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Worst EXAM 2 > Fibromyalgia > Flashcards

Fibromyalgia Flashcards

1
Q

What is Fibromyalgia?

A

“Widespread pain occurring for >3 months and pain in at least 11 out of 18 areas”

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2
Q

What’s the cause for Fibro?

A

Unknown

Can be idiopathic or preceded by traumatic event or viral illness

Thought to be associated with abnormal peripheral nociceptive mechanisms and central pain processing

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3
Q

True/ False

Fibro is the third most commonly diagnosed rheumatic disorder after OA and RA

A

True

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4
Q

Is it more common in males or females

A

Females

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5
Q

What’s the onset?

A

29-37 years old

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6
Q

What age is it usually diagnosed at?

A

43-53 years old

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7
Q

What’s the prevalence in the population?

A

2-4% of the American population

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8
Q

What are the Hallmark Symptoms? (5)

A 
Widespread pain
Tender points
Fatigue
Sleep disturbances 
HAs
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9
Q

Where are tender points mainly located?

A

Cluster around neck and shoulders, upper chest wall, and lower back

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10
Q

Define Trigger point vs tender point:

A

Trigger point: “localized spot within a firm area of muscle (taut band) that elicits a characteristic pattern of radiating pain, tingling, or numbness in response to sustained pressure”

Tender point: “can occur in muscle, ligament, tendon, or periosteal tissue, localized rather than referred pain to adjacent areas upon sustained stimulation”

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11
Q

How should we palpate for tender points?

A

“Palpated bilaterally, at each site using thumb or first 2 fingers to apply steady, uniform pressure firmly enough to blanch the examiner’s nail bed”

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12
Q

Name other conditions that could be present in the pt’s history (10)

A

Central sensitization

Anxiety, depression, mood disorders, sleep disturbances

Chronic tension and migraine HAs

PTSD and sexual abuse
Bowel and bladder irritability/IBS
Dysmenorrhea
Paresthesia
 Raynaud’s phenomenon
Chest pain
Swelling and numbness of extremities
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13
Q

What are 4 important aspects in the exam in order to establish the diagnosis?

A
  1. American College of Rheumatology Classification of Fibromyalgia (Tender Point Chart)
  2. Detailed history
  3. Thorough exam
  4. Blood work for differential diagnosis
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14
Q

Why would you use blood work in the differential diagnosis (2)

A

Pts may have comorbidities that present with similar s/s

Blood work can help rule in/out other diagnoses that may need to be addressed as well

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15
Q

What are the 8 components of the Multifactorial Approach in Fibro management

A 
Patient education 
Traditional exercise
Aquatic therapy
Pharmacology
Psychosocial factors
Modalities
Outcome measures
Patient resources
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16
Q

What should Pt Ed include? (7)

A

Information about disease process
Established disease

Coping strategies

Stress management

Proper body mechanics

Energy conservation

Improvement in sleep

Proper nutrition
Alcohol, caffeine, nicotine determine sleep and energy levels
Carbs increase serotonin
Supplements

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17
Q

What are the recommendations for exercise in management of Fibro?

A

Aerobic exercise

Strengthening exercise

Moderate intensity

Pts with Fibromyalgia are known to be aerobically unfit with poor strength and flexibility

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18
Q

What are the recommended parameters for aerobic exercise?

A 
20-30 minutes
2-3x/week
Low impact aerobic exercise:
Walking, cycling, swimming
60-70% max HR
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19
Q

How do you determine max HR?

A

220-age

20
Q

What are the recommended parameters for strengthening exercise?

A

30 min

2-3x/week

Self-selected resistance

Increase resistance according to pt tolerance

Starting with less reps (4-5) progressing to 12 may be more beneficial for these pts

Free weights and body weights

21
Q

What is better strengthening or flexibility training?

A

Strengthening exercises yielded significant benefits compared to flexibility training

22
Q

What should we know about stretching and Fibro Patients?

