Fibromyalgia Flashcards
Define fibromyalgia (FMS)
Chronic non-inflammatory, non-autoimmune diffuse central pain-processing syndrome
True or false, FMS is inflammatory
False
True or false, FMS is an autoimmune disease
False
What are the cardinal manifestations of FMS?
Diffuse tenderness on physical examination Fatigue Disturbed mood General somatic hyperawareness Poor sleep
True or false, FMS is a disease of the MSK system
False
What are the diagnostic criteria for FMS?
Widespread pain index score > 7 based
Symptom severity scale >5 based on fatigue, cognitive, non-restorative sleep, general presence of somatic symptoms, and exclusion of other medical conditions that could account for pain.
No tender point exam required.
Who is the typical patient with FMS?
Middle-aged women
An alternative diagnosis should be strongly considered in men, and persons that develop symptoms after the age of 55
What is secondary FMS?
Can develop in those with lupus or RA
More likely to develop with longer uncontrolled disease state or longer time to treat
Risk in overtreating RA/lupus rather than recognizing 2 FMS
What is the etiology of FMS?
Unknown, but evidence has accumulated which argues strongly that FMS is a central pain processing disorder. This hypothesis is supported by CSF, genetic and functional MRI studies.
True or false, central sensitization appears to play a role in FMS
True
How do substance P levels compare between the typical pt and the typical pt with FMS?
2-3x higher in pts with FMS
True or false, genetics appear to play a major role in FMS?
True
Patients 8.5x more likely to have a relative with FMS compared to RA patients
What gene appears to play a role in FMS and what is the mechanism?
COMT
Associated with pain tolerance
Association with low COMT and TMD
How do FMS pts compare to typical pts with respect to pressure stimulus?
At same pressure, pts with FMS have substantially higher pn; In order to achieve same pn levels, typical pts required far more pressure to be applied
How does brain activity compare btwn FMS pts and controls during application of pressure?
FMS pts showed activation in primary somatosensory cortex, secondary somatosensory cortex, and anterior cingulate cortex
No overlap in brain activity btwn groups with low-level pressure
Some overlapping activity in somatosensory cortex btwn groups at same pn level, but no ACC activation in control group
Name some disorders that could present like FMS
Endocrine: Hypothyroidism, adrenal insufficiency, Cushing’s syndrome, hyperparathyroidism, and hypovitaminosis D,
GI: Hepatitis C, celiac sprue
Sleep disorders: OSA
Psychiatric: Major depressive disorder
Neurologic: MS, myotonic dystrophy type 2
Hematologic: Anemia
Rheumatologic: RA, connective tissue diseases, spondyloarthropathies
What is the typical pt presentation for FMS?
Pain from “head to toe” or “everywhere.”
Pan-positive Review of systems for sensory phenomenon
Fatigue
Difficulty falling asleep and non-restorative sleep
Depression
Physical examination and labs should be normal.
What are the principles of FMS tx?
Not just meds Start low, go slow Change only one medication at a time Avoid opiods NSAIDs don’t work Target the central neurologic mechanisms of FMS
True or false, opioids are effective for treating FMS
False
Why are opioids ineffective for treating FMS?
Receptors already saturated in pts with FMS – antagonists may actually help
What types of meds may help treat FMS?
NE, 5HT supplementation, GABA and substance antagonists
True or false, NSAIDs are effective for treating FMS
False
True or false, cognitive behavioral therapy is effective in treating FMS?
True, studies show it can help
What sorts of non-medical tx are used for FMS and what are the effects?
Aerobic training superior to resistance training for pain benefit in women with FMS.
Moderate-intensity resistance training improves functional status, pain, tenderness and muscle strength
Flexibility training was helpful in terms of pain and functional status, but less than aerobic or resistance training.
True or false, the evidence shows high efficacy of non-medical tx for pts with FMS
False, at this point the evidence is low quality
What sorts of pts with FMS may benefit from pool therapy?
Those with comorbid depression and/or anxiety
True or false, supervised group exercise is recommended for pts with FMS?
True, may improve adherence
What is a reasonable goal for someone with severe pn, disability, and deconditioning from FMS?
A reasonable goal for homebound, disabled and deconditioned FMS is to walk 20 minutes, 5 days a week.
To reach this objective and reduce post-exertional pain, start with “homework” of 1-5 minutes of walking and gradually increase over weeks to reach goal.
Why is a formal diagnosis of FMS important to patients?
The FMS dx alleviates patients’ stress about mysterious underlying conditions.
Patients can’t get better if they are constantly trying to prove that they are sick.
True of false, pharmacologic management is the key to treating FMS
False, they should not be the focal point of treatment
