Content: Chronic Pain Syndromes:
- Childhood onset
- Adult onset
- Amplified Musculoskeletal Pain Syndrome (includes all types of pain syndromes - don’t label children)
- Fibromyalgia
Content: Amplified Musculoskeletal Pain Syndrome (AMPS) (4)
- Unknown etiology but can be related to injury/illness/psychological distress
- pre- to adolescent girls (mean 12-13 yo)
- Pain may be diffuse or localized to one body part
- Higher SES
Content: Hallmarks of AMPS (3)
- Increasing pain over time
- Heightened pain intensity
- Absence of other causes
Content: Assessment of AMPS (5)
- Pain is not restricted to dermatome or peripheral nerve
- Can have autonomic dysfunction
- Multiple joint involvement and painful points
- Report numbness or weakness
- Normal neurological exam, blood work, and radiographs
Content: Fibromylagia (4)
- Chronic musculoskeletal pain syndrome of unknown etiology
- Centralized pain with some characteristics of associated symptoms
- Prevalence in 2-10% with female:male = 8:1
- Mean age is 30-60 yo
Content: Fibromyalgia Tender Points (9)
- Low Cervical Region: anteriorly at interspaces between the C5-C7 over sternocleidomastoid.
- Second Rib: at second costochondral junction
- Occiput: at suboccipital muscle insertions
- Trapezius Muscle: at midpoint of the upper border.
- Supraspinatus Muscle: above the med border of the scapular spine.
- Lateral Epicondyle: 2cm distal to the lateral epicondyle anteriorly.
- Gluteal: at upper outer quadrant of the buttocks.
- Greater Trochanter: post to the greater trochanteric prominence.
- Knee: at the medial fat pad proximal to the joint line.
Content: Associated symptoms (Pain) (5)
- (Affects) Concentration
- Fatigue
- Anxiety
- Depression
- Sleep
Content: Associated Symtpoms (Fibromyalgia) (4)
- Morning stiffness
- Headache
- Numbness/tingling
- Temperature sensitivity
Content: Medical Diagnosis of Fibromyaglia (OLD) (3)
- Bilateral side pain involving upper and lower body
- Presence of associated symptoms
- Rule out other conditions
Content: Widespread Pain Index (WPI) (2)
- 0-19
- Check each area you feel pain in over the past week
Content: Symptoms Severity (4)
- Score for fatigue, waking unrefreshed and cognitive symtpoms from 0-3
- 0 = no problem; 3 = severe problem - Score other symptoms from 0-3
- no symptoms = 0; 1-10=1; 11-24=2, >25=3
Content: Diagnostic Criteria for Fibromyalgia (NEW) (5)
- Part 1 = WPI
- Part 2 = SS
- WPI > 7 AND SS > 5 OR WPI 3-6 and SS > 9
- Presence of symtpoms for 3 months
- R/O (rule out) other pain conditions
Q: What is the difference between the old and new diagnostic criteria for fibromyalgia?
Tender points have been removed and replaced by a symtpoms checklist
Inclusive of comprehensive assessment
Content: Predisposing Factors for Fibromyalgia (4)
- Rheumatic conditions
- Hereditary
- Environmental factors
- Traumatic events
Content: Musculoskeletal Dysfunction (2)
- Abnormalities in fibers (decreased type 1, atrophy in type 2, muscle tetany) - difficulty with endurance and strength
- Abnormalities in muscle energy metabolism (low oxidative enzymes (phosphocreatine))
Content: CNS Dysfunction (4)
- Altered endogenous opioid activity
- decreased opioid receptors in pain inhibitory pathways - Altered neurotransmitters and neuropeptides
- decreased serotonin; increased substance P and glutamate
Content: Endocrine Dysfunction (2)
- Imbalance of many hormone (growth hormone:cortisol, important for muscle healing)
- Immune system (elevated immune markers)
Content: Neuroendocrine System (2)
- Abnormality in hypothalamus-pituitary-adrenal gland axis (HPA)
- Fatigue and sleep distrubance
Content: Psychological aspect of chronic pain (4)
- Patient focuses on pain
- Patient presents with emotional distress and verbalizes anxiety, depression and frustration
- Suffering of pain is present in absence of pain severity
- Demonstrate avoidance of physical activity due to fear of injury/harm
Diagram: Biopsychosocial model
Defn: Biopsychosocial model
A dynamic interaction between physiological, psychological and social factors that propagates clinical pain presentation
Content: Pain Assessment for Fibromyalgia Patients (4)
- VAS (pain intensity; 0-10 scale) < NOT useful for chronic pain
- Behavior (posture, facial expression, motor behavior)
- Standard pain questionnaires
- Don’t ask often, want to deviate away from pain (will always have pain)
Q: What is the main goal of fibromyaglia interventions?
Improve function
Q: What is the best intervention approach for fibromyalgia?
Interdisciplinary treatmemt approach is best (combo of meds, physical activity and cogntivie behavior therapy)