A

Stretching should be mild, kiss the pain

If too intense, may stretch the nerves resulting in neural tension

Max stretching results in limited ROM versus an increase

Light stretching before and after exercise is more appropriate for these pts

23
Q

What are the benefits of strengthening and aerobic?

A

Clinical benefits for strength, pain relief, physical disability, depression, quality of sleep, fatigue, tender point counts, and quality of life

24
Q

True False

Strengthening is better than aerobic

A

False

Strengthening and aerobic exercise provide similar benefits

25
Q

What are the benefits od Aquatic therapy when compared with no treatment?

A

When compared to no treatment after 20 weeks, pts showed improvements in:
Stiffness
Quality of life
Physical function

26
Q

What are the benefits od Aquatic therapy when compared with land base treatment?

A

When compared with land based therapy, there are no significant differences

More research is needed, but shows no negative results

27
Q

What is the optimal water temp for aerobic versus stretching and strengthening?

A

Aerobic: 82˚-86˚ Fahrenheit, do not exceed 86˚

Stretching and strengthening: 90+˚ (increased extensibility)

28
Q

What works best as far as exercise in the pool? (type, intensity, duration)

A

Moderate intensity

Deep running, height of water in reference to xiphoid, subaquatic cycling, or adapted swimming

Duration 3x/week at least 20 minutes

Minimum 20 weeks

29
Q

Name three additional things we should consider before we choose aquatics:

A

Fluid mechanics
Resistance of water

Pt preference

Experience of the PT

30
Q

Name the 5 groups of meds they are most often taking?

A

SSRIs and SNRIs

Tricyclic Antidepressants

Muscle Relaxants

Anti-epileptics

Opiods, NSAIDs, and other Analgesics

31
Q

What are the effects of SSRIs and SNRIs?

A

Most effective antidepressants

May reduce pain and sleep disturbances

32
Q

What are the effects of Tricyclic Antidepressants?

A

Better at treating fatigue

May also reduce pain and sleep disturbances

33
Q

What are the effects of Muscle Relaxants?

A

Flexeril improves pain and sleep quality, but not fatigue

34
Q

What are the effects of Anti-epileptics?

A

May be used in adjunct to treat pain

35
Q

What are the effects of Opiods, NSAIDs, and other Analgesics?

A

Limited effectiveness

Associated with serious adverse effects

36
Q

What are the psychosocial factors associated with Fibro?

A

Depression

Support groups

Stress can amplify symptoms

Motivation

Goals

Health perception

37
Q

Should we use modalities?

A

You decide!

Hot or cold modalities may be used

38
Q

What is the recommended tool for outcomes?

A

Fibromyalgia Impact Questionnaire:

10 items

39
Q

What does Fibromyalgia Impact Questionnaire measure?

A

physical functioning, pain, depression, anxiety, fatigue, morning tiredness, stiffness, job difficulty, and overall well-being

40
Q

What are some (3) Additional Outcome Measures?

A

FABQ
PSFS
ODI

41
Q

What should the objective exam include?

A 
Pain and tender points
Functional mobility
ROM
Strength
Endurance
42
Q

What are some treatment options/considerations?

A 
Pt Ed
Mild stretching never to the point of pain
Light strengthening 
Low impact aerobics
Aquatic therapy
43
Q

How should we formulate the goals?

A

Not pain centered

Incorporate outcome measures

44
Q

What is the etiology and demographics for Fibro?

A

Unknown etiology

Demographics:
Females > Males
Onset: 29-37 years old

45
Q

What are the most common symptoms?

A 
Symptoms:
Widespread pain
Tender points
Fatigue
Sleep disturbances
HAs
46
Q

Key points in diagnosis (4)

A

Pain > 3 mos

11/18 areas on Tender Point Chart

Hx and exam

Differential dx

47
Q

What does the Multifactorial Treatment approach for Fibro include?

A 
Pt ed
Aerobic & strengthening
Aquatic therapy
Modalities
Pharmacology
Psychosocial factors

Worst EXAM 2 (4 decks)

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