Gen Pain And Fibromyalgia

Question 1

A pt with multi site pain complains that are WIDESPREAD and Waxes and WANES over a period of 3 months..

Answer 1

Fibromyalgia

Question 2

What labs are recommended in all pts with fibromyalgia

Answer 2

CBC 
CMP 
ESR 
CRP 
Thyroid Function Test

All used to EXCLUDE other Dx.
(Elevations should clue the clinician away from the Dx of Fibromyalgia)

Question 3

What are the WPI and SSS scores to Dx fibromyalgia

Answer 3

American College of Rheumatology 2016 Diagnostic Criteria
1. WPI ≥7 and SSS ≥5 or WPI 4–6 and SSS score ≥9.

2. Generalized pain, defined as pain in at least four of five regions, is present (left upper, right upper, left lower, right lower, axial).
3. Symptoms have been present at a similar level for at least 3 months!
4. A diagnosis of fibromyalgia is valid regardless of other diagnoses that the patient may have. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses.

Question 4

What is the treatment options for Fibromyalgia

Answer 4

nonRx: Exercise, CBT, Wt loss as needed, Sleep hygiene

Rx: SNRIs (duloxetine or milnaciparin), Pregabalin

Question 5

What two Rx should be avoided in pts with fibromyalgia

Answer 5

Steroids and Growth hormone

Question 6

Where is Complex Regional pain specific too

Answer 6

Only in the limbs

Question 7

What is the cardinal S/s of Complex regional pain syndrome

Answer 7

Burning disproportionate pain

Question 8

What is the differences of Complex regional pain syndrome compared to post traumatic neuralgia

Answer 8

CRPS develops ONLY in limbs while post-traumatic neuralgia can develop anywhere

Also Limb edema and skin color/temp changes
-Visible signs of microvascular damage distinguish CRPS from PTN!

CRPS causes pale, blue skin & hyperperfusion causes redness & warmth

Question 9

What are the clinical findings of a pt with complex regional pain syndrome

Answer 9

PAIN (duh)

Limb edema and color changes

Sensory Loss

Movement Disorder

D/o sweatingk, skin and hair growth (trophic changes)

Bone and joint resorption (contractures)

And a general spread of S/s distal to the site of injury or ‘mirroring” to the uninsured limb

Question 10

What is the Dx criteria for Complex Regional pain Syndrome

Answer 10

1. Continuing pain that is disproportionate after an even
2. Must have 1 symptom in 3/4 categories
   - Sensory
   - Vasomotor
   - edema
   - Motor/Trophic
3. Must have 1 S/s in 2 or more of the following at time of eval
   - Senosry (pain/ temp changes)
   - vasomotor
   - edema
   - motor/ trophic
4. No other Dx can better explain S/s

Question 11

What is the approach to Tx CRPS

Answer 11

Most cases improve spont.

Steroids have shown some benefit
(Compare this with fibromyalgia)

Rx: Notriptyline, desipramine , SSRI/ SNRI, gabapentin, Pregabalin, topical lido, tramadol,

Counsel the pt to avoid smoking, to exercise.
+compression garments
CCB for vascular dysregulation and topical nitroglycerin

Most effective oral agent for dystonia: Baclofen

Surgical options are implanted bipolar neural stimulators

Question 12

What factors are barriers to CRPS treatment

Answer 12

Smoking, DM, obesity