Fibromyalgia Flashcards
Chronic widespread pain disorder (> 3 months) with associated tender points, stiffness, fatigue with disrupted sleep, cognitive difficulties and multiple other S & S’s (anxiety, depression, ADL function problems
Fibromyalgia
Leads to whole body hypersensitivity to pain with increased responsiveness to peripheral stimuli
Central sensitization in fibromyalgia
what is the effect of excess excitatory NT (substance P)
Increased activity of pain facilitatory pathways
one of the believed causes of fibromyalgia is central sensitization.
How does central sensitization occur?
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Central sensitization:
- Too much excitatory NT (substance p)
- Too little inhibitory NT (serotonin)
- Maintained enhancement of temporal summation of second pain (C fibers)
- Altered endogenous opioid analgesic activity
Leads to whole body hypersensitivity to pain with increased responsiveness to peripheral stimuli
In fibromyalgia, dysfunction of hypothalamic-pituitary-adrenal axis (HPA axis)
Abnormal function of stress response system may be triggered by acute physical or emotional event
Biopsychosocial model in fibromyalgia
- No specific cause but multifactorial etiology:
- Psychological variables
- Sociocultural variables
- Biological variables
Name 3 of the S & S in fibromyalgia
- Widespread pain (dull ache) on both sides of body, above & below
the waist- Allodynia
- Hyperalgesia
- Muscle stiffness, especially in the morning
- Paresthesias
- Headache
- General fatigue
- Nonrestorative sleep, (waking unrefreshed)
- Hypersensitivity to cold/heat
Diagnosis of fibromyalgia:
- History
- Physical Examination
- Lab Tests: to rule out other conditions
Original diagnostic criteria of fibromyalgia criteria (American College of Rheumatology 1990)
- Widespread pain in all 4 quadrants of body for at least 3 consecutive months
- Tenderness in at least 11 of 18 specific points
Updated Diagnostic Criteria (ACR 2010); Fibromyalgia DX if 3 conditions met:
(must know this!)
- Widespread pain index (WPI) > 7 AND Symptom severity scale (SS scale) > 5
- WPI = pain in 19 body areas
- OR WPI: 3-6 AND SS scale > 9
- Symptoms present at similar level for at least 3 months
- Patient does not have another disorder that would explain the pain
What is the Fibromyalgia Impact Questionnaire?
How is scored?
- a measure of disease impact in patients with fibromyalgia.
- Higher scores indicate greater impact of fibromyalgia on functioning.
Name 2 PT interventions for patient with fibromyalgia
Multimodal Approach
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Patient education:
- Identification of triggers of flare-ups
- Activity mgmt
- Lifestyle changes
-
Physical exercise:
- Aerobic
- Strengthening
- Stretching
- Aquatic
- Yoga
- Tai chi
-
Mind-Body
- Meditation
- Relaxation therapies
-
Passive interventions:
- Manual threapy
- Dry needling
- Massage
- TENS
- MFR
Name some exercise recommendations for patients with fibromyalgia
- Start slow and set realistic goals
- Get an understanding of the pt exercise tolerance
- Modify the program in times of stress
- Progress exercise intensity, duration and frequency gradually according to patient tolerance
3 drugs approved by FDA for treatment of fibromyalgia
-
Lyrica ( pregablin )
Decreases pain, improves sleep -
Cymbalta (duloxetine)
Decreases pain, fatigue & sleep problems -
Savella (milnacipran)
Decreases pain, fatigue & sleep problems
Fybromyalgia prognosis
- Chronic relapsing condition
- Rarely see full reversal of allodynia & hyperalgesia
- Strong evidence for successful management of fibromyalgia with patient education, aerobic and strengthening exercise
