Fibromyalgia Flashcards
what is fibromyalgia
- syndrome causing widespread musclar pain
- not a disease
- mutliple tender points
What typically goes along with fibromyalgia
- sleep disturbances
- autonomic nervous system dysfunction
- immune system dysfunction
- related to central processing of pain
Initiating/precipitating factors of Fibromyalgia
- sleep disorder
- acute illness/infection
- prolonged anxiety and emotional stress
- trauma
- rapid steriod withdrawal
- hypothyroidism
what is reactive Fibromyalgia
- secondary/reactive Fibromyalgia occurs after another disorder
- such as lupus, polymyalgia rheumati, thyroid disorder, cancer
Fibromyalgia and autonomic nervous system
- hyperactivity of sympathetic nervous system
- increased HR, vasoconstriction
- assoicated involvement of enteric nervous system
Describe how there is hyperactivity of sympathetic nervous system in Fibromyalgia
- underactivity of parasympathetic nervous system
- decreased vagal tone assoicated with pain, inflammation,
- link between HTN and chronic pain
what occurs with Fibromyalgia and it’s affect on the enteric nervous system
- impaired digestion and nutrient absorption
- linked to impairments in CNS and immune function
- poor gastic acid secretion
What are the normal phases of sleep
- 3 non REM: N1, N2, N3
- each phase is a deeper sleep
- N3 is deepest sleep and comprises longest part of sleep cycle (you are not moving)
- 1 REM: dreaming phase
What is the importance of sleep
consolidation of learning and memory
- REM sleep important for procedural memory
- non-REM sleep important for declarative memory
important for immune function
- decreased sleep = decrease in natural killer cell activity, cirulating immune complexes, antibody responses
- decrease sleep = impaired efficiency of glymphatic system (lymph system for the brain)
What are components of good sleep hygiene
- regular schedule
- physical activity
- diet
- alcohol and caffeine intake (limit)
- stress (limit)
Fibromyalgia and sleep disturbances
- decreased deep sleep and REM sleep
- decreased time spent with muscles relaxes
- decreased release of GH used for tissue repair
- pain, fatigue, mood disturbances, disorders in thinking
- memory may also be affected by lack of REM sleep
Fibromyalgia and immune system
- immune system activation release pro-inflammatory cytokines
- also causes release of inflammatory markers that release glia in CNS
- increase in glial activiation in spinal cord
- increase in substance P, nitric oxide
- glial cells also cause further release of pro-inflammatory cytokines
- importance of minimizing risk of infection and controling inflammation with diet and exercise
large amount of inflammation
Typical clinical Fibromyalgia presentation
- muscle pain
- blurred or double vision
- mental or physical fatigue
- morning stiffness >30 minutes
- mitral valve prolapse
- anxiety
- memory problems
how is Fibromyalgia diagnosed
- criterion-based
- areas of pain/widespread pain index
- symptom severity: fatigue, waking unrefreshed, cognitive symptoms
- symptoms severity of other problems
- diagnosis based on severity of both widespread pain and symptoms
What are some potential differential diagnosis for Fibromyalgia
- endocrine disorders
- autoimmune disorders
- cancer
- metabolic myopathy
Fibromyalgia management
- holistic/interdisciplinary approach
- cognitive-behavioral therapy/pain neuroscience education
- stress management
- nutritional education
- PT for pain management and exercise
- medications
Fibromyalgia PT inerventions
focus?
- exercise
- manual therapy
- Work/ADL modification
- modalities (TENS, heat, biofeedback, laser)
Fibromyalgia PT inerventions considerations with exercise
- aerobic exercise to reduce inflammation and fatigue
- consider need for increased warm up/cool down
- monitor vitals
- outcome measures to track progress
- may need to progress slowly, monitor fatigue and tolerance
they may fatigue quicker
