Fibromyalgia Syndrome Flashcards
What is fibromyalgia?
and incidence
- widespread MS aches, pains, stiffness
- general fatigue
- age 35-50
- women>men (80-90% are men)
- 2-4% American Population - 10 million people
What has the etiology been linked to
- negative life events - emotional and physical trauma
- repetitive injuries
- surgery
- infection
- migraines, tension headaches
- TMJ disorder
What disease is fibromyalgia also linked to
- R/A
- Lupus
- Ankylosing Spondylitis
What are some concurrent syndromes assoicated with FMS
- anxiety
- depression
- panic disorder
- irritable bowel syndrome
- chronic fatigue syndrome
- sleep disorders (sleep apnea)
- dyscongnition: trouble concentrating, disorganized, slow thinking
FMS: hypothesis on accentuation of pain
- can be related to pathophysiology/disturbance of pain mechanisms
- CNS = hyper-senitization
- deficits in endogenous pain inhibitory mechanisms
- Nociplastic pain
FMS: hypothesis on accentuation of pain
Nociplastic pain component
- disproportionate, non-mechanical, unpredictable, pattern of pain provocation
- pain disproportionate to the nature and extent of an injury/pathology, or present without injury
- diffuse widespread/non-anatomic areas of pain and tenderness on palpation
- strong association with maladaptive psychological factors
what are the possible etiology factors for FMS
- deprevation of restorative sleep
- neurobiochemical abnormalities
- Sympathetic Nervous system
- Viral correlations
- Psychological syndromes
- Unchanged local tissue states
possible etiology factors for FMS
Deprivation of restorative sleep
- 3rd stage of Non-REM sleep is when the body respairs, regrows tissues, builds bone and muscle, strengthens the immune system
- why you feel well rested, energetic the next day
- they may be missing out on this
possible etiology factors for FMS
Neurobiochemical Abnormalities
1) reduced concentration of trytophan (amino acid precursor of serotonin)
- results in
- depletion of serotonin - NT involved in deep sleep
- deprivation of restorative sleep
- increase in perceived pain and depression
2) Substance P release is accentuated
- NT involved in pain transmission
- transmission of peripheral nocioceptive stimuli from neural dorsal root fibers to higher brain centers
3) Endrophin Deficit
- modulates pain by inhibiting the release of substance P at an axonal level
- endorpins increased with aerobic exercise
- in FMS patietns the exercise may not be tolerated for long enough to see effects
possible etiology factors for FMS
Sympathetic Nervous system
- sympathetic system activity changes
- decrease muscle tissue circulation => hypoxia
- muscle hypoxia linked to…
- excessive muscle tenderness/painful
- increased pain of fibromyalgia
- fatigue
possible etiology factors for FMS
Viral correlations
- possible viral correlations with FMS
- epstein-barr
- HIV - Human immunodeficiency virus
- lyme disease
possible etiology factors for FMS
Psychological syndromes
- anxiety
- depression
- stress disorders: exacerbate FMS, treated with stress management
possible etiology factors for FMS
Unchanged local tissue states
- no structural abnormalities in muscle
- no abnormal muscle metabolism
- no different in lactate and potassium levels in mm
- however there is a correlation between number of painful tender points and decreased muscle contraction
How is the FMS diagnosis difficult and confusing
- medical hx = history/etiology unclear
- physical exam: MSK exam, Neuro exam can be normal or not correlate well with specific MOI, injury or condition
- diagnostic testing: Labs, MRI/X-ray can be normal
- may rule in FMS if assoicated pathologies are present (RA, lupus, ankylosing spondylitis)
what conditions can FMS get confused with
- myofascial pain syndrome with trigger points
- polymyositis
- chronic fatigue syndrome
- hypothyroidism
Criteria for making a FMS diagnosis
- history of diffuse widespread pain >3 months
- pain on both sides of body and below waist
- pain in 4/5 areas: L upper region (shoulder arm or jaw), R upper region , L lower region, R lower region (hip, buttock or leg), axial region (neck, back, abdominal)
- presence of 11 or more 18 bilateral tender points in muscle tissue
Tender points: localized pain upon muscle palpation; B/L and widespread
What are the 18 tender points for FMS
- occiput
- Lower cervical bilaterally
- second rib
- trapezius
- suprapsinatus
- lateral epicondyle
- greater trochanter
- knees
- gluteal
FMS impact questionaire
- self administered
- measures functional and symptom components of most affected by FMS
- administered at initial eval, re-eval, and DC outcome
- higher score indicates a greater disability
- average FM patient scores a 50
FMS diagnosis methods
- H&I, systems review, medical conditions factors
- tests and measures: ROM/length, strength
- diagnostic criteria for fibromyalgia journal clinical medicine
- American college of rheumatiology criteria
Management of FMS
- no single cure; treatment is management
- management is multidimensional: MD, psychological, physical rehab
- common goals of management: break pain cycle, restore normal sleep, increase funcitonal activity levels
FMS- patient education
- disease process
- pain management
- stress management
- consistent normal sleep routine
- nutrition
- posture and body mechanics
- physical exercise
Medications FMS management
- for pain, poor sleep pattern: tricyclic antidepressants, muscle relaxants, NSAIDs/tylenol
- lyrica
- cymbalta, savella
- Opioids are not used: side effects = dependence and increase in pain
FMS PT management
- aerobic and strengthening exercise
- aerobic exercise 30-40 minutes 3-4 times per week
- gentle stretching within pain tolerance
- strengthening deconditioned muscles within pain tolerance
- tender point massage/STM: to promote circulation, muscle relaxation
- *watch passive modalities as they may get depened and not want to exercise
