Fibromyalgia Flashcards

1
Q
  • What substances enhance Pain?

* What substances decrease Pain?

A

• Enhance: Glutamate, Substance P, Nerve growth factor

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

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2
Q

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

A

• True - not associated with inflammation

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3
Q
  • What does FM pain present like?

* What is the pain a result of?

A
  • widespread musculoskeletal pain with no cause.

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

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4
Q

What type of pain
• CNS pain
• Neuroactive neurotransmitters

A

• Central Sensitization/Centralized Pain

- (FM, IBS, TMJD, Tension HA)

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5
Q

• What is Noxious Stimuli in FM patients?

A
  • Heat, Electrical, Pressure.

* Painful at lower threshold

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6
Q

• What is CNS dysfunction associated with?

A

Sleep and mood disturbances

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7
Q

• What is the first 3 steps of FM tx?

A

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

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8
Q

• What medication will most FM patients be on?

A

• Tricyclic Antidepressants, Antidepressants, or anticonvulsants

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9
Q

• What are non-pharm Tx for FM?

A
• Education
• Tai Chi / Yoga (graded exercies)
• CBT
CAM (chiropractic, acupuncture, massage)
•  CNS neurostim
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10
Q

• What are pharm Tx for FM?

MD GAPC

A
  • Amitriptyline
  • Cyclobenzaprine
  • Duloxetine
  • Milnacipran
  • Gabapentin
  • Pregabalin
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11
Q
  • Only a _____ of patients experience substancial improvement with FM medication.
  • ______ benefit is seen in pain and sleep
A
  • Minority

* Moderate

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12
Q
  • How does Amitriptyline work?

* What are ADEs?

A
  • Blocks NET and SET channels

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

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13
Q
  • How does Cyclobenzaprine work?

* What are ADEs?

A
  • Skeletal muscle relaxant

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

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14
Q
  • How is Duloxetine used?

* What are ADEs?

A
  • SNRI with breakfast

* N/V dry mouth

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15
Q
  • What is Milnacipran for?

* What are ADEs?

A
  • SNRI severe fatigue and pain

* Nausea, HA, Constipation

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16
Q
  • What does Gabapentin do?

* What are ADEs?

A
  • 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
17
Q

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

A
  • Hydroxybutyrate

* Cannabinoids

18
Q

Which tx should never be used for FM?

A
  • NSAIDs

* Opioids