Fibromyalgia/Chronic fatigue

Question 1

Fibromyalgia is a diagnosis of….

Answer 1

EXCLUSION

Question 2

How many tender trigger points of fibromyalgia

Answer 2

18

Posterior…neck, should, PSIS, under butt bilaterally
Anterior..neck, clavicle, elbows, knees bilaterally

Question 3

Lab testing in fibromyalgia

Answer 3

PROCEED W TESTING

Thyroid fxn
Electrolyte/chemistries 
Vitamin D
CBC
ESR/CRP
Hep C
CPK
Celiacs or IBS

Question 4

Pathogenesis of fibromyalgia

Answer 4

Pain threshold disorder 
Pain aggregated by activity, stress, lack of sleep
6:1 female to male 
*rule out sleep apnea 
Often have first degree relatives 
2% females by age 20, 8% by age 70
Also seen w depression or anxiety

Question 5

Fibromyalgia as a central pain syndrome

Answer 5

Pts have increased activity activity in somatosensory cortex, somatosensory cortex, posterior insula and thalamus

Question 6

Allodynia and hyperalgesia

Answer 6

Pts w fibromyalgia can experience both

Allodynia: pain perceived with normally non painful stimuli
Hyperalgesia: amplified pain response to normally painful stimuli

Question 7

Therapies that will NOT work with fibromyalgia

Answer 7

NSAIDS (bc no inflammation)
Narcotics (work temporarily but result in dependency)
Trigger point injections

Question 8

Therapies that might work for fibromyalgia

Answer 8

TriCyclic anti depressants
SSRIs
Dual acting agents (cymbalta, savella, Effexor)
Lyrica/Neurontin

Question 9

Lifestyle changes in fibromyalgia

Answer 9

Low impact aerobics (water based)
Sleep hygiene
Address underlying stressors
Any hx of abuse?

Question 10

Chronic fatigue syndrome

Answer 10

Poorly understood syndrome that typically affects previously active ppl resulting in unbearable exhaustion

*no infectious entity linked

Question 11

Criteria for diagnosis of chronic fatigue syndrome

Answer 11

Unexplained persistent or relapsing fatigue that is new or definite onset that is not result of ongoing exertion
Not alleviated by rest

Question 12

Four or more of these symptoms that recur for 6 or more consecutive months of illness that do not predate the fatigue used to dx chronic fatigue syndrome

Answer 12

Impairment of short term memory or concentration 
Sore throat 
Tender cervical or axillary nodes 
Muscle pain 
Multijoint pain w out red or swelling 
Headaches of new pattern or severity 
Unrefreshing sleep
Post exertional malaise lasting >24 hrs

Question 13

Epidemiology of chronic fatigue syndrome

Answer 13

2:1 females to males
25-45 yo
Patients tend to be previously healthy

Question 14

Treatments that don’t work in chronic fatigue syndrome

Answer 14

Antivirals
Corticosteroids
IV immunoglobulin

Question 15

Treatment that might work in chronic fatigue syndrome

Answer 15

(All symptom based treatment)
NSAIDS for aches and pains, headaches 
Anti histamines for allergic rhinitis sxs
Antidepressants 
Cognitive behavior tx
Education!!!!!!

Question 16

What to tell pts w chronic fatigue

Answer 16

REASSURE, REASSURE, REASSURE 
education improves outcome 
Emphasize benign nature 
Acknowledge condition does exist 
Stress reduction/exercise

Question 17

Fibromyalgia clinical presentation

Answer 17

Widespread musculoskeletal pain 
Sleep disturbances 
No objective physical findings 
11/18 tender points 
****positive review of systems 
(Chest pain, IBS, pelvic pain, parasthesias, cognitive "fog")