Fibromyalgia Flashcards

1
Q

Epidemiology

A

Women more than men

Usually dx in women aged 20-50 years old

  • Peak prevalence in women 60-70
  • Can occur at any age
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2
Q

Pathophysiology

A

Central sensitization

Dysfunction of HPA axis

Other biochemical changes seen in FM

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3
Q

Central Sensitization

A

Excess excitatory NT (substance p)

Low levels of inhibitory NT (serotonin)

Maintained enhancement of temporal summation of second pain

Altered endogenous opioid analgesic activity

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4
Q

Dysfunction of HPA axis

A

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

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5
Q

Other biochemical changes

A

Low ATP in RBCs

Increase nerve growth factor

Decreased growth hormone

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6
Q

Biologic variables

A
Genetics
Sex
Sleep deprivation
Trauma/tissue injury
Stress
Infection
Arthritis
Surgery
Exposure to toxins

Assoc with RA, SLE, Ankylosing spondylitis, CFS, CRPS

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7
Q

FM Clinical Presentation

A

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

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8
Q

Diagnosis

A

Lab test to rule out other conditions

New research may have ID’d bio marker to distinguish FM from arthritis

History

Physical Examination

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9
Q

Differential Dx

A
Joint disorders
Inflammatory disorders
Neurological disorders
Soft tissue trauma
Disc related pain
Referred visceral pain
Lupus
Mechanical stresses
Nutritional, metabolic, endocrine
Psychological
Infectious diseases
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10
Q

Updated Dx Criteria

A

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

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11
Q

Widespread Pain Index

WPI

A

19 body areas

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12
Q

Symptom Severity Scale

SS Scale

A

Fatigue, waking unrefreshed, cognitive symptoms

Somatic symptoms in general (IBS, cramps in abdomen and pelvis)

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13
Q

FM Impact Questionnaire

FIQ

A

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

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14
Q

FIQR Domains

A

Function

Overall impact on functioning and symptom severity

Symptoms

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15
Q

FIQR

A

All questions relate to past 7 days

0-10 (10 the worst)

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16
Q

Total FIQR

A

Sum of 3 domain scores

Total score = 100

17
Q

FIQ total score interpretation

A

0-38 Mild effect

39-58 Moderate effect

59-100 Severe effect

18
Q

Pt education

A

Nature of disease process and symptoms

Activity management

Lifestyle change - nutrition, sleep, stress management

19
Q

Physical Exercise

A
Aerobic
Strengthening
Stretching
Aquatic
Yoga
Tai chi
20
Q

Exercise planning

A

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

21
Q

Mind-Body Intervention

A

Cognitive-behavioral therapy

Mindfulness meditation

Biofeedback

Relaxation therapies

22
Q

Passive Interventions

A
Manual therapy
Dry needling
Massage
MFR
TENS
23
Q

Pharmacotherapy

A

Lyrica
Cymbalta
Savella

24
Q

Lyrica

A

Decreases pain

Improves sleep

25
Q

Cymbalta

A

Decreases pain, fatigue, and sleep problems

26
Q

Savella

A

Decreases pain, fatigue, and sleep problems

27
Q

Prognosis

A

Chronic relapsing condition

Strong evidence for successful management of FM with patient education, aerobic, and strengthening exercise

28
Q

Chronic relapsing condition

A

Not progressive or life-threatening

Rarely see full reversal of allodynia and hyperalgesia

Symptoms can show significant improvement with continued, multifactorial treatment

29
Q

Juvenile FM

A

Occurs in children and adolescents

Most frequently 13-15

One of the most commonly diagnosed pediatric amplified pain syndromes

30
Q

Juvenile FM Clinical Presentation

A
Widespread pain
Fatigue
Sleep disturbances
Poor memory
Other somatic complaints
31
Q

JFM Intervention

A

Pt and family/parent education

Physical exercise

Cognitive-behavioral therapy

Medication - may not be used as much in children

32
Q

JFM Important Goals

A

Return to normal activity (sports and social activities)

Maintain/increase aerobic conditioning

33
Q

JFM Research

A

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

34
Q

Intensive PT/OT Program sans pain level results

A

At one year follow-up, 33% with no pain

35
Q

JFM Prognosis

A

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

36
Q

Fibromyalgia (FM)

FM Syndrome

A

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)