fibromyalgia_flashcards
What is fibromyalgia?
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain caused by CNS/PNS hyperirritability. It primarily affects middle-aged women, typically aged 20-55 years, and worsens with stress, leading to fatigue, headache, muscle pain, sleep issues, and cognitive dysfunction.
How is fibromyalgia diagnosed?
Diagnosis of fibromyalgia is clinical and often a diagnosis of exclusion. Labs such as ESR, CRP, CBC, and TSH are typically normal, helping to rule out other conditions. Current guidelines focus on symptom severity using the Widespread Pain Index and Symptom Severity Scale for diagnosis, rather than counting tender points.
What are the risk factors for fibromyalgia?
Risk factors for fibromyalgia include being a middle-aged woman (20-55 years old) and a history of chronic pain conditions such as IBS, depression, or dysmenorrhea.
What are the clinical features of fibromyalgia?
Clinical presentation includes :
Fatigue.
Chronic, diffuse musculoskeletal pain lasting for more than 3 months.
Neuro-psych issues that include abnormal sleep patterns, cognitive disturbances (fibro fog and headaches), psychiatric symptoms (depression and anxiety), and paresthesia.
Patients often experience tenderness in specific anatomical locations, including the neck, shoulders, hips, and lower back.
What is the Widespread Pain Index for diagnosing fibromyalgia?
Fibromyalgia diagnosis involves the Widespread Pain Index (WPI), where the patient reports pain in at least 11 out of 18 tender points, and the Symptom Severity Scale (SSS), assessing fatigue, sleep, and cognitive dysfunction.
What are the non-pharmacologic management strategies for fibromyalgia?
Non-pharmacologic treatments are initiated first for fibromyalgia and include patient education, regular exercise, and cognitive-behavioral therapy (CBT). Exercise therapy has been shown to reduce pain and improve sleep. CBT helps with coping strategies.
What are the pharmacologic treatments for fibromyalgia?
Pharmacological treatment may include:
1. Duloxetine or Milnacipran (SNRI): First-line treatment to address pain, fatigue, and depression.
- Pregabalin: An anticonvulsant used for pain and sleep disturbances.
- Amitriptyline (TCA): Second-line therapy for improving sleep and pain.
Opioids (e.g., tramadol and acetaminophen-codeine) are not recommended due to dependency risks and limited efficacy for chronic pain.
How are severe cases of fibromyalgia managed?
In severe, refractory cases, a combination of pharmacological treatments and biofeedback therapy can be considered. Biofeedback helps in managing pain perception and improving the patient’s ability to cope with stressors.
Biofeedback is an extremely rare answer n USMLE exams.
