Fibromyalgia

Question 1

What is the definition of Fibromyalgia?

Answer 1

Form of nonarticular (not joints) rheumatism characterized by widespread chronic musculoskeletal pain for >3 months

Question 2

What are the common symptoms of FM?

Answer 2

1. Fatigue
2. Nonrestorative Sleep
3. Cognitive Dysfunction
4. Mood Distubrance

Question 3

What is Hyperalgesia?

Answer 3

Increased response to painful stimuli

Question 4

What is Allodynia?

Answer 4

Pain from stimuli that is not usually painful

Question 5

What is the 2nd most common rheumatologic disorder?

Answer 5

Fibromyalgia

Question 6

What are common etiologies of FM?

Answer 6

1. Non-REM Sleep Disturbances
2. Neurotransmitter abnormalities
3. Neurotransmitter imbalance
4. Pyschological abnormalities

Question 7

What are some neurotransmitter abnormalities?

Answer 7

1. Decrease NE and Serotonin
2. Increase Substance P and Glutamate
3. Increase CNS Endogenous Opioids

Question 8

What are clinical characteristics of FM?

Answer 8

1. Widespread pain
2. Fatigue
3. Nonrestorative sleep
4. Morning stiffness
5. Cognitive dysfunction

Question 9

What is Fibro Fog and how many patients with FM are affected?

Answer 9

50-80% patients with FM
1. Learning, retaining, processing info
2. Recall
3. Finding the right word

Question 10

1990 ACR Criteria for FM

Answer 10

1. 11/28 tender points sites (allodynia)
2. Widespreading pain >3 months
3. Axial skeletal pain

Question 11

2016 Update to 2010/2011 ACR Criteria

Answer 11

1. Generalized pain >4 body regions
2. Symptoms present >3 months
3. Widespread pain index WPI and Symptom severity scale SSS
4. No other disorder explains pain

Question 12

What is the WPI and SSS Score for 2016 ACR Update?

Answer 12

WPI >7 and SSS >5 OR
WPI 4-6 and SSS>9

Question 13

What is included in the SSS?

Answer 13

1. Severity over past week on 0-3 scale
2. Number of following symptoms in the past 6 months

Question 14

FM diagnosis is valid regardless of other diagnoses meaning

Answer 14

May coexist with other diseases

Question 15

2019 AAPT Diagnostic Criteria

Answer 15

1. Multisite pain in >6 of 9 pain sites
2. Moderate to severe sleep problems/fatigue
3. MSP + fatigue/sleep >3 months

Question 16

FM is more common in what gender?

Answer 16

Females

Question 17

What is defined as effective treatment in FM?

Answer 17

Sustained improvement of >20%

Question 18

In terms of exercise and FM, which one is superior?

Answer 18

Aerobic exercise, superior to flexibility with relaxation or stretching

Question 19

What is Balenotherapy?

Answer 19

Warm mineral baths

Question 20

Cognitive Behavioral Therapy is most successful in what type of FM patients?

Answer 20

1. High level distress
2. High FM impact on daily life

Question 21

Acupunture in FM Non-drug treatment can what?

Answer 21

1. Increase serotonin
2. Can increase FM pain

Question 22

What is the MOA of Anticonvulsants?

Answer 22

Bind to alpha-2 delta protein = decrease NT release = decrease substance P and glutamate

Question 23

What is the schedule of Lyrica?

Answer 23

Schedule V

Question 24

What are the side effects of Lyrica?

Answer 24

Dizzy
Sommolence

Question 25

Is Neurontin approved for FM treatment?

Answer 25

NO

Question 26

What is the MOA of Tricyclics?

Answer 26

Inhibit reuptake of serotonin and NE, affect other NTs

Question 27

What do you do with the tricyclic dose to decrease sedation?

Answer 27

Increase dose

Question 28

Dual Serotonin and NE Reuptake Inhibitors Counseling Points

Answer 28

1. Do not stop abruptly 2. Avoid alcohol 3. Serotonin Syndrome

Question 29

What is the Black Box Warning for Tricyclics?

Answer 29

Increased suicide risk

Question 30

What is the CIs for tricyclics?

Answer 30

1. MAOI 2. Uncontrolled Glaucoma

Question 31

What are the side effects of Cymbalta?

Answer 31

1. Nausea 3. Somnolence 3. Fatigue

Question 32

What are the pearls of Cymbalta?

Answer 32

1. Dose adjust CrCl <30 2. Take in AM

Question 33

What are Savella indicated for?

Answer 33

Approved ONLY for FM

Question 34

What are the side effects of Savella?

Answer 34

1. Nausea 2. Headache 3. HTN 4. Palpitations

Question 35

SSRIs Selective Serotonin Reuptake Inhibitors when used alone for FM are?

Answer 35

No better than placebo for pain, fatigue, or sleep

Question 36

Prozac is best combined with what, and when should it be given?

Answer 36

Amitriptyline or Cyclobenzaprine Give AM

Question 37

Are benzos effective in FM?

Answer 37

NO

Question 38

What is preferred over opioids for pain in FM?

Answer 38

Ultram

Question 39

What are the risks of Ultram?

Answer 39

Serotonin Syndrome or Seizures

Question 40

What is the MOA of Ultram?

Answer 40

Inhibits serotonin and NE uptake

Question 41

Should NSAIDs and APAP be used in FM?

Answer 41

NO, not effective

Question 42

Should Opioids be used in FM?

Answer 42

NO, avoid can cause hyperalgesia, abuse potential

Question 43

Is Prednisone effective for FM?

Answer 43

NO

Question 44

What are the FM treatment goals?

Answer 44

1. Decrease pain 2. Improve function 3. Increase restorative sleep

Question 45

When should non-drug therapy for FM be initiated?

Answer 45

Early before maladaptive behaviors develop 1. Aerobic exercise (aka increase sedentary time = increased pain) 2. Cognitive behavioral therapy

Question 46

What is EXPRESS?

Answer 46

EX: Exervise P: Pyschiatric Comorbidity R: Regaining Function E: Education S: Slepp Hygiene S: Stress Management

Question 47

What are the FDA Approved drugs for FM?

Answer 47

1. Lyrica 2. Cymbalta 3. Savella

Question 48

Pain and Sleep issues while on Amitriptyline, should add on what drug?

Answer 48

Fluoxetine

Question 49

Severe Pain, consider what drugs?

Answer 49

1. Cymbalta 2. Lyrica 3. Ultram +/- APAP 4. Amitriptyline

Question 50

Sleep Complaint, consider what drugs?

Answer 50

1. Amitriptyline 2. Cyclobenzaprine 3. Lyrica

Question 51

Fatigue Complaint, consider what drugs?

Answer 51

1. Milnacipran 2. Amitriptyline

Question 52

FM Benefits take how long to be seen?

Answer 52

Weeks

Question 53

Strong Recommendations to FM in the 2016 EULAR are what?

Answer 53

1. Aerobic and Strengthening Exercise

Question 54

Strong Against Recommendations to FM in the 2016 EULAR are what?

Answer 54

1. Growth Hormone 2. Sodium Oxybate 3. Strong Opioids 4. Glucocorticoids