Firbomyalgia Syndrome and Complex Regional Pain Syndrome Flashcards
Fibromyalgia syndrome?
chronic MSK pain, prolonged morning stiffness, and fatigue associated with multiple tender points
Considerations?
women mostly, 30-60
40% meet criteria
Clin presentation?
gradual onset diffuse pain morning stiffness bilateral tender points fatigue depression
American College of Rheumatology criteria?
History widespread pain
axial skeleton pain must be present
Tender points
axial skeleton pain?
cervical spine, anterior chest, thoracic spine, low back
Tender points?
Post C1 C5-C7 bilateral trapezius supraspinatus second rib lateral epicondyle gluteal greater trochanter knee
Fibromyalgia control points?
symptoms at the following indicate symptom magnification
-Forehead, volar forearm, anterior thigh, thumbnail
American college of rheumatology measurement of symptom severity 2010 purpose?
develop a simple, practical criteria for diagnosis without tender point exam
provide a severity scale for characteristic symptoms
American college of rheumatology measurement of symptom severity 2010 methods?
Widespread pain index (WPI) a measure of the number of painful body regions Symptom Severity (SS) scale
Symptom severity scale?
categorical scales for cognitive symptoms
un-refreshed sleep
fatigue
number of somatic symptoms
Diagnose fibromyalgia with 2010 guidelines?
WPI >=7 and SSS >= 5 or WPI 3-6 and SSS >=9
classifies 88.1 of cases and does not require a tenderpoint exam
3 types of fibromyalgia syndrom?
Primary, Secondary, Post-traumatic
Sleep deprive?
cause stage 4 non-rem sleep deprivation
alpha waves intrusion on delta waves (restorative) sleep
called non restorative sleep syndrome
Probable etiology?
abberation of central pain mechanism, associated with abnormal sleep patterns
Hyperalgesia?
exaggerated response to pain
Allodynia?
pain following normally non-painful stimulus
Diagnose?
diagnosis of exclusion, clinical diagnosis
Prognosis?
most improve within 5 yrs
continue to have pain indefinitely
aggravating factors, relieving factors
Treatment?
reassure them that pain is real lifestyle changes meds OMT-treat what you find Physical therapy stress management exercise is the cornerstone of treatment
Complex regional pain syndrome type 1?
CRPS 1
without a deinable nerve lesion
90% presentations
aka reflex sympathetic dystrophy (RSD)
Complex regional pain syndrome type 2?
definable nerve lesion is present
Define Complex regional pain syndrome type 1?
burning pain in the upper or lower extremities associated with
- swelling, decreased ROM, vasomotor instability, trophic skin changes, patchy bone demineralization
Diagnostic criteria for CRPS 1?
develops after initiating noxious event not limited to a single peripheral nerve injury
continuing pain, allodynia, or hyperalgesia
evidence at some time of edema, change in skin blood flow or abnormal sudomotor activity
diagnosis is excluded by existance of conditions that would otherwise account for the degree of pain and dysfunction
Etiology Complex regional pain syndrome type 1?
60% cases follow major/minor trauma
assumed to be sympathetic origin
(afferent C fibers become hyperactive)
artifical synapse theory- damage to myelin sheath causes conduction between efferent sympathetic fibers and afferent somatic nerves
constant sympathetic stimulation leads to pain
constant peripheral sensitization
sympathetic bombardment
Stage I of Complex regional pain syndrome type 1?
acute, weeks to 3 months after injury severe burning, aching pain extremities hot, edematous skin red and blotchy hyperhidrosis patchy osteoporosis on xray 3-4 wks after injury
Stage II Complex regional pain syndrome type 1?
Dystrophic, 3-6 months after injury persistence of pain and disability skin pale, cyanotic, cool, doughy hyperhidrosis nails brittle and rigid patchy osteoporosis on xray subcutaneous atrophy- muscle wasting decreased ROM
Stage III Complex regional pain syndrome type 1?
>6 months after injury signs and symptoms come and go generally irreversible pain spreads proximally skin cool, pale, cyanotic, tight and glossy loss of muscle tone fascia become thickened flexion contractures anklyosis
Diagnosis of CRPS 1?
clinical
thermography-sig temp diff in extremities
patchy osteoporosis on plain xray
three phase bone scan- increased periarticular uptake
sympathetic neural blockade
Treatment Complex regional pain syndrome type 1?
prevention aggresive treat of somatic dysfunction and facilitated segments after trauma OMT Physical therapy Neural blockade trigger point injection TENS unit Meds smoking cessation acupuncture biofeedback spinal cord stimulators surgery
