Fibromyalgia

Question 1

what is fibromyalgia

Answer 1

• syndrome causing widespread musclar pain
• not a disease
• mutliple tender points

Question 2

What typically goes along with fibromyalgia

Answer 2

• sleep disturbances
• autonomic nervous system dysfunction
• immune system dysfunction
• related to central processing of pain

Question 3

Initiating/precipitating factors of Fibromyalgia

Answer 3

• sleep disorder
• acute illness/infection
• prolonged anxiety and emotional stress
• trauma
• rapid steriod withdrawal
• hypothyroidism

Question 4

what is reactive Fibromyalgia

Answer 4

• secondary/reactive Fibromyalgia occurs after another disorder
• such as lupus, polymyalgia rheumati, thyroid disorder, cancer

Question 5

Fibromyalgia and autonomic nervous system

Answer 5

• hyperactivity of sympathetic nervous system
• increased HR, vasoconstriction
• assoicated involvement of enteric nervous system

Question 6

Describe how there is hyperactivity of sympathetic nervous system in Fibromyalgia

Answer 6

• underactivity of parasympathetic nervous system
• decreased vagal tone assoicated with pain, inflammation,
• link between HTN and chronic pain

Question 7

what occurs with Fibromyalgia and it’s affect on the enteric nervous system

Answer 7

• impaired digestion and nutrient absorption
• linked to impairments in CNS and immune function
• poor gastic acid secretion

Question 8

What are the normal phases of sleep

Answer 8

• 3 non REM: N1, N2, N3
• each phase is a deeper sleep
• N3 is deepest sleep and comprises longest part of sleep cycle (you are not moving)
• 1 REM: dreaming phase

Question 9

What is the importance of sleep

Answer 9

consolidation of learning and memory

• REM sleep important for procedural memory
• non-REM sleep important for declarative memory

important for immune function

• decreased sleep = decrease in natural killer cell activity, cirulating immune complexes, antibody responses
• decrease sleep = impaired efficiency of glymphatic system (lymph system for the brain)

Question 10

What are components of good sleep hygiene

Answer 10

• regular schedule
• physical activity
• diet
• alcohol and caffeine intake (limit)
• stress (limit)

Question 11

Fibromyalgia and sleep disturbances

Answer 11

• decreased deep sleep and REM sleep
• decreased time spent with muscles relaxes
• decreased release of GH used for tissue repair
• pain, fatigue, mood disturbances, disorders in thinking
• memory may also be affected by lack of REM sleep

Question 12

Fibromyalgia and immune system

Answer 12

• immune system activation release pro-inflammatory cytokines
• also causes release of inflammatory markers that release glia in CNS
• increase in glial activiation in spinal cord
• increase in substance P, nitric oxide
• glial cells also cause further release of pro-inflammatory cytokines
• importance of minimizing risk of infection and controling inflammation with diet and exercise

large amount of inflammation

Question 13

Typical clinical Fibromyalgia presentation

Answer 13

• muscle pain
• blurred or double vision
• mental or physical fatigue
• morning stiffness >30 minutes
• mitral valve prolapse
• anxiety
• memory problems

Question 14

how is Fibromyalgia diagnosed

Answer 14

• criterion-based

1. areas of pain/widespread pain index
2. symptom severity: fatigue, waking unrefreshed, cognitive symptoms
3. symptoms severity of other problems

• diagnosis based on severity of both widespread pain and symptoms

Question 15

What are some potential differential diagnosis for Fibromyalgia

Answer 15

• endocrine disorders
• autoimmune disorders
• cancer
• metabolic myopathy

Question 16

Fibromyalgia management

Answer 16

• holistic/interdisciplinary approach
• cognitive-behavioral therapy/pain neuroscience education
• stress management
• nutritional education
• PT for pain management and exercise
• medications

Question 17

Fibromyalgia PT inerventions

focus?

Answer 17

• exercise
• manual therapy
• Work/ADL modification
• modalities (TENS, heat, biofeedback, laser)

Question 18

Fibromyalgia PT inerventions considerations with exercise

Answer 18

• aerobic exercise to reduce inflammation and fatigue
• consider need for increased warm up/cool down
• monitor vitals
• outcome measures to track progress
• may need to progress slowly, monitor fatigue and tolerance

they may fatigue quicker