Fibromyalgia & Myofascial Pain Syndrome Flashcards
nociceptive pain pathway
*communication from peripheral nerves → dorsal horn of spinal cord → brain → back to spinal cord
*communication between brain and spinal cord is via spinothalamic tract
nociceptive pain
*stimulation coming from the periphery; external stimulus
*includes somatic (bones, muscles) & visceral (organs) pain
*the stimulus-response process involving stimulation of peripheral pain-carrying nerve fibers and the transmission of impulses along peripheral nerves to the CNS, where the stimulus is perceived as pain
neuropathic pain
*pain that is caused by a pathology within the nervous system and is typically described as burning, stabbing, shooting, numbness, or tingling
*can be central or peripheral
nociplastic pain
*altered recognition and/or transmission of pain: hypersensitization / hyperresponsiveness
*pain that arises or is sustained by altered nociception, despite the absence of tissue damage
*fibromyalgia and other chronic pain conditions fall in this category
myofascial pain syndromes (MPS) - defined
*MPS: sensory, motor, and autonomic symptoms caused by myofascial trigger points
*trigger points: a hyperirritable focus within a taut band of skeletal muscle or fascia
-painful on compression
-produce a local twitch response on muscle manipulation (snapping)
myofascial pain syndromes (MPS) - clinical features
*predisposition to muscle microtrauma (deconditioned state, poor posture, underlying arthritis, certain occupations or recreational activities)
*persistent pain at REST
*restricted movement
*referred pain (does not follow dermatome or nerve distribution)
ddx for myofascial pain syndromes (MPS)
*regional: bursitis, tendinitis, axial radiculopathy
*diffuse: fibromyalgia
*overlapping syndrome: significant overlap between MPS and fibromyalgia; trigger point areas may entrap a nerve
myofascial pain syndromes (MPS) - treatment
*physical therapy
*identify predisposing MSK abnormalities
*correct posture and/or other abnormal mechanics
*transcutaneous electrical stimulation
*thermal modalities
*trigger point injection
fibromyalgia (FM) - overview
*most common rheumatic cause of widespread pain
*clinical features: diffuse aching and stiffness, fatigue, sleep disturbances
*diagnosis based on 2 parameters:
-widespread pain index
-symptom severity scale
fibromyalgia (FM) - clinical features
- diffuse aching and stiffness
- fatigue
- sleep disturbance
fibromyalgia diagnostic criteria
*the following 3 conditions should be present:
1) widespread pain index 7+ and symptom severity score 5+ OR WPI 3-6 and SS score 9+
2) symptoms have been present at a similar level for 3+ months
3) patient does not have a disorder that would otherwise explain the pain
ddx for fibromyalgia
other diffuse pain syndromes:
*systemic rheumatic disease
*infections (ex. Hep C)
*chronic fatigue
*hyper- or hypothyroidism
*fibromyalgia
fibromyalgia (FM) - central sensitization
*central sensitization: abnormalities of descending inhibitory pain pathways
*allodynia: sensations that were formerly non-painful now become painful
*hyperalgesia: sensations that formerly were mildly painful now become excessively painful
*temporal summation: after an initial painful stimulus, subsequent equal stimuli are perceived to be more intensely painful
fibromyalgia (FM) - pathophysiology
- central sensitization
- neurotransmitter abnormalities
- neurohormonal abnormalities
roles of stress/psychological factors in fibromyalgia (FM)
- predisposing factors (physical abuse, trauma, injuries)
- triggering factors (life threatening events)
- PERPETUATING FACTORS:
-the alarming portrayal of the condition as catastrophic and disabling
-pain signifies damage and that activity should be avoided
-one is unable to function because of pain
-higher body-related attention
fibromyalgia (FM) - epidemiology
*women > men (60-70% female)
*peak age: 30-50
*can have its onset in childhood; can present over age 60
fibromyalgia (FM) - associated symptoms
*fatigue
*sleep disturbances
*stiffness
*paresthesias
*headaches
*IBS (irritable bowel syndrome)
*depression
*anxiety
secondary fibromyalgia (FM)
*can occur in the following settings:
-rheumatoid arthritis, lupus, scleroderma, other connective tissue diseases
-Hep C, HIV
-multiple sclerosis
fibromyalgia (FM) and depression
*increased rates of depression in pts with fibromyalgia
*the presence of depression worsens pain outcomes and vice versa
*despite substantial overlap, most pts with FM are NOT clinically depressed
lab tests to exclude medical conditions that may be presenting as fibromyalgia
*thyroid test (rule out hypo or hyperthyroidism)
*glucose
*creatinine and SGPT
*blood count
fibromyalgia (FM) - general treatment principles
*education - nature of the illness
*improve quality of sleep
*increase level of physical activity (graded aerobic exercise)
*consider pharmacological treatment for pain relief or relief of coexisting psych disorders (non-drug approach is preferred)
fibromyalgia (FM) cognitive behavioral therapy
includes:
*progressive muscle relaxation
*activity pacing
*pleasant activity scheduling
*reframing of negative or self-defeating thoughts
*problem solving skills and stress management
drugs used in fibromyalgia (FM)
- tricyclic compounds
- muscle relaxants
- serotonin norepinephrine reuptake inhibitor (SNRI) [ex. duloxetine]
- anti-convulsants [ex. pregabalin]
myofascial pain syndrome (MPS) vs fibromyalgia (FM)
*MPS is more of peripheral nociception (nociceptive pain)
*FM is more of central nociception (nociplastic pain)
