Fibromyalgia Flashcards
Which substances cause pain augmentation?
- Glutamate
- Substance P
- Nerve growth factor
- Serotonin
**high levels of these cause more pain
Which substances inhibit pain transmission?
- GABA
- Descending antinociceptive pathways
- Norepinephrine-serotonin (ex. TCA, SNRIs, Tramadol)
- Opioids
- Cannabinoids
**Low levels of these can set stage for hyperanalgesia
Centralized pain
-Disturbance in CNS processing of pain
classic examples:
- Fibromyalgia
- Irritable bowel sydrome
- TMJD
- Tension headache
What other CNS system dysfunction is often seen with fibromyalgia
- Sleep disturbance
- Mood disturbance
Also,
- decreased activity
- isolation
Fibromyalgia survery criteria
Scoring 0-31
0-19: number of body parts with pain
0-3: presence of fatigue, sleep, memory problems
1: depression, irritable bowel symptoms, and headache
Above 12 or 13 is diagnosis for Fibromyalgia
What are the 3 parts of a stepwise approach to treating fibromyalgia
- Initial approach (confirm diagnosis, education, treat comorbidities)
- Medicine and exercise (graded exercise like Tai Chi)
- If not responding to above: referral, combination drug therapy, PT, cognitive behavioral therapy
Which drugs are best for pain and sleep in FM?
- Amitripyline (TCA)
- Cyclobenzaprine
- Duloxetine
- Milnacipran
- Gabapentin
- Pregabalin
Amitriptyline
-TCA
ADE: dry mouth, constipation, fluid retention, weight gain, grogginess, difficulty concentrating
*possible cardiotoxicity limit use in older adults
Cyclobenzaprine
-Centrally acting skeletal muscle relaxant
Indication: mild to moderate FM
ADE: drowsiness, dry mouth, decreased mental acuity, constipation, neuromuscular and skeletal weakness, blurred vision
SNRIs
Duloxetine
Milnacipran
Venlafaxine
Duloxetine
- SNRI
- Preferred if patient has depression
- Improves mental fatigue, not general fatigue
ADE: nausea, headache, dry mouth
Milnacipran
-SNRI
Indications: severe fatigue and pain
-Improved pain, global wellbeing and physical function
ADE: nausea, headache, constipation
Venlafaxine
SNRI
-Not used so much because of withdrawal symptoms which occur commonly due to short half life
Gabapentin
- Anticonvulsant (blocks release of various neurotransmitters)
- Reduces pain, improves sleep, and quality of life**
ADE: dizziness, sedation, lightheadedness, weight gain
Pregabalin [Lyrica]
- Anticonvulsant
- prevents voltage gated calcium channels within CNS from releasing excitatory neurotransmitters
Indications: Severe sleep disturbance in addition to pain
ADE: Peripheral edema***
