Fibromyalgia and Myofascial Pain Syndrome

Question 1

Fibromyalgia: Basics

Answer 1

• CNS overresponds to stimuli
• Affects 0.5-5%
• 2nd or 3rd most common Dx in rheumatology (20% of visits)
• 9x more prevalent in women
• May follow trauma, viral illness, or stress; etiology unknown
• Some suspect autoimmune
• Dx of exclusion

Question 2

Fibromyalgia: Definition

Answer 2

• > 3mo of MSK pain
• Pain present above and below waist bilaterally
  Pain on palpation of tender joints
• No other source of pain identified
• Associated with fatigue and non-restorative sleep
• Myofascial pain: limited to shoulder and neck region

Question 3

Fibromyalgia: Clinical Presentation

Answer 3

• Variety of other somatic complaints
• IBS, CP, sense of joint swelling, anxiety, and mood disorders, depression, HA/Migraines
• Document trigger points as recommended; must have 11/18 trigger point sites
• Cognitive difficulty (more common in teenage girls)
• Auditory, vestibular, and ocular complaints
• Palpitations
• On exam, imperative to note NL muscle strength and no evidence of synovitis or soft tissue inflammation

Question 4

Fibromyalgia: Tx

Answer 4

• Cognitive - behavior therapy
• Meds: TCAs; SSRI/SNRI, anticonvulsants
• Exercise (yoga, yoga, gentle stratching, swimming)
• Alternative Tx: Massage, chiropractics; hypnosis; biofeedback; trigger point injections
• Chronic opioids: only as last resort

Question 5

Chronic Fatigue Syndrome(CFS): Basics

Answer 5

• Subset of fibromyalgia
• Fatigue: new onset; unexplained; not linked to exertion; persistent
• 2/3rd adolescents report this occurred after viral sore throat
• 2 Criteria for Dx:
  1) Severe and debilitating fatigue present for 6mo+ not relieved by rest
  2) Another Dx does NOT explain Sx

Question 6

CFS: Symptom Criteria

Answer 6

4/8 must be present:

1) impaired short-term memory
2) sore throat that is recurrent
3) painful cervical/axillary nodes
4) myalgia
5) Arthralgia without swelling or redness
6) HAs
7) Unrefreshing sleep
8) Postexertional malaise lasting >24hr

Question 7

CFS: Dx & Mgmt.

Answer 7

• EBV has been implicated, but most likely culmination of infectious agent, immune response, and stress
• Also Dx of exclusion
• Pharmacologic therapy is not effective
• Psychosocial support
• Usually improves in 1-4yrs