Fibromyalgia Syndrome

Question 1

Fibromyalgia Syndrome (FMS)

Defintion & Epi

Answer 1

A syndrome characterized by widespread chronic pain (diffuse pain - not localized) & increased pain response (refers to a pain disorder) to pressure with no other cause
Dx of exclusion - left w/ nothing else

Can have pain in joints w/o any S/S- ex no degeneration/ inflammation
No concrete physical signs

F>M
Typical age of onset during reproductive years (15-40)

Question 2

S/S

(3) - related to pain & (5) related to psychiatric S/S

Answer 2

1. Chronic widespread pain - diffuse
2. Allodynia - heightened pain response to a stimulus that is non-painful
3. Headache
4. Fatigue - very common
5. Sleep disturbance
6. Cognitive dysfunction - “fibro fog”
7. Anxiety/depression - correlated to this population
8. Irritable bowel syndrome

Question 3

Diagnosis

1990 American College of Rheumatology Criteria for fibromyalgia

Answer 3

• Widespread chronic pain > 3 months affecting all 4 quadrants
• 11 of 18 Tender points
  1. Occiput
  2. Low cervical (anterior)
  3. Trapezius
  4. Supraspinatus (above medial border of spine of scapula)
  5. 2nd rib (at costochondral junction)
  6. Lateral epicondyle
  7. Gluteal
  8. Greater Trochanter
  9. Knee (medial)

9x2 = 18
Need to count both sides

Nothing past the knee

Question 4

2010 ACR provisional revised diagnostic criteria for FM

Answer 4

Uses 2 measures instead of tendor point testing

1. Widespread Pain Index (WPI)
   Counts up to 19 general body areas which the person has had pain in the last 2 weeks
2. Symptom Severity Scale (SS)
   Looks at:
   - Fatigue
   - Sleep disturbances - called “unfreshed” sleeping
   - Cognitive symptoms
   - General somatic symptoms

WPI>7 & SS>5 or WPI 3-6 & SS>9 = Dx w/ FM
No other diagnosed condition which can explain the pain

Question 5

Physical Therapy Management

(4)

Answer 5

1. Education & Reassurance
   NOT dangerous & there are things to help. FMS is not rare. Not a death sentence & can live happy & fullfilling lives
2. Cognitive Behavioural Therapy
   Relaxation
   Visual Imagery
   Schedules/ Routines
   Goal Setting
   Pacing
3. Exercise
   Aerobic exercise specifically has been shown to improve function as well as pt symptoms
   Start w/ low-level & low impact - progressively increase & incorporate into their lifestyle
   - Educate on benefit of AEROBIC ex -> ACTIVE treatment
   - Helps with control & self-efficacy - take ownership of their therapy
4. Sleep Hygiene
   Regular sleep
   Quiet room
   DEC caffeine intake
   No cellphone before bed