fibromyalgia and chronic fatigue syndrome Flashcards
characteristic features of fibromyalgia
chronic pain, fatigue, sleep disorder (poor non restorative sleep), impaired cognitive function, mood disorders (headache, GI symptoms, and paresthesia)
men with fibromyaglia
don’t have tender points
Do tenderpoints matter with diagnosis of fibromyalgia?
no they do not.
clinical presentation of fibromyaglia
widespread MSK pain, fatigue, cognitive difficulties (impaired attention), non specific GI symptoms, depression and anxiety, examination shows tenderpoints (mid trapezius, costochondral junction, greater trochanter)
diagnosis of fibromyaglia
symptoms >3 months, normal inflammatory markers WPI>7 and SS score>5 OR WPI of 3-6 and SS score> 9
treatment of fibromyalgia
educate pts that fibromyaglia has a favorable prognosis lifestyle: aerobic exercise, sleep hygiene Medication: TCA or SNRI
who has fibromyaglia
commonly middle aged women
what is the scale we use to determine fibromyaglia severity
the Widespread Pain index (score 0-19) and the symptom severity score (0-12 pts)
any role for NSAIDS and fibromyaglia
not first line treatment.
treatment of fibromyaglia is
patient education, regular aerobic exercise, good sleep hygiene Those who don’t respond to conservative medications need TCA (amitriptyline) as first line If they don’t respond to TCA try (pregabalin, duloxetine, milnacipran)
refractory fibromyalgia tx
combination of drug therapy referral for supervised rehab or pain management referral or cognitive behavioral therapy
Chronic fatigue syndrome is also known as
systemic exertion intolerance dx (SEID)
Chronic fatigue syndrome symptoms:
sudden onset fatigue after a URI, resolution of infection but residual intense fatigue and sleep or cognitive disturbances symptoms exacerbated by physical activity pts are healthy and high functioning prior to onset of fatigue physical exam is normal
Chronic fatigue syndrome tx
cognitive behavioral therapy and graded exercise therapy
diagnosis of Chronic fatigue syndrome
can be misdiagnosed as malingering due to lack of objective findings diagnosis excludes other causes of fatigue like a thorough history, PE, and lab evidence Check CBC, CMP, TSH, ESR are all normal
potential comorbid or differential diagnoses for Chronic fatigue syndrome
depression or anxiety
difference between Chronic fatigue syndrome and fibromyalgia:
fibromyaglia will have diffuse MSK pain and tenderness on exam Chronic fatigue syndrome will have fatigue without pain and PE is normal.
sudden onset of intense fatigue that is worse with exertion and not relieved by rest, and see marked deterioration from previous level of functioning. see sleep and and cognition affected
Chronic fatigue syndrome
What is chronic fatigue syndrome?
systemic exertional intolerance disease (SEID) hx of fatigue, exhaustion after exertion, lack of restful sleep and inability to function at work
Who gets chronic fatigue syndrome?
young to middle age adults with high level of functioning prior to onset of illness. 2x common in women
Diagnosis of chronic fatigue syndrome:
psychiatric disorders, medical conditions, thorough history, physical examination, TSH, CMP, CBC and ESR
1st line tx for chronic fatigue syndrome?
cognitive behavioral therapy to targets thoughts or behaviors that hinder recovery or graded exercise therapy (slowly increasing exercise tolerance over time under supervision of a PT)
also known as systemic exertion intolerance dx
What is biofeedback and can be used for chronic fatigue syndrome?
use of electronic devices to help patients recognize and control physiological processes. Used for treatment of pain
what is systemic exertion intolerance dx is also known as
chronic fatigue sydnrome
