Fibromyalgia Flashcards
FMA signs and symptoms?
Fibromyalgia (FM) is a medical condition characterised by chronic widespread pain and a heightened pain response to pressure.[3] Other symptoms include tiredness to a degree that normal activities are affected, sleep problems and troubles with memory.[4] Some people also report restless legs syndrome, bowel or bladder problems, numbness and tingling and sensitivity to noise, lights or temperature.[5] Fibromyalgia is frequently associated with depression, anxiety and posttraumatic stress disorder.[4] Other types of chronic pain are also frequently present.[4]
The defining symptoms of fibromyalgia are chronic widespread pain, fatigue, sleep disturbance, and heightened pain in response to tactile pressure (allodynia).[17] Other symptoms may include tingling of the skin (paresthesias),[17] prolonged muscle spasms, weakness in the limbs, nerve pain, muscle twitching, palpitations,[18] and functional bowel disturbances.[19][20]
Many people experience cognitive dysfunction[17][21] (known as “fibrofog”), which may be characterized by impaired concentration,[22] problems with short[22][23] and long-term memory, short-term memory consolidation,[23] impaired speed of performance,[22][23] inability to multi-task, cognitive overload,[22][23] and diminished attention span. Fibromyalgia is often associated with anxiety and depressive symptoms.[23]
Other symptoms often attributed to fibromyalgia that may be due to a comorbid disorder include myofascial pain syndrome, also referred to as chronic myofascial pain, diffuse non-dermatomal paresthesias, functional bowel disturbances and irritable bowel syndrome, genitourinary symptoms and interstitial cystitis, dermatological disorders, headaches, myoclonic twitches, and symptomatic hypoglycemia. Although fibromyalgia is classified based on the presence of chronic widespread pain, pain may also be localized in areas such as the shoulders, neck, low back, hips, or other areas. Many sufferers also experience varying degrees of myofascial pain and have high rates of comorbid temporomandibular joint dysfunction. 20–30% of people with rheumatoid arthritis and systemic lupus erythematosus may also have fibromyalgia.[24]
FMA cause?
The cause of fibromyalgia is unknown. However, several hypotheses have been developed including “central sensitization”.[17] This theory proposes that people with fibromyalgia have a lower threshold for pain because of increased reactivity of pain-sensitive nerve cells in the spinal cord or brain.[3] Neuropathic pain and major depressive disorder often co-occur with fibromyalgia – the reason for this comorbidity appears to be due to shared genetic abnormalities, which leads to impairments in monoaminergic, glutamatergic, neurotrophic, opioid and proinflammatory cytokine signaling. In these vulnerable individuals, psychological stress or illness can cause abnormalities in inflammatory and stress pathways which regulate mood and pain.
Eventually, a sensitization and kindling effect occur in certain neurons leading to the establishment of fibromyalgia and sometimes a mood disorder.[25] The evidence suggests that the pain in fibromyalgia results primarily from pain processing pathways functioning abnormally. In simple terms, it can be described as the volume of the neurons being set too high and this hyper-excitability of pain processing pathways and under-activity of inhibitory pain pathways in the brain results in the affected individual experiencing pain. Some neurochemical abnormalities that occur in fibromyalgia also regulate mood, sleep, and energy, thus explaining why mood, sleep, and fatigue problems are commonly co-morbid with fibromyalgia.[15]
Genetics
A mode of inheritance is currently unknown, but it is most probably polygenic.
Stress may be an important precipitating factor in the development of fibromyalgia.[33] Fibromyalgia is frequently comorbid with stress-related disorders such as chronic fatigue syndrome, posttraumatic stress disorder, irritable bowel syndrome and depression.[34] A systematic review found significant association between fibromyalgia and physical and sexual abuse in both childhood and adulthood, although the quality of studies was poor.[35] Poor lifestyles including being a smoker, obesity and lack of physical activity may increase the risk of an individual developing fibromyalgia.[36] A meta analysis found psychological trauma to be associated with FM, although not as strongly as in chronic fatigue syndrome.[37]
Sleep disturbances
Poor sleep is a risk factor for fibromyalgia.
sychological factors
There is strong evidence that major depression is associated with fibromyalgia as with other chronic pain conditions (1999),[44] although it is unclear the direction of the causal relationship.[45] A comprehensive review into the relationship between fibromyalgia and major depressive disorder (MDD) found substantial similarities in neuroendocrine abnormalities, psychological characteristics, physical symptoms and treatments between fibromyalgia and MDD, but currently available findings do not support the assumption that MDD and fibromyalgia refer to the same underlying construct or can be seen as subsidiaries of one disease concept
FMA pathophysiology?
