Treatment of Fibromyalgia Exam 2

Question 1

proposed disease mechanisms in fibromyalgia

Answer 1

• Neurologic change in how patients perceive pain
• Pain inhibition system impaired by deficiency of norepinephrine (NE) & serotonin (5-hydroxytryptamine, 5-HT) in CNS
• Substance P and glutamate increased
• Increased CSF concentration endogenous opioids

Question 2

For a patient with FM and mood disorder or poor coping strategies, which medication should be used?

Answer 2

cognitive behavioral therapies

Question 3

For a patient with FM and severe pain, which medication should be used?

Answer 3

duloxetine, pregabalin, tramadol (+/- acetaminophen)

Question 4

For a patient with FM and severe sleep disturbance, which medication should be used?

Answer 4

low-dose amitriptyline, cyclobenzaprine, pregabalin

Question 5

For a patient with FM and fatigue, which medication should be used?

Answer 5

Milnacipran, amitriptyline e. Severe disability: multimodal rehabilitation

Question 6

For a patient with FM and severe depression / anxiety, which medication should be used?

Answer 6

duloxetine

Question 7

Considering EULAR 2016 recommendations, which nonpharm is the best?

Answer 7

Aerobic & strengthening exercise

Question 8

Which medications are approved to use in FM?

Answer 8

• pregabalin
• duloxetine
• milnacipran

Question 9

Pregabalin

Answer 9

Modestly effective for pain, sleep, improved quality of life, not depression

Question 10

Gabapentin

Answer 10

significantly improved pain, sleep, global measures of FM impact; not tender points or depression

Question 11

Tricyclic antidepressants (TCA)

Answer 11

thought to mediate effects on sleep, pain, and fatigue; also affect other neurotransmitters

Question 12

Duloxetine

Answer 12

Significantly improved pain, depression, mental quality of life, FIQ; effects on sleep unclear

Question 13

Milnacipran

Answer 13

Improved pain, fatigue, physical function, patient global assessment; mixed effects on depression, sleep

Question 14

Muscle relaxants

Answer 14

More effective than placebo at one month, but not after 3 or 6 months