Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Practice Topics Exam 8 > Rheum 6 - Fibromyalgia > Flashcards

Rheum 6 - Fibromyalgia Flashcards

1
Q

Definition

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Statistics

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinical diagnosis

A

There is no pathognomonic exam, laboratory, nor radiologic finding to “prove” the diagnosis of fibro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Criteria for diagnosis

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Characteristics of FMS

A 
Fatigue
Sleep disturbance
Subjective stiffness
HA
IBS
Depression
Anxiety
TMJ
Vestibular
ENT
Nondermatomal paresthesias
Raynauds
Autonomic dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Concomitant disease states

A

FMS present in 10-30% of other systemic inflammatory disorders
Lupus, RA, Ankylosing spondylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Differentials with FMS

A 
Hypothyroidism
Drug induced myopathies
PMR
Myofascial pain
Lyme disease
Sciatica
MS
Metabolic myopathy
Depression
TMJ syndrome
Misc Rheum disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of fibro

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Variables in development of fibro

A 
Genetics
Infection
Trauma
Psychiatirc disorder
Sleep disturbance
Neuroendocrine abdnormality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Central sensitization hypothesis with fribo

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bio osycho social hypothesis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Questions to ask (fibro)

A

How is your pain level
How are you sleeping
How is your mood
What type of exercise are you doing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment - fibro

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Multidisciplinary approach to firbo

A

Concurrent tx by specialties like - OT, PT, Physiatry, Rheumatology, anesthesiology, mental health prof

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nonpharm tx

A 
Land and aquatic therapy
Exercise
Massage therapy
Cog bx tx
Acupuncture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Water exercises

A

Low impact CV exercise
Warm water helps soothe mm pain
Water lessens the force placed on joints
Group setting may be beneficial

17
Q

Community resources for fibro

A

Arthritis foundation has good tools

Self help stuff, support groups, newsletters

18
Q

FDA approved meds for fibro

A

Lyrica (pregabalin)
Cymbalta (duloxetine)
Savella (milnaciprin)

19
Q

FDA approved meds for fibro - lyrica (pregabalin) - common SE

A

Diizy, peripheral edema, weight gain, somnolence, constipation, blurred vision

20
Q

FDA approved meds for fibro - cymbalta (duloxetine) -

A

Inhibitor of NE and 5HT reuptake = SNRI (helps more with pain process)

21
Q

FDA approved meds for fibro - savella (milnacipran)

A

Also an SNRI

Only approved for fibro though (not depression)

22
Q

Anti depressants - fibro

A

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
23
Q

Pain meds - fibro

A

NSAIDs might be helpful as well as acetominophen

Tramadol - non opiate pain reliever - also mild SNRI

24
Q

Sleep aids - fibro

A

Sedative hypnotics - ambien, lunesta, sonata

MM relaxants and TCAs might also hel

25
Q

MM relaxants - fibro

A

Might help mm pain and tightness

Might also help with falling asleep

26
Q

Prognosis - fibro

A

Disease state has variable severity and symptoms will wax and wane
Not life threatening or deforming
Many pts pursue long term disability

27
Q

Myofascial pain syndrome is what

A

Pain in a region of the body without an obvious pathological cause

28
Q

Myofascial pain syndrome - presence of

A

Trigger points
Hyperirritable focus
Taut band of mm or mm fascia that is painful with compression
Involved mm might have limited ROM and weak without atrophy

29
Q

Myofascial pain syndrome - etiology

A

Mm overload to overuse or trauma causes dysfunction at teh neuromuscular endplate
Multiple knots in an area form the trigger point within the taut band of mm

30
Q

Myofascial pain syndrome - clinical features - history

A

Predisposition to mm trauma/microtrauma = deconditioned state, poor posture, arthritis, certain jobs, rec activities

“active” trigger point = pain at rest

“latent” = weak or restricted motion related to mvmnt or palpation of mm

31
Q

Trigger vs. Tender point

A

Trigger = pain radiates or spreads from the trigger point in a peripheral or central direction

Tender - does not radiate

32
Q

Myofascial pain syndrome - physical exam

A

Discrete site of tenderness in a taut band of skeletal mm
Local twitch response
Palpation of trigger point might elicit referred pain response

33
Q

FMS vs. Myofascial pain

A

FMS - mm/tendon junction
Myo - muscle belly

FMS = F
Myo = 2:1 with M
34
Q

Myofascial pain syndrome - tx

A 
PT 
Cog bx therapy
NSAIDs
MM relaxants 
Trigger point injections

Practice Topics Exam 8 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions