Fibromyalgia

Question 1

what might a person with fibro feel like

Answer 1

they always have the flu/hurt all over

Question 2

what does PE involve

Answer 2

tenderness in mult soft tissue anatomic locations

Question 3

what side of the body is the MS pain?

Answer 3

both sides of the body, above and below the waist

Question 4

what time is their fatigue?

Answer 4

all day long

Question 5

what is fibro fog?

Answer 5

attention deficit, difficulty completing tasks (cognitive disturbances)

Question 6

what are the psych sx?

Answer 6

depression and/or anxiety

Question 7

what other sx do they experience

Answer 7

headache (tension and migraine), parasthesias, abdominal pain (IBS symptoms), chest wall pain

Question 8

how long must the pt experience these sx?

Answer 8

at least 3 mo

Question 9

how many tender points do they need?

Answer 9

11/18

Question 10

how is the rest of their PE?

Answer 10

normal

Question 11

what lab tests should you order initially?

Answer 11

CBC and SED rate (should be normal)

Question 12

what type of nonpharmacotherapy is helpful with fibromyalgia?

Answer 12

exercise

Question 13

is it associated with increased mortality rates?

Answer 13

no

Question 14

what are the meds you try first and second?

Answer 14

(TCAs)
amitriptyline (Elavil)
cyclobenzaprine (Flexeril)

Question 15

tips and SE’s of amitriptyline?

Answer 15

start at low dose and slowly titrate up
QHS
SE: dry mouth, dry eyes, constipation, weight gain are MC

Question 16

tips and SE of cyclobenzaprine?

Answer 16

used as an alternative to amitriptyline

little antidepressant effects

Question 17

if TCAs dont work, what other drug classes can you try

Answer 17

SSRIs
SNRIs
Anticonvulsants

Question 18

which SNRI’s can you use

Answer 18

duloxetine (Cymbalta)
milnacipran (Savella)
venlaxafine (Effexor)

Question 19

what are the common SE’s of SNRI’s

Answer 19

nausea, dry mouth, HA

Question 20

which anticonvulsants can you use

Answer 20

pregabalin (Lyrica), gabapentin (Neurontin)

Question 21

what is the MOA of the anticonvulsants we can use?

Answer 21

effect cellular Ca channels and may exert their analgesic effects by blocking the release of various neurotransmitters such as glutamate and glutamine which are involved in the pain pathway

Question 22

what are the SE’s of the anticonvulsants

Answer 22

wt gain, dizziness, somnolence, periph edema, dry mouth

Question 23

what is the order of the w/u of this dz

Answer 23

1. hx of chronic widespread pain x3 mo
2. r/o other conditions with these sx
3. general PE, neuro exam, CBC, SED rate, sleep & mood eval
4. confirm the presence of tender points (11/18)
5. confirm dx of fibromyalgia