fibromyalgia Flashcards
fibromyalgia
bilateral extremity, axial widespread pain, excessive point tenderness in 11/18 defined points.
diagnostic
widespread pain greater than 7 and symptom severity score at least 5, or WPI 3-6 and symptom severity at least 9. symptoms present at least 3 months. cannot have another disorder
what does the symptom severity score measure?
fatigue, waking unrefreshed, cognitive symptoms.
physical exam and labs
observe musculoskeletal abnormalities, check range of motion, check strength, check reflexes, ask about the tender palpation points.
sleep EEG can be diagnostic by the stage 4 sleep abnormalities.
what other diseases to consider
lyme, syphilis, and consider lupus and other inflammatory sydrome
common symptoms
muscle pain, fatigue, insomnia, joint pain, headaches, restless legs, memory and anxiety and depression.
what about the pain?
patients have pain on physical exam. there are no other neurological signs. seem to be in pain for no reason.
how are fibromyalgia viewed>
hysterical, difficult, somatic, hypochondriac.
possible etiology
serotonin pump, COMT abnormalities. HPA and autonomic nervous abnormal. lower pain threshold, increased temporal summation of pain. increased CSF substance P.
sleep deprivation in fibro?
patients sleep less hours, lose deep sleep because stage 4 is disrupted by alpha waves intrusion. as a consequence they have less growth hormone release.
exercise
seems to be helpful. aerobic exercise, muscle strengthening and aqua therapy all seemed to improve.
CBT?
reduces pain severity and improves functioning. meditation, relaxation and stress management also help.
medications to use?
TCA, SSRI, SNRI. all raise NE or SR.
analgesics: tramadol -opiate. NSAIDS-ineffective.
seems that AED are very effective. carbamezepine, gabapentin, pegabalin
comorbidities
high association with depression and anxiety. hard to tell which comes first?
