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)