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MSK > Myofascial conditions and chronic pain > Flashcards

Myofascial conditions and chronic pain Flashcards

1
Q

Fibromyalgia presentation

A
  1. Widespread pain
  2. Chronic fatigue
  3. Sleep disturbances
  4. Cognitive disturbances
  5. No objective signs of inflammation
  6. Dx of exclusion
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2
Q

Fibromyalgia epidemiology

A
  1. 2-3% US pop
  2. 7-9 times more likely in women
  3. ~50% have co-morbid anxiety and depression
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3
Q

Fibromyalgia risk factors

A 
1. Family history
  A. Risk inc 8x if 1st degree relative dx
  B. Risk ratio = 13.6 if sibling dx
  C. Hx chronic pain
2. Female
3. Infection (Lyme disease, Hep C)
4. Stress
5. Physical trauma/injury
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4
Q

Fibromyalgia pathophysiology

A
  1. Central sensitivity syndrome
  2. Genetic predisposition
  3. Sleep abnormalities
  4. ANS dysfxn
  5. HPA axis
  6. Infection, inflammation, trauma
  7. Psychological factors and stress
  8. CNS sensitization
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5
Q

Fibromyalgia Dx criteria

A 
1. Pain and symptoms over past week
  A. Fatigue
  B. Waking unrefreshed
  C. Cognitive problems
2. Symptoms > or = 3 months
3. No other problems explaining symptoms
4. Widespread pain index
5. Symptom severity index
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6
Q

Fibromyalgia tx

A
  1. Effective if dec pain 30-50%
  2. No cure
    A. Alleviate symptoms, inc fxn
    B. Generally chronic
    1. ~25% improve over 2-3 yrs
  3. Aerobic exercise
  4. Cognitive behavioral therapy
  5. Yoga, tai chi, qigong
  6. OMT-MFR
    A. Conterstrain
  7. Massage
  8. Acupuncture
  9. Behavioral model osteopathic tx
  10. Pharmacological
    A. FDA approved
    1. Pregabalin
    2. Duloxetine
    3. Milnacipram
      B. Anti-depressants
    4. SSRI’s
    5. Serotonin and NE reuptake inhibitors
    6. Tricyclic
      C. Anti-epileptic
    7. Pregabalin
    8. Gabapentin
      D. Muscle relaxants
      E. NSAIDS, ASA, acetaminophen
      F. Vit D
      G. Mg (oral and topical)
      H. Omega-3 F.A.
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7
Q

Myofascial pain syndrome presentation

A
  1. Limited to one area/quadrant of body
  2. Pain from aggravated myofascial trigger pts in muscle or fascia
  3. Trigger pt = tender spot found w/ palpation + radiation pattern of pain
    A. Taut band of tissue
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8
Q

Myofascial pain syndrome Epidemiology

A
  1. # 1 cause MSK pain
  2. Women > men
  3. MPS > fibromyalgia in men
  4. 85% pop experience in life
  5. Prevalent 30-60 y/o
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9
Q

Myofascial pain syndrome pathophysiology

A
  1. Trigger pts now well understood
  2. Local and central change
  3. ACh leakage in dysfxnal motor plates
    A. Shortened sarcomeres -> knot/band in muscle
  4. Latent TrP -> active TrP -> MPS
  5. Predispositions
    A. Skeletal and soft tissue abnormalities
    B. Functional asymmetry
    C. Neurologically mediated reflex sympathetic
    D. Other rheumatologic disorders
    E. Metabolic deficiencies
    F. Medical conditions
    G. Psychological disorders
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10
Q

Myofascial pain syndrome diagnosis

A
  1. TrP +/- referred pain
  2. Tender w/ palpation
  3. Clinically
    A. Referred pain in target area
    B. Limited ROM
    C. Local twitch response
    D. Taut band/nodule in tender area
  4. Rule out other possible causes
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11
Q

Myofascial pain syndrome tx

A
  1. No widely accepted guidelines
  2. TrP injection and dry needling
  3. Acupuncture
  4. Yoga
  5. Chiropractic care, manual therapy, MFR
  6. Therapeutic massage
  7. Mind/body therapy
  8. Exercise
  9. Sleep Hygiene
  10. Dietary considerations
  11. Stress management
  12. Biotech therapy
    A. Botulinum A (conflicting evidence)
    B. Cyclobenzaprine (insufficient evidence)
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12
Q

Complex regional pain syndrome

A

Aka: reflex sympathetic dystrophy, causalgia
1. Chronic, spontaneous evoked regional pain
2. Pain > magnitude/duration than typical
3. Other associate w/ autonomic, inflammatory, sensory, and vasomotor symptoms
4. Type 1
A. Minor injury/limb fx before symptoms
B. Normal n. Conduction study
C. Symptoms encompass those described as reflex symptom dystrophy
5. Type 2
A. Injury to major peripheral n.
B. Evidence of injury on N. Conductance study
C. Symptoms encompass those described as causalgia

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13
Q

Complex regional pain syndrome signs/symptoms

A
  1. Cont burning pain localized to extremity
  2. Swelling
  3. Color and temp disturbances
  4. Dystrophic changes in skin and nails
  5. Dec ROM
    A. Mech and thermal allodynia
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14
Q

Complex regional pain syndrome Dx

A
  1. Cont pain disproportionate inciting event
  2. 1< or = in >3 or = categories and 1 < or = sign in > or = 2
    A. Sensory
    B. Vasomotor
    C. Sudomotor/edema
    D. Motor/trophic
  3. No other dx better explains symptoms
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15
Q

Complex regional pain syndrome tx

A 
1. Multidisciplinary
  A. PT and OT
2. CPRS type 1
  A. Bisphosphonates (dec inflammation)
3. CPRS type 2
  A. Bisphosphonates
  B. Gabapentin
  C. Corticosteroids
  D. IV ketamine
4. Refer to pain management
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MSK (13 decks)

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