Fibromyalgia

Question 1

• What substances enhance Pain?

* What substances decrease Pain?

Answer 1

• Enhance: Glutamate, Substance P, Nerve growth factor

• Decrease: Norepinephrine, Opioids, GABA, Serotonin,
Dopamine

Question 2

• T/F: Pain is different that Nociceptive pain?

Answer 2

• True - not associated with inflammation

Question 3

• What does FM pain present like?

* What is the pain a result of?

Answer 3

• widespread musculoskeletal pain with no cause.

* Pain as a result of Abnormal CNS or PNS function (central pain disorder, Hyperalgesia, Allodynia)

Question 4

What type of pain
• CNS pain
• Neuroactive neurotransmitters

Answer 4

• Central Sensitization/Centralized Pain

- (FM, IBS, TMJD, Tension HA)

Question 5

• What is Noxious Stimuli in FM patients?

Answer 5

• Heat, Electrical, Pressure.

* Painful at lower threshold

Question 6

• What is CNS dysfunction associated with?

Answer 6

Sleep and mood disturbances

Question 7

• What is the first 3 steps of FM tx?

Answer 7

1) Confirm Diagnosis
2) Education
3) Eval and tx comorbidities

Question 8

• What medication will most FM patients be on?

Answer 8

• Tricyclic Antidepressants, Antidepressants, or anticonvulsants

Question 9

• What are non-pharm Tx for FM?

Answer 9

• Education
• Tai Chi / Yoga (graded exercies)
• CBT
CAM (chiropractic, acupuncture, massage)
•  CNS neurostim

Question 10

• What are pharm Tx for FM?

MD GAPC

Answer 10

• Amitriptyline
• Cyclobenzaprine
• Duloxetine
• Milnacipran
• Gabapentin
• Pregabalin

Question 11

• Only a _____ of patients experience substancial improvement with FM medication.
• ______ benefit is seen in pain and sleep

Answer 11

• Minority

* Moderate

Question 12

• How does Amitriptyline work?

* What are ADEs?

Answer 12

• Blocks NET and SET channels

* Dry mouth, constipation, weight gain, Cardiotoxic in older patients

Question 13

• How does Cyclobenzaprine work?

* What are ADEs?

Answer 13

• Skeletal muscle relaxant

* Dry mouth, constipation, AMS, muscle weakness, blurred vision

Question 14

• How is Duloxetine used?

* What are ADEs?

Answer 14

• SNRI with breakfast

* N/V dry mouth

Question 15

• What is Milnacipran for?

* What are ADEs?

Answer 15

• SNRI severe fatigue and pain

* Nausea, HA, Constipation

Question 16

• What does Gabapentin do?

* What are ADEs?

Answer 16

• Improve sleep - binds to Alpha 2 delta voltage gated Calcium Channels. - reduce Glutamate, similar to GABA
• Peripheral Edema, Dizziness, Ataxia, Dry mouth, Tremor, Blurred vision

Question 17

Which tx are less recognized for FM.
• Due to Safety Concerns
• Not approved by US

Answer 17

• Hydroxybutyrate

* Cannabinoids

Question 18

Which tx should never be used for FM?

Answer 18

• NSAIDs

* Opioids