Fibromyalgia

Question 1

Facts about fibromyalgia diagnosis:

Answer 1

1. Pretty high prevalence (10-12%) for widespread, unexplained pain
2. bilateral extremity, axial widespread pain, excessive point tenderness in 11/18 defined points

Wince in pain with just a bit of pressure; HIT WITH A HAMMER!!

Question 2

Criteria of diagnosing fibromyalgia:

Answer 2

1. Certain score of widespread pain index (above and below the waste)
2. Symptoms present at similar level for at least 3 months
3. Patient without disorder that could otherwise explain pain: neuropathic condition, psychiatric condition, med SE’s, etc.

Question 3

Symptom severity score:

Answer 3

measures items outside of pain:

1. fatigue
2. waking unrefreshed
3. cognitive symptoms

Question 4

PE and labs:

Answer 4

1. Look for musculoskeletal abnormalities; check ROM, strength, reflexes, then ask and palpate tenderpoints;
2. Consider SLEEP EEG: you’ll see alpha waves in stage four mixed with the normal delta waves; less GH release!!
3. Think maybe lyme or syphilis; maybe lupus based on LABS

Question 5

Most frequent symptoms?

Answer 5

Muscle pain, fatigue

Question 6

Etiology of fibro:

Answer 6

1. abnormal serotonin pump gene, COMT as well (NT’s not around)
2. HPA and ANS abnormal
3. Lower pain threshold, abnormal brain imaging, increased CSF substance P;

Reflex symp dystrophy or sensitization: initial real physical injury allows remodeling of pain and sensation fibers, or dysfunction of NE/SR spinal pathways allows for crossed wires

Somatic depression: sad and weepy people who have more bodily pain and medical symptoms!!

Question 7

Education:

Answer 7

1. Let people know they have it: won’t increase morbidity, symptom reporting, disability claims
2. educational groups can improve outcomes: improve pain, sleep, QOL, fatigue, self-efficacy, 6 min walk

Question 8

Exercise:

Answer 8

1. Cardio
2. aquatherapy, aerobic exercise, tender points
3. do 20 weeks: high intensity exercise to improve fitness

Question 9

CBT is

Answer 9

helpful, could reduce pain severity and general functioning; meditation, relaxing, stress management help!!

Question 10

Multidisciplinary:

Answer 10

CBT + education + exercise (+ biofeedback)

Question 11

Meds:

Answer 11

1. TCA
2. SSRI (help pain, fatigue, depression, NOT tender points!!)
3. SNRI: duloxetine and milnacipran (can raise NE as well as SR): BETTER THAN SSRI!!
4. Tramadol (synthetic opiate) with SNRI and glutamate dampening, but LAST RESORT
5. Carbamazepine
6. Gabapentin (Ca channel blocker)
7. Pregabalin (block Ca channels in pain fibers, decreasing ascending pain signals from the spinal cord)

Question 12

If one develops depression or FM, more than likely

Answer 12

the Reticular activating system is sub optimal in that it does not feed or produce enough NE for example. Patients can be tired, fatigued, cognitively impaired- all as overlapping symptoms.
Normally, would help us think clearly, problem-solve, and be creative

Question 13

NE pathways

Answer 13

descend upon and dampen the pain signals heading towards the brain; with enough NE tone, many pain signals do not get to the cortex to be interpreted as pain!!

Question 14

With excess Ca and Na influx, AND excessive pain fiber firing and glutamate release

Answer 14

synapses become better integrated and fire more often; they are sens to fire with smaller painful stimuli or bodily sensations