Fibromyalgia

Question 1

Who gets fibromyalgia?

Answer 1

Women 20-55

Question 2

What is fibromyalgia?

Answer 2

Complex, chronic syndrome manifested primarily by diffuse pain and fatigue

Physiologic, psychological, sociocultural factors

Question 3

Presentation of fibromyalgia is divided into?

Answer 3

Musculoskeletal - aching muscle pain

Non-musculoskeletal - fatigue

Question 4

Musculoskeletal presentation?

Answer 4

Aching muscle pain

• multiple sites
• occasional spasms
• stiffness

Swelling (hands and feet)

Axial skeletal involvement

Question 5

Onset of fibromyalgia?

Answer 5

Spontaneous onset - worse with exertion

Question 6

Non-musculoskeletal symptoms of fibromyalgia?

Answer 6

Fatigue
- overwhelmingly tired
Non-restorative sleep - self-perpetuating cycle of pain and poor sleep

Question 7

Fibromyalgia pts may say?

Answer 7

• tied in knots
• hurts all over
• overwhelmingly tired

Question 8

How is fibromyalgia diagnosed?

Answer 8

Diagnosis of exclusion

Widespread pain x 3 months

11/18 pain points
- enough pressure to blanch your thumb nailbed

Question 9

Pain index and symptom severity scores?

Answer 9

Widespread pain index >/= 7 and
Severity score >/=5

Or

Widespread pain index 3-6 and
symptoms severity score >/=9

Question 10

Tx for fibromyalgia?

Answer 10

Nonpharmocologic therapy is most effective

• aerobic exercise
• strength tx
• CBT
• PT
• Stress

Question 11

Drugs for fibromyalgia?

Answer 11

TCA (amitriptyline/nortriptyline)
Muscle relaxants  (sleep)
Tramadol (pain)
SNRI
- duloxetine (cymbalta)
- milnacipran (savella)