Myofascial Conditions And Chronic Pain Flashcards
Fibromyalgia characteristics
Widespread pain w/ chronic fatigue Due to altered central nervous system processing.
Sleep and cognitive disturbance
No signs of inflammation
7-9x more likely in women than men
Often presents with co-morbid depression and anxiety.
Risk factors for fibromyalgia
Family history: 8x more likely if 1st degree relative is diagnosed. 13x more likely if it is a sibling.
Being a female
Having infections (specifically Lyme disease and Hep C)
Stress (can be illness, trauma, psychosocial)
Physical Trauma or injury
Common pathologies of fibromyalgia
Central sensitivity syndromes
Sleep abnormalities
Genetic predisposition
ANS dysfunction
HPA axis (communication between endocrine glands causing increased cortisol releases in times of stress)
Infection, trauma
CNS sensitization (substance P increased levels)
Diagnostic criteria for fibromyalgia
Fatigue, widespread pain, poor sleep and cognitive disfunction for over 3 months without disappearing.
No other health problems can explain the pain and symptoms.
Widespread pain index and symptom severity index values that indicate fibromyalgia
Widespread pain index = greater than or equal to 7
Symptom severity index = greater than or equal to 5
OR
Widespread pain index = 3-6
Symptom severity index = greater than or equal to 9
Symptoms must also be 3 months or longer in both combinations .
- must be widespread!!*
Treatment of fibromyalgia
No cure
Only focus on symptom relief and improved function
- promote aerobic exercise, behavioral therapy, acupuncture.
- OMT (myofascial release or counter strain only)
Serotonin supplements
Labs to order to determine fibromyalgia
No labs really.
However CBC, TSH and electrolyte tests are often done to rule out other things (since fatigue is very common).
Sometimes test for HCV or Lyme if patient history suggests it should be done
Myofascial Pain syndrome
Caused by myofascial trigger points in skeletal muscle or fascia.
Limited to one area or quadrant based on muscle positioning.
NOT WIDESPREAD
Active Trigger point definition
Tender spot found with palpating and radiation pattern of pain.
Produces taut band of tissue.
Active trigger point
Referred pain with predictable patterns to specific to muscles
Not usually located where pain is and pain does not follow a dermatome map
Comes before latent trigger point
Latent trigger point
Modular area that is associated with a taut band of muscle
Does not actually produce pain, but produces muscle tension and restricted range of motion
Comes after active trigger point.
Epidemiology of myofascial pain syndrome
Leading causes of MSK pain
Women are more likely then men, but the ratio is smaller compared to fibromyalgia.
Prevalence during middle age (30-60)
Myofascial pain syndrome pathology
Leakage of acetylcholine in dysfunctional motor end points causes constant shortened sarcomeres (taut band)
Complex regional pain syndrome (causalgia)
Chronic pain condition characterized by spontaneous or evoked regional pain
Pain is very strong and usually develops after an injury and is not characteristic to the event described.
Often accompanied by varied combinations of autonomic, inflammation and vasomotor symptoms
Very similar to compartment syndrome with symptoms
can also be called reflex sympathetic dystrophy
Two types of complex regional pain syndrome
Type 1: minor injury or limb fracture prior to symptoms.
- nerve is NOT injuries on nerve conduction study
Type 2: injury to major peripheral nerve
- nerve is injured on nerve conduction study
