fibromyalgia Flashcards
Define fibromyalgia
A chronic health problem that causes diffuse musculoskeletal pain with tenderness to touch or pressure affecting muscles and sometimes joints or even the skin.
It is frequently associated with other symptoms and tends to vary in severity. Stress often worsens the symptoms.
What additional syndromes fall under the umbrella term Amplified Musculoskeletal Pain syndrome? (AMPS)
Falls under umbrella term known as Amplified Musculoskeletal Pain syndrome (AMPS) Fibromyalgia Complex regional pain syndrome (CRPS) Myofascial pain syndrome Neuropathic pain Psychogenic pain Reflex neurovascular dystrophy (RND) Reflex sympathetic dystrophy (RSD)
What are commonly reported symptoms of fibromyalgia?
Commonly reported symptoms* include:
Sleep problems (waking up unrefreshed) and severe fatigue
Problems with memory or thinking clearly – “fibro fog”
Depression and/ or anxiety
Migraine or tension headaches
Digestive problems: irritable bowel syndrome (IBS) or gastroesophageal reflux disease (GERD)
Irritable or overactive bladder
Chronic pelvic pain
Temporomandibular (TMJ) complaints which may include jaw pain or clicking
Tinnitus (ringing in the ears)
- In the absence of another identifiable cause of these symptoms
Describe the different pain sensations and distributions of a person with fibromyalgia.
Pain tends to wax and wane, and is often migratory
Patients often complain of feeling achy “all over”
Paresthesia may be present in non-anatomical pattern
Patients may complain of a sensation of weakness but there is no objective weakness on exam (assuming good effort by patient)
Remember that pain is not always the presenting symptom!
Ask about associated symptoms
What should you see on a PA of a person with fibromyalgia?
Multiple tender points
No signs of inflammation (calor, rubor, tumor)
No objective weakness
No signs suggesting structural or systemic disease
What lab testing should be done to evaluate fibromyalgia?
CBC w/ differential and CMP
evaluating for evidence of inflammation or organ pathology
ESR (Erythrocyte Sedimentation Rate) and CRP (C-Reactive Protein)
CPK (Creatine Phosphokinase)
TSH (Thyroid Stimulating Hormone)
25(OH)-vit D
Other…
Remember to think about the significance of each test you order!
Do not order an ANA (Anti-Nuclear Antibody) or RF (Rheumatoid Factor) unless you think the patient may have an auto-immune inflammatory condition
What three criteria must be met in order for a person to be diagnosed with fibromyalgia?
- widespread pain >7
- present for at least 3 months
- pt does not have disorder that would otherwise explain symptoms
- may have fatigue, waking unrefreshed, cognitive symptoms
How do you assess tender points?
Digital palpation should be performed with an approximate force of 4 kg. A tender point has to be painful (think distress) at palpation, not just "tender.” 11 Of 18 Tender Points Occipital Low Cervical Trapezius Supraspinatus Second Rib Lateral Epicondyle Gluteal Greater Trochanter Knee
Who is affected by fibromyalgia?
2-4 % of population
women > men (7x more likely)
average age onset 30-50 years old
first degree relatives have a higher than expected frequency of fibromyalgia syndrome
Describe the pathogenesis of fibromyalgia
Genetically susceptible host exposed to stressor Aberrant central nervous system functioning - Enhanced excitability - Decreased inhibition - Altered sensory processing - Altered autonomic functioning - Altered neuroendocrine functioning
Describe hoe generalized sensory processing abnormality manifests in those with fibromyalgia
Central pain sensitization rather than a peripheral process
Fibromyalgia patients experience pain at a lower threshold
Sensitivity to noises, bright lights, odors, drugs, chemicals may also exist
Describe the relationship between fibromyalgia and autoimmune disorders
There is a high prevalence of fibromyalgia syndrome in patients with underlying chronic painful conditions and autoimmune disease including: Systemic lupus erythematosus (SLE) Rheumatoid arthritis (RA) Sjogren’s syndrome (a systemic autoimmune disease affecting moisture-secreting glands leading to dryness or “sicca”)
How should a provider approach managing fibromyalgia?
Schedule adequate time to explain the diagnosis!
Appreciate that labeling patients can be helpful in most and harmful in others
Try to narrow down and find out what is bothering the patient most
What is the impact of his/her symptoms on their life
What is the patient’s perception of the cause
What are the stressors that exacerbate symptoms
Assist the patient in understanding the goals of therapy
Consider a multidisciplinary approach early
What are three main focuses off fibromyalgia treatment?
In addition to the H&P and addressing associated symptoms and underlying “primary” conditions, consider focusing on:
Sleep disturbances
Psychological factors
Importance of physical activity
What are sleep disturbances in fibromyalgia?
Fibromyalgia patients experience poor sleep
Sleep studies demonstrate “alpha wave intrusion” into deep delta wave sleep
occurs during NREM (non- rapid eye movement) stage-4 (deep) sleep and causes the patient to awaken or to be aroused into a lighter level of sleep
* not specific to fibromyalgia
