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ECOS IV Midterm > Osteopathic Approach to the Patient with Chronic Pain/Fibromyalgia > Flashcards

Osteopathic Approach to the Patient with Chronic Pain/Fibromyalgia Flashcards

1
Q

What is the epidemiology of fibromyalgia?

A
  • More common in females vs males
  • Diagnosis may be under recognized in clinical practice
  • Prevalence much higher using surveys with standard criteria vs estimates based on pt charts
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2
Q

What is the ACR diagnostic criteria for fibromyalgia?

A

Must meet 3 conditions:

  1. Widespread pain index ≥7 AND symptom severity scale ≥5 OR WPI 3-6 and SS scale ≥9

AND

  1. Symptoms present at least three months
  2. No other cause which explains pain
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3
Q

What are some symptoms of fibromyalgia?

A
  • Widespread MSK pain
  • Fatigue and sleep disturbances
  • Cognitive disturbances
  • Psychiatric symptoms
  • Headache
  • Paresthesia
  • Could see IBS, GERD, or interstitial cystitis
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4
Q

What are some associated symptoms of fibromyalgia?

A
  • Mood –> roughly 1 in 4 have major depression
  • Cephalgia –> 50% have chronic headaches
  • Cognitive disturbances –> feeling of not being able to think clearly
  • GI –> linked to IBS and GERD
  • Sleep disturbance –> screen for OSA and refer for sleep study
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5
Q

What may a PE or labs show in fibromyalgia?

A
  • Soft tissue tenderness with palpation
  • Must do careful exam to rule out other inflammatory processes/illness
  • Avoid fishing expeditions with labs –> target to what is found on history and physical
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6
Q

What may be on the DDx for fibromyalgia?

A
  • Rheumatic disease
  • Spondyloarthritis
  • Polymyalgia rheumatica
  • Osteoarthritis
  • Inflammatory and metabolic myopathies
  • Statin myopathy
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7
Q

What is the pain processing like in fibromyalgia patients?

A
  • Problem of pain processing –> upregulation of pain
  • Altered pain processing seen with temporal summation of pain, decreased endogenous pain inhibition, and pain receptors and pain related neuropeptides
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8
Q

How can the patient be educated about the treatment of fibromyalgia?

A
  • Reassure that their symptoms are not imaginary
  • Not thought to be caused by persistent infection
  • Managing stress/mood will help manage symptoms
  • Teach patients about sleep hygiene
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9
Q

What is the usual prognosis of fibromyalgia?

A
  • Fatigue and pain may persist

- Other symptoms may increase and decrease but able to live normal lives

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10
Q

How can exercise be used in fibromyalgia?

A
  • May be efficacious to reduce pain and improve function
  • Challenge is implementing due to experiencing more pain initially
  • Low impact activities are most studied and easiest
  • Formal referral to PT may help
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11
Q

What is the EULAR weak against (shouldn’t use)?

A
  • NSAIDs
  • MAO inhibitors
  • SSRI
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12
Q

What is the EULAR weak for (could use)?

A
  • Amitriptyline
  • Anticonvulsants
  • Cyclobenzaprine
  • Tramadol
  • SNRI
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13
Q

What is the EULAR strong against?

A
  • GH

- Sodium oxybate evaluation

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14
Q

What are the best recommendations from the EULAR for fibromyalgia?

A
  • Patient education
  • Comprehensive assessment of pain, function, and the psychosocial context
  • Stepwise approach to improve QOL –> start with exercise and if they have trouble sleeping then use meds
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15
Q

Should you use opioids or corticosteroids in fibromyalgia?

A
  • No
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16
Q

How does vitamin D correlate with chronic pain?

A
  • Deficiency may be a factor

- Increasing levels may decrease pain overall

17
Q

How can OMT be used for fibromyalgia?

A
  • Great tool for treating patients with chronic pain
  • Start with indirect techniques and see how patient does
  • Want to avoid a flare by doing too vigorous techniques
  • Indirect MFR is a great way to start
18
Q

What should be done to patients who do not respond to initial fibromyalgia therapy?

A
  • Combination drug therapy
  • Refer if challenges with exercises
  • Refer if challenges with symptom control
  • Use multidisciplinary approach
19
Q

What is the usual follow up for patients with firbromyalgia?

A
  • Start one week at a time then taper it out every few weeks

ECOS IV Midterm (8 decks)

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