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PTRS 746 Exam 2 > Fibromyalgia > Flashcards

Fibromyalgia Flashcards

1
Q

Content: Chronic Pain Syndromes:

  1. Childhood onset
  2. Adult onset
A
  1. Amplified Musculoskeletal Pain Syndrome (includes all types of pain syndromes - don’t label children)
  2. Fibromyalgia
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2
Q

Content: Amplified Musculoskeletal Pain Syndrome (AMPS) (4)

A
  1. Unknown etiology but can be related to injury/illness/psychological distress
  2. pre- to adolescent girls (mean 12-13 yo)
  3. Pain may be diffuse or localized to one body part
  4. Higher SES
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3
Q

Content: Hallmarks of AMPS (3)

A
  1. Increasing pain over time
  2. Heightened pain intensity
  3. Absence of other causes
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4
Q

Content: Assessment of AMPS (5)

A
  1. Pain is not restricted to dermatome or peripheral nerve
  2. Can have autonomic dysfunction
  3. Multiple joint involvement and painful points
  4. Report numbness or weakness
  5. Normal neurological exam, blood work, and radiographs
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5
Q

Content: Fibromylagia (4)

A
  1. Chronic musculoskeletal pain syndrome of unknown etiology
  2. Centralized pain with some characteristics of associated symptoms
  3. Prevalence in 2-10% with female:male = 8:1
  4. Mean age is 30-60 yo
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6
Q

Content: Fibromyalgia Tender Points (9)

A
  1. Low Cervical Region: anteriorly at interspaces between the C5-C7 over sternocleidomastoid.
  2. Second Rib: at second costochondral junction
  3. Occiput: at suboccipital muscle insertions
  4. Trapezius Muscle: at midpoint of the upper border.
  5. Supraspinatus Muscle: above the med border of the scapular spine.
  6. Lateral Epicondyle: 2cm distal to the lateral epicondyle anteriorly.
  7. Gluteal: at upper outer quadrant of the buttocks.
  8. Greater Trochanter: post to the greater trochanteric prominence.
  9. Knee: at the medial fat pad proximal to the joint line.
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7
Q

Content: Associated symptoms (Pain) (5)

A
  1. (Affects) Concentration
  2. Fatigue
  3. Anxiety
  4. Depression
  5. Sleep
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8
Q

Content: Associated Symtpoms (Fibromyalgia) (4)

A
  1. Morning stiffness
  2. Headache
  3. Numbness/tingling
  4. Temperature sensitivity
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9
Q

Content: Medical Diagnosis of Fibromyaglia (OLD) (3)

A
  1. Bilateral side pain involving upper and lower body
  2. Presence of associated symptoms
  3. Rule out other conditions
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10
Q

Content: Widespread Pain Index (WPI) (2)

A
  1. 0-19
  2. Check each area you feel pain in over the past week
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11
Q

Content: Symptoms Severity (4)

A
  1. Score for fatigue, waking unrefreshed and cognitive symtpoms from 0-3
    - 0 = no problem; 3 = severe problem
  2. Score other symptoms from 0-3
    - no symptoms = 0; 1-10=1; 11-24=2, >25=3
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12
Q

Content: Diagnostic Criteria for Fibromyalgia (NEW) (5)

A
  1. Part 1 = WPI
  2. Part 2 = SS
  3. WPI > 7 AND SS > 5 OR WPI 3-6 and SS > 9
  4. Presence of symtpoms for 3 months
  5. R/O (rule out) other pain conditions
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13
Q

Q: What is the difference between the old and new diagnostic criteria for fibromyalgia?