Autonomic nervous system
Autonomic nervous system abnormalities have been observed in fibromyalgia, including decreased vasoconstriction response, increased drop in blood pressure and worsening of symptoms in response to tilt table test, and decreased heart rate variability. Heart rate variabilities observed were different in males and females.[51]
Sleep
Disrupted sleep, insomnia, and poor quality sleep occur frequently in FM, and may contribute to pain by decreased release of IGF-1 and human growth hormone, leading to decreased tissue repair. Restorative sleep was correlated with improvement in pain related symptoms.[51]
FMA diagnosis?
There is no single test that can fully diagnose fibromyalgia and there is debate over what should be considered essential diagnostic criteria and whether an objective diagnosis is possible. In most cases, people with fibromyalgia symptoms may also have laboratory test results that appear normal and many of their symptoms may mimic those of other rheumatic conditions such as arthritis or osteoporosis. The most widely accepted set of classification criteria for research purposes was elaborated in 1990 by the Multicenter Criteria Committee of the American College of Rheumatology. These criteria, which are known informally as “the ACR 1990”, define fibromyalgia according to the presence of the following criteria:
A history of widespread pain lasting more than three months – affecting all four quadrants of the body, i.e., both sides, and above and below the waist.
Tender points – there are 18 designated possible tender points (although a person with the disorder may feel pain in other areas as well). Diagnosis is no longer based on the number of tender points.[62][63]
Differential diagnosis
People referred to rheumatologists may incorrectly receive a diagnosis of fibromyalgia in up to two thirds of cases.[70] Certain systemic, inflammatory, endocrine, rheumatic, infectious, and neurologic disorders may cause fibromyalgia-like symptoms, such as systemic lupus erythematosus, Sjögren syndrome, non-celiac gluten sensitivity, hypothyroidism, ankylosing spondylitis, polymyalgia rheumatica, rheumatoid arthritis, psoriatic-related polyenthesitis, hepatitis C, peripheral neuropathies, entrapment syndromes (such as carpal tunnel syndrome), multiple sclerosis and myasthenia gravis. The differential diagnosis is made during the evaluation on the basis of the person’s medical history, physical examination, and laboratory investigations.[49][70][71][72]
FMA treatment?
Exercise
There is strong evidence indicating that exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia.[120][121] In particular, there is strong evidence that cardiovascular exercise is effective for some people.[122] Studies of different forms of aerobic exercise for adults with fibromyalgia indicate that aerobic exercise improves quality of life, decreases pain, slightly improves physical function and makes no difference in fatigue and stiffness.[123] Long-term effects are uncertain.[123]
A recommended approach to a graded exercise program begins with small, frequent exercise periods and builds up from there.[124] In children, fibromyalgia is often treated with an intense physical and occupational therapy program for musculoskeletal pain syndromes. These programs also employ counseling, art therapy, and music therapy. These programs are evidence-based and report long-term total pain resolution rates as high as 88%.[125]
Medications
Health Canada and the US Food and Drug Administration (FDA) have approved pregabalin[77] and duloxetine for the management of fibromyalgia. The FDA also approved milnacipran, but the European Medicines Agency refused marketing authority.[78]
Antidepressants
Antidepressants are “associated with improvements in pain, depression, fatigue, sleep disturbances, and health-related quality of life in people with FMS.”[79] The goal of antidepressants should be symptom reduction and if used long term, their effects should be evaluated against side effects
Anti-seizure medication
The anti-convulsant drugs gabapentin and pregabalin may be used to reduce pain.
FMA Epidemiology?
Fibromyalgia is estimated to affect 2–8% of the population.[4][127] Females are affected about twice as often as males based on criteria as of 2014.[4]
Fibromyalgia may not be diagnosed in up to 75% of affected people.[15]
