydro
Infectious illness
Treatment
Medically, a 3 month history of generalized symmetrical pain is diagnostic. After palpating 11 of 18 tender points bilaterally, the physician will often use blood tests and x-rays because the secondary symptoms are also common to arthritis and these tests are performed to confirm that diagnosis of FM rather that arthritis
There is no cure for FM
The condition is frequently treated with medication, physical therapy (can be AROM or PROM) and development of lifestyle management skills
Low doses of antidepressants are found most effective in increasing deep sleep, improving serotonin levels and decreasing pain
Exercise is encouraged, though it must be introduced gradually
Lifestyle management involves learning to listen to the body for pain and fatigue levels and then reorganizing activities accordingly
Symptoms
The most common and characteristic symptoms of FM is generalized pain which occurs in all clients with this syndrome
Stiffness is also common and it is usually worse in the morning and the evening
A moderate or severe level of fatigue is experienced in most people
Fatigue can lead to feelings of weakness and is aggravated by physical activity and can affect the person’s ability to perform ADL’s
Poor sleep is commonly experienced. Morning fatigue may aggravate pain
Other symptoms that may be experienced are intolerance to cold, a swollen feeling in tissue, dysmenorrhea (đau bụng kinh), anxiety, palpitations, altered sensation usually in the extremities, dry eyes and mouth, skin sensitivities, cognitive disorders
Contraindications
Avoid very deep work or techniques that overstretch the client’s muscles. Deep or invasive techniques will frequently result in increased pain post-treatment
Treatments should not be so long and vigorous as to fatigue the client. Massage treatments over 1 hour should be avoided
Frequently muscle relaxants, analgesics and antidepressants will be prescribed to help the client cope with the symptoms. Techniques should be modified accordingly
Health History Questions
How is your general health?
Has FM been diagnosed by a physician? What method of diagnosis was used? Were specific tender points palpated?
What other symptoms are you experiencing?
Have you received massage since your diagnosis? How did you respond? Was post-treatment soreness experienced?
What other therapies have you tried or are you currently doing?
What is your activity level?
Are you taking any medication for pain, depression or sleep disturbances?
Further Assessment
- Observation & Palpation:
A postural assessment is performed, antalgic postures are often evident
Apical or paradoxical breathing patterns may be observed
Pain is present bilaterally on palpation
Trigger points are palpated, but these should not be confused with tender points
- Testing:
AF ROM may result in reduced ranges in affected areas due to pain and weakness of the muscles crossing the joints
AR strength testing may result in pain and weakness in affected muscles
Pain will be experienced by the client in 11 of the 18 tender points
Differential assessment for FM is that palpation of these tender points causes pain local to the area palpated. Unlike myofascial TP’s, there are no referral patterns of pain or taut bands present with FM tender points
Massage
Initially the massage tx should be 30 mins to avoid exhausting and overworking the client
Shorter, more frequent treatments are ideal
Positioning and pillowing are for client comfort
Pre-treatment hydrotherapy of heat can be applied for a general relaxation effect. Cold hydrotherapy is appropriate in areas experiencing acute tenderness (not extreme)
Diaphragmatic breathing should be taught and encouraged
The treatment is in the context of a relaxation massage including unforced diaphragmatic breathing
Treatment of postural imbalances and secondary syndromes are addressed over a series of treatments to not overwork the client
If an area cannot tolerate touch, areas distant to the painful site are massaged as this may still provide the client with an overall feeling of decreased pain
Interspersed with Swedish techniques are gentle, rhythmical mobilizations, stretching, joint play and TP therapy
Key relaxation areas such as the head, neck, shoulders, abdomen, hands and feet should be included
Self-Care
Warm or hot hydrotherapy such as Epsom Salt baths and heating pads (not extreme)
Self-massage to the abdomen will assist in relaxation
Referral to a naturopath may help with strengthening the immune system and support for the system taxed by chronic pain
Relaxation strategies such as diaphragmatic breathing and medication
Daily exercise is encouraged at the time of day that they feel most energetic
