Fybromyalgia

Question 1

Fibromyalgia

Answer 1

Definition: An idiopathic, chronic nonarticular pain syndrome defined by widespread musculoskeletal pain & generalized tender point all over body
women more than men, generally from 20 – 50 yrs of age
Pathophysiology unclear

Question 2

Predisposing Factors

Answer 2

Many think that anxiety, stress, low income, and family history of depression predisposes

Question 3

Symptoms

Answer 3

Presents with pain at multiple sites
Fatigue, poor sleep quality
Stiffness, soreness and aching
Subjective swollen joint feeling without objective findings
Headaches, cognitive changes
Aggravation of symptoms with cold weather
Good history of physical & social issues are extremely important

Question 4

Dx

Answer 4

Widespread pain bilaterally and above and below the waist for at least 3 months
Tender points in 11 of 18 points
Clinical diagnosis- no tests necessary
May have associated Irritable bowel Syndrome (IBS)

Question 5

Pharm Tx

Answer 5

Treatment consist of symptomatic management and improving general health
Often requires teams approach HC providers, physical therapists, mental health therapist, pain management
Analgesics: Tylenol, NSAIDS, Ultram, and in some cases stronger narcotic analgesia
Muscle relaxants e.g. Flexeril or Soma
Benzodiazepines: relaxing tense muscles, (RLS), stabilizing brain waves that interfere with deep sleep (addictive)
Antidepressants correct brain and spinal chemical imbalances smaller doses recommended in fibromyalgia e.g. TCA i.e. Amitriptyline 25-50 mg qHS, SSRIs e.g. Prozac, or Cymbalta are helpful for pain and sleep
Lyrica has helped as well but is early

Question 6

Non-Pharm Tx

Answer 6

Non-pharmacologic- probably most effective- exercise (all types- aerobic, endurance, flexibility & strength)
Cognitive behavior therapy- learning balance in life
Questionable:
Chiropractic
Yoga, tai chi, massage
Magnetic therapy
Tender point injectionsAcupuncture
Biofeedback