Fibromyalgia Flashcards
Epidemiology
Women more than men
Usually dx in women aged 20-50 years old
- Peak prevalence in women 60-70
- Can occur at any age
Pathophysiology
Central sensitization
Dysfunction of HPA axis
Other biochemical changes seen in FM
Central Sensitization
Excess excitatory NT (substance p)
Low levels of inhibitory NT (serotonin)
Maintained enhancement of temporal summation of second pain
Altered endogenous opioid analgesic activity
Dysfunction of HPA axis
Neuroendocrine abnormalities
Involved in stress adaptation response system - influences pain processing via dorsal horn glucocorticoid receptors and GABA NT
Abnormal function of stress response system may be triggered by acute physical or emotional event
Other biochemical changes
Low ATP in RBCs
Increase nerve growth factor
Decreased growth hormone
Biologic variables
Genetics Sex Sleep deprivation Trauma/tissue injury Stress Infection Arthritis Surgery Exposure to toxins
Assoc with RA, SLE, Ankylosing spondylitis, CFS, CRPS
FM Clinical Presentation
WIdespread pain (dull ache) on both sides of body, above and below the waist
Mm stiffness, especially in am
HA
Thinking and memory problems
General fatigue
Poor sleep, waking unrefreshed
Paresthesias
Depression/Anxiety
Pain/cramps in abdomen or pelvis
IBS
Irritable bladder syndrome
TMJ pain
TTP
Diagnosis
Lab test to rule out other conditions
New research may have ID’d bio marker to distinguish FM from arthritis
History
Physical Examination
Differential Dx
Joint disorders Inflammatory disorders Neurological disorders Soft tissue trauma Disc related pain Referred visceral pain Lupus Mechanical stresses Nutritional, metabolic, endocrine Psychological Infectious diseases
Updated Dx Criteria
WPI and SS considered
Symptoms present at similar level for at least 3 mos
Pt does not have another disorder that would explain the pain
Widespread Pain Index
WPI
19 body areas
Symptom Severity Scale
SS Scale
Fatigue, waking unrefreshed, cognitive symptoms
Somatic symptoms in general (IBS, cramps in abdomen and pelvis)
FM Impact Questionnaire
FIQ
Measure of disease impact in Pts with FM
One of the most freq used tools in evaluation of FM
Originally developed in 1991
Several minor revisions
FIQR Domains
Function
Overall impact on functioning and symptom severity
Symptoms
FIQR
All questions relate to past 7 days
0-10 (10 the worst)
Total FIQR
Sum of 3 domain scores
Total score = 100
FIQ total score interpretation
0-38 Mild effect
39-58 Moderate effect
59-100 Severe effect
Pt education
Nature of disease process and symptoms
Activity management
Lifestyle change - nutrition, sleep, stress management
Physical Exercise
Aerobic Strengthening Stretching Aquatic Yoga Tai chi
Exercise planning
Start slow
Get an understanding of exercise tolerance
Modify program in times of stress
Set realistic goals with the patient for specific exercise and overall activity
Mind-Body Intervention
Cognitive-behavioral therapy
Mindfulness meditation
Biofeedback
Relaxation therapies
Passive Interventions
Manual therapy Dry needling Massage MFR TENS
Pharmacotherapy
Lyrica
Cymbalta
Savella
Lyrica
Decreases pain
Improves sleep
Cymbalta
Decreases pain, fatigue, and sleep problems
Savella
Decreases pain, fatigue, and sleep problems
Prognosis
Chronic relapsing condition
Strong evidence for successful management of FM with patient education, aerobic, and strengthening exercise
Chronic relapsing condition
Not progressive or life-threatening
Rarely see full reversal of allodynia and hyperalgesia
Symptoms can show significant improvement with continued, multifactorial treatment
Juvenile FM
Occurs in children and adolescents
Most frequently 13-15
One of the most commonly diagnosed pediatric amplified pain syndromes
Juvenile FM Clinical Presentation
Widespread pain Fatigue Sleep disturbances Poor memory Other somatic complaints
JFM Intervention
Pt and family/parent education
Physical exercise
Cognitive-behavioral therapy
Medication - may not be used as much in children
JFM Important Goals
Return to normal activity (sports and social activities)
Maintain/increase aerobic conditioning
JFM Research
Better outcomes with cognitive-behavioral therapy and exercise than with meds
Physically active JFM Pts appear to better maintain ability to modulate pain as compared to less active patients
Intensive PT/OT Program sans pain level results
At one year follow-up, 33% with no pain
JFM Prognosis
Often see improvement in signs and symptoms
Children and adolescents with FM more likely to have favorable outcome as compared to adults with FM
80% of children with JFM had persistent symptoms into adulthood
Fibromyalgia (FM)
FM Syndrome
Chronic widespread pain disorder (greater than or equal to 3 mos) with associated tender points, stiffness, fatigue with disrupted sleep, cognitive difficulties, and multiple other Sx/sy (Anxiety, depression, ADL function problems)
