Rheum 6 - Fibromyalgia Flashcards
Definition
Diffuse MSK pain wihtout an obvious pathological cause
Pain is chronic
OVerlaps and may include myofascial pain syndrome
Disturbance of deep and restorative sleep
Presence of tender points in all four quadrants of the body including the axial skeleton
Statistics
Prevalence = 2-5% in US
F to M is 8/10 to 1
Mean age is 30-60 (prev inc with age)
May be present in children and elderly
Clinical diagnosis
There is no pathognomonic exam, laboratory, nor radiologic finding to “prove” the diagnosis of fibro
Criteria for diagnosis
Pain for at least 3 months of the
- R and L sides of the body
- Axial skeleton
- At least 11 of the 18 tender points on digital exam
Characteristics of FMS
Fatigue Sleep disturbance Subjective stiffness HA IBS Depression Anxiety TMJ Vestibular ENT Nondermatomal paresthesias Raynauds Autonomic dysfunction
Concomitant disease states
FMS present in 10-30% of other systemic inflammatory disorders
Lupus, RA, Ankylosing spondylitis
Differentials with FMS
Hypothyroidism Drug induced myopathies PMR Myofascial pain Lyme disease Sciatica MS Metabolic myopathy Depression TMJ syndrome Misc Rheum disorders
Causes of fibro
Usually the precipitating factor can’t be identified but most common are:
- Minor or substantial trauma
- emotional trauma
- flu like or viral illnesses
- withdrawing from corticosteroids
Variables in development of fibro
Genetics Infection Trauma Psychiatirc disorder Sleep disturbance Neuroendocrine abdnormality
Central sensitization hypothesis with fribo
Disorder of abnormal pain processing by CNS
Reduced blood flow to specific pain processing areas of the brain
Higher concentrations of sub P
Results in reduced pain tolerance to pressure (tender points), heat, and electrical pulse
Bio osycho social hypothesis
Focuses on the roles of social activity, psych status, work, family and society on the formation of FMS
Environment and learned bx patterns such as how family members react to pain and stress
Genetics may play role
Questions to ask (fibro)
How is your pain level
How are you sleeping
How is your mood
What type of exercise are you doing
Treatment - fibro
Needs to be a combo of things!
Pt education is key!
Reassurance that its a real illness
Not caused by infection or other factors
Avoidance of bx and physical activity is counterproductive
Provider and pt must work together to make pt better
Multidisciplinary approach to firbo
Concurrent tx by specialties like - OT, PT, Physiatry, Rheumatology, anesthesiology, mental health prof
Nonpharm tx
Land and aquatic therapy Exercise Massage therapy Cog bx tx Acupuncture
Water exercises
Low impact CV exercise
Warm water helps soothe mm pain
Water lessens the force placed on joints
Group setting may be beneficial
Community resources for fibro
Arthritis foundation has good tools
Self help stuff, support groups, newsletters
FDA approved meds for fibro
Lyrica (pregabalin)
Cymbalta (duloxetine)
Savella (milnaciprin)
FDA approved meds for fibro - lyrica (pregabalin) - common SE
Diizy, peripheral edema, weight gain, somnolence, constipation, blurred vision
FDA approved meds for fibro - cymbalta (duloxetine) -
Inhibitor of NE and 5HT reuptake = SNRI (helps more with pain process)
FDA approved meds for fibro - savella (milnacipran)
Also an SNRI
Only approved for fibro though (not depression)
Anti depressants - fibro
goal is to treat centrally mediated pain with a medication that potentiates 5HT and/or NE
Tricyclic antidepressants (amitriptyline, cyclobenzaprine) - low dose befores sleep If combined with daytime SSRI migh tbe mroe effective
Pain meds - fibro
NSAIDs might be helpful as well as acetominophen
Tramadol - non opiate pain reliever - also mild SNRI
Sleep aids - fibro
Sedative hypnotics - ambien, lunesta, sonata
MM relaxants and TCAs might also hel
