Firbomyalgia Syndrome and Complex Regional Pain Syndrome

Question 1

Fibromyalgia syndrome?

Answer 1

chronic MSK pain, prolonged morning stiffness, and fatigue associated with multiple tender points

Question 2

Considerations?

Answer 2

women mostly, 30-60

40% meet criteria

Question 3

Clin presentation?

Answer 3

gradual onset
diffuse pain
morning stiffness
bilateral tender points
fatigue
depression

Question 4

American College of Rheumatology criteria?

Answer 4

History widespread pain
axial skeleton pain must be present
Tender points

Question 5

axial skeleton pain?

Answer 5

cervical spine, anterior chest, thoracic spine, low back

Question 6

Tender points?

Answer 6

Post C1
C5-C7
bilateral trapezius
supraspinatus
second rib
lateral epicondyle
gluteal
greater trochanter
knee

Question 7

Fibromyalgia control points?

Answer 7

symptoms at the following indicate symptom magnification

-Forehead, volar forearm, anterior thigh, thumbnail

Question 8

American college of rheumatology measurement of symptom severity 2010 purpose?

Answer 8

develop a simple, practical criteria for diagnosis without tender point exam
provide a severity scale for characteristic symptoms

Question 9

American college of rheumatology measurement of symptom severity 2010 methods?

Answer 9

Widespread pain index (WPI) a measure of the number of painful body regions
Symptom Severity (SS) scale

Question 10

Symptom severity scale?

Answer 10

categorical scales for cognitive symptoms
un-refreshed sleep
fatigue
number of somatic symptoms

Question 11

Diagnose fibromyalgia with 2010 guidelines?

Answer 11

WPI >=7 and SSS >= 5 or WPI 3-6 and SSS >=9

classifies 88.1 of cases and does not require a tenderpoint exam

Question 12

3 types of fibromyalgia syndrom?

Answer 12

Primary, Secondary, Post-traumatic

Question 13

Sleep deprive?

Answer 13

cause stage 4 non-rem sleep deprivation
alpha waves intrusion on delta waves (restorative) sleep
called non restorative sleep syndrome

Question 14

Probable etiology?

Answer 14

abberation of central pain mechanism, associated with abnormal sleep patterns

Question 15

Hyperalgesia?

Answer 15

exaggerated response to pain

Question 16

Allodynia?

Answer 16

pain following normally non-painful stimulus

Question 17

Diagnose?

Answer 17

diagnosis of exclusion, clinical diagnosis

Question 18

Prognosis?

Answer 18

most improve within 5 yrs
continue to have pain indefinitely
aggravating factors, relieving factors

Question 19

Treatment?

Answer 19

reassure them that pain is real
lifestyle changes
meds
OMT-treat what you find
Physical therapy
stress management 
exercise is the cornerstone of treatment

Question 20

Complex regional pain syndrome type 1?

Answer 20

CRPS 1
without a deinable nerve lesion
90% presentations
aka reflex sympathetic dystrophy (RSD)

Question 21

Complex regional pain syndrome type 2?

Answer 21

definable nerve lesion is present

Question 22

Define Complex regional pain syndrome type 1?

Answer 22

burning pain in the upper or lower extremities associated with
- swelling, decreased ROM, vasomotor instability, trophic skin changes, patchy bone demineralization

Question 23

Diagnostic criteria for CRPS 1?

Answer 23

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

Question 24

Etiology Complex regional pain syndrome type 1?

Answer 24

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

Question 25

Stage I of Complex regional pain syndrome type 1?

Answer 25

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

Question 26

Stage II Complex regional pain syndrome type 1?

Answer 26

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

Question 27

Stage III Complex regional pain syndrome type 1?

Answer 27

>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

Question 28

Diagnosis of CRPS 1?

Answer 28

clinical
thermography-sig temp diff in extremities
patchy osteoporosis on plain xray
three phase bone scan- increased periarticular uptake
sympathetic neural blockade

Question 29

Treatment Complex regional pain syndrome type 1?

Answer 29

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