Quiz 3- Fibromyalgia:

Question 1

Key Points:

Answer 1

• There are several triggers that may precede FM.
• Affects women more than men.
• Chronic widespread pain in multiple areas.
• Abnormal tenderness at 11 or more of the 18 specific tender points.
• There are no laboratory tests that can definitively diagnose FM.
• Treatment needs to encompass a wide variety of modalities.

Question 2

FM Triggers: 8

Answer 2

• Physical trauma (esp the trunk) – within 6 months
• Infections (Hep C, EBV, parvo, Lyme)
• Emotional stress responses
• Autoimmune diseases (RA, SLE, OA)
• History of physical or sexual abuse (PTSD)
• Small intestinal bacterial overgrowth (SIBO)
• Lead and mercury toxicity
• Presence of rheumatic diseases (RA, lupus, AS)

Question 3

FM Clinical Features: 9

Answer 3

• Morning stiffness, swelling in the extremities possible
• Fatigue (with or without sleep disturbances)
• Sensitivity to lights, noise, smell
• Cognitive disturbances – brain fog, memory loss, concentration problems
• Psychiatric symptoms – depression/anxiety
• Headaches
• Paresthesias
• PE: tenderness to palpation of soft-tissue locations (trigger points):
• Tenderness of at least 11 of 18 defined tender points

Question 4

FM ACR Diagnostic Criteria:
•Tenderness points
•Symptoms present at similar levels for > ?? months

Answer 4

• Tenderness in > 11 of 18 tender points

* Symptoms present at similar levels for > 3 months

Question 5

FM Lab Testing:

Answer 5

There is no diagnostic laboratory test or radiographic or pathologic finding for FM. Lab testing is only done to rule out other conditions.

Question 6

Conventional Medications: 5

Answer 6

• Tricyclic Antidepressants
  
  • Amitriptyline – 10mg at night
  • Improvement occurs in 25 – 45% of patients
• Dual reuptake inhibitors (SNRIs)
• Duloxetine, milnacipran, venlafaxine
• Anticonvulsants
• Pregabalin and gabapentin

Question 7

Nutritional Supplementation: 3

Answer 7

• 5-HTP:
• Magnesium:
• SAMe:

Question 8

Treat Underlying Conditions: 3

Answer 8

• Hypothyroidism
• SIBO and candida4
• Viral Infections – assess for EBV, CMV

Question 9

Exercise & Physical Medicine: 4

Answer 9

• Exercise to tolerance
• Cardiovascular exercise program6,7
• Low-impact aerobic activities: fast walking, biking, swimming, water aerobics
• Minimum of 30 minutes, 3x per week