fibromyalgia + chronic fatigue Flashcards
what is fibromyalgia?
Soft tissue disorder that causes chronic musculoskeletal pain
what is another name for fibromyalgia?
AKA fibrositis (bad term, because of lack of inflammation)
why are migraines + IBS similar to fibromyalgia
they’re both neurosensitivity disorders
Second most common “rheum” illness after OA
fibromyalgia (even though its not a rheum disorder at all!)
who gets fibromyalgia?
women in industrialized countries
fibromyalgia explained as a pain sensitivity syndrome
Generalized sensitivity to multiple stimuli “central sensitivity syndrome”
Generalized lowering of the pain perception threshold
3 parts of clinical presentation of fibromyalgia
- 50% occur after an event (trauma, illness etc)
- Pain and fatigue
- Allergic and vestibular symptoms also prominent
define allodynia and hyperalgesia
allodynia: pain with stimuli that should not cause pain, such as gentle touching
hyperalgesia: amplification of pain experienced from peripheral stimuli that are expected to be painful
what is the pain from FM aggravated by?
Aggravated by exertion, stress, lack of sleep and weather changes
what is the fatigue like with FM?
Non-restorative sleep - wake up tired
- worse after activity
- accompanied with memory difficulties
4 subjective symptoms of FM (kinda weeds)
Heat and cold intolerance
Large fluctuations in weight
Subjective sensation of weakness
Sensation of swelling over joints
what are the “allergic” symptoms that come with FM?
More adverse drug reactions
More rhinitis and nasal congestion
ears & eye symptoms of FM
eyes: High incidence of sicca symptoms: Dry eye and mouth. ocular dysmotility , Exaggerated nystagmus
ears: dizzy , Low frequency sensorineural hearing loss
cardinal sign of FM on physical exam
Tender triggers or tender points
what is the classifcation of “tender points” and what is the mean value for the normal population?
4 kg of pressure is applied (enough to blanch examiner’s nail), delivered at 1 kg/sec rate
Mean value in normal population 1-4
what are the 2 problems with the “tender points” measurement ?
Not a good measure of tenderness
Nobody knows how to do 4 kg pressure, 1 kg/sec
labs in FM ?
ALL NORMAL
differential for FM - what things should you check for? (kinda weeds)
CBC: anemia or infection
thyroid: hypothyroidism
creatine phosphate: inflammatory myopathies
ESR: inflammatory d/o or occult malignancy
ANA: SLE
rheumatoid factor: RA
is FM considered a disability by social security?
yes, but you can have FM and not meet the criteria
american college of rheumatology criteria: how many trigger points do you need for FM dx? (2010/2016 vs now?)
2010/2016: 11/18
now: less strict but w/ specific criteria
american college of rheumatology 2016 criteria for FM: WSI + SSS
WPI ≥7 + SSS score ≥5
Or
WPI 4–6 and SSS score ≥9.
what is WSI ? how is it scored?
widespread pain index: where theyve had pain in the last week (score 0-19)
what is SSS? how is it score?
3 symptoms:Fatigue, Waking unrefreshed, Cognitive Sx
- severity of each symptoms ranked 0-3
(no problem - severe)
ALSO considering somatic symptoms
Total: 12
primary txt for FM
non-pharm: CBT, aerobic exercise, PT (start low go slow)
+ EDUCATE Pt
what does CBT for RM include (kinda weeds)
Relaxation training Activity pacing Pleasant activity scheduling Visual imagery Distraction strategies
aerobic exercise for FM
give analgesic + antidepressive effect
- low impact
- pain will get worse immediately after workout (exacerbated by weight gain)
what kind of physical modalities can be offered for FM ?
dry needle trigger point “injections”
2 meds for FM
Amitriptyline and cyclobenzaprine (helps sleep)
what med to avoid for FM?
narcotics (b/c its a chronic illness- can’t take this for long)
As the illness of FM progresses… what happens to txt?
less responsive to treatment (but tends to improve by itself eventually)
what is chronic fatigue syndrome?
FM but primary complaint is fatigue
various unrelated infectious diseases like EBV- mono, lyme, etc. lead to a state of prolonged fatigue… so what makes it chronic fatigue syndrome ?
If the condition is accompanied by cognitive difficulties, the disease is termed CFS
clinical presentation of CFS
Sudden onset in previously active person
Unbearable fatigue
Associated symptoms of HA, sore throat, tender nodes, muscle and joint aches
CFS CDC Dx criteria: fatigue that is… (4)
New
Not from exertion
Not better with rest
Causes reduction in occupational, social, or personal activity
“additional” symptoms with CFS
4+ in 6 months... Trouble concentrating Sore throat Tender lymph nodes Myalgias Arthralgias HA Non restorative sleep Postexertion malaise
txt for CFS (3 part)
- Symptomatic meds: Same as for FM, antidepressants (perhaps NSAIDs)
- balance rest + exercise
- CBT
prognosis of CFS
Doesn’t progress, and most slowly improve
overall FM vs CFS
CFS: FATIGUE, mild fever or chills and sore throat
Fibromyalgia: PAIN better with heat or massage, worse by sitting or standing