A

Tender points have been removed and replaced by a symtpoms checklist

Inclusive of comprehensive assessment

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14
Q

Content: Predisposing Factors for Fibromyalgia (4)

A
  1. Rheumatic conditions
  2. Hereditary
  3. Environmental factors
  4. Traumatic events
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15
Q

Content: Musculoskeletal Dysfunction (2)

A
  1. Abnormalities in fibers (decreased type 1, atrophy in type 2, muscle tetany) - difficulty with endurance and strength
  2. Abnormalities in muscle energy metabolism (low oxidative enzymes (phosphocreatine))
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16
Q

Content: CNS Dysfunction (4)

A
  1. Altered endogenous opioid activity
    - decreased opioid receptors in pain inhibitory pathways
  2. Altered neurotransmitters and neuropeptides
    - decreased serotonin; increased substance P and glutamate
17
Q

Content: Endocrine Dysfunction (2)

A
  1. Imbalance of many hormone (growth hormone:cortisol, important for muscle healing)
  2. Immune system (elevated immune markers)
18
Q

Content: Neuroendocrine System (2)

A
  1. Abnormality in hypothalamus-pituitary-adrenal gland axis (HPA)
    - Fatigue and sleep distrubance
19
Q

Content: Psychological aspect of chronic pain (4)

A
  1. Patient focuses on pain
  2. Patient presents with emotional distress and verbalizes anxiety, depression and frustration
  3. Suffering of pain is present in absence of pain severity
  4. Demonstrate avoidance of physical activity due to fear of injury/harm
20
Q

Diagram: Biopsychosocial model

A
21
Q

Defn: Biopsychosocial model

A

A dynamic interaction between physiological, psychological and social factors that propagates clinical pain presentation

22
Q

Content: Pain Assessment for Fibromyalgia Patients (4)

A
  1. VAS (pain intensity; 0-10 scale) < NOT useful for chronic pain
  2. Behavior (posture, facial expression, motor behavior)
  3. Standard pain questionnaires
  4. Don’t ask often, want to deviate away from pain (will always have pain)
23
Q

Q: What is the main goal of fibromyaglia interventions?

A

Improve function

24
Q

Q: What is the best intervention approach for fibromyalgia?

A

Interdisciplinary treatmemt approach is best (combo of meds, physical activity and cogntivie behavior therapy)

25
Q

Content: Exercise Principles for Fibromyalgia (5)

A
  1. Minimize muscle microtrauma
  2. Minimize central pain
  3. Emphasize on low-moderate intensity exercise and consistency
  4. Exercise program must be individualized
  5. Encourage self-efficacy
26
Q

Content: Patient Education for Fibromyalgia (4)

A
  1. Life-style changes
  2. Importance of exercises - tie to + effect on symp/function
  3. Pain education / neuroscience education
  4. Self-management (Improve sleep, Reduce pain/stress, Energy consumption)
27
Q

Diagram: Summary of Treatment for Fibromyalgia

A
28
Q

Content: Prognosis of Fibromyalgia

  1. Negative Predictors
  2. Positive Predictors
A
  1. Depression, pain related anxiety, kinesiophobia/movement avoidance
  2. Acceptance of condition, lack of anxiety and depression
29
Q

Q: What is the body’s number 1 defense system against pain?

A

Opioid system

30
Q

Q: What causes the trigger points associated with fibromyalgia?

A

Muscle tetany

31
Q

Content: Cortisol (3)

A
  1. Directly related to stress level
  2. Regulates many things: Immune system, BP, stress, insulin
  3. Affects ability for tissue to heal - low cortisol = compromised healing capacity
32
Q

Q: What drugs work well for fibromyalgia?

A

Antidepressants and muscle relaxers

33
Q

T/F: Fibromyalgia treatment should focus on localized areas of pain.

A

False: The whole metabolism

34
Q

Q: What is the biggest prognostic factor for fibromyalgia?

A

Pt. motivation and compliance

35
Q

Content: PT Interventions for fibromyalgia (3)

A
  1. aerobic exercise (1st choice - jump starts opioid system) - low impact, mod intensity (60-70%), 30 min
  2. strengthening - low rep/weight, concentric (don’t want to cause DOMS, avoid eccentric < don’t heal well)
  3. flexibility - not effective alone

PTRS 746 Exam 2 (9 decks)

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