Fibromyalgia

Question 1

fibromyalgia was once defined as a chronic, generalized, MSK pain disorder with the presence of ___ of ___ tender point sites on physical exam

Answer 1

11 of 18

Question 2

focus of fibromyalgia is now based on ___ rather than tender points

Answer 2

symptoms

Question 3

core symptoms of FM

Answer 3

• chronic widespread pain
• fatigue
• sleep disturbance

Question 4

FM: chronic widespread pain » details

Answer 4

• R and L sides of body
• above and below waistline
• covers axial skeleton

Question 5

FM dx

Answer 5

• presence of core sx along with physical function limitations
• at least 3 months duration of sx
• lab testing

Question 6

FM and lab testing

Answer 6

• can’t dx FM

- rule out anemia, electrolyte disturbances, and thyroid disease

Question 7

FM: 75% of pts report

Answer 7

troublesome headaches (ranges from occasional to chronic migraines)

Question 8

FM: 40% of pts have

Answer 8

IBS

Question 9

FM: 65% of pts have

Answer 9

depression/anxiety

Question 10

FM: ~50% of pts have

Answer 10

• personality disorder

- obesity

Question 11

FM locus of control

Answer 11

primarily external

Question 12

Other associated conditions with FM

Answer 12

• PTSD

- sexual abuse

Question 13

relationship of FM and PTSD

Answer 13

• 45% of FM pts meet PTSD criteria

- FM and PTSD are risk factors for one another

Question 14

FM and sexual abuse

Answer 14

• hx of sexual abuse associated with chronic nonspecific pain
• hx of rape associated with FM

Question 15

This has been found to increase exercise adherence in pts with FM

Answer 15

motivational interviewing

Question 16

multifactorial tx strategies for FM

Answer 16

• education
• exercise
• modalities
• medication
• nutrition
• stress mgmt and relaxation

Question 17

effective exercise types for FM pts

Answer 17

• stretching
• aquatic therapy
• strengthening
• aerobic exercise

Question 18

FM and nutrition: caution the use of

Answer 18

• caffeine
• alcohol
• nicotine

Question 19

FM and nutrition: suggested nutritional supplements

Answer 19

• calcium/magnesium (1000-1500 mg/day)

- B complex

Question 20

common meds seen with FM pts

Answer 20

• antidepressants
• antiepileptics
• muscle relaxants
• opioids

Question 21

FM: antidepressants (tricyclics)

Answer 21

reduce pain, fatigue, and sleep disturbances

Question 22

FM: antidepressants (SSRIs)

Answer 22

slight benefit for pain reduction

Question 23

FM: antidepressants (SNRIs)

Answer 23

some benefit for reducing pain, sleep disturbances, and depressed mood

Question 24

FM: antiepileptics

Answer 24

may reduce pain in some pts

Question 25

FM: muscle relaxants

Answer 25

- can improve pain and sleep quality, but not fatigue | - when combined with antidepressants or antiepileptics

Question 26

FM: opioids

Answer 26

- provide no benefit | - increased rate of adverse effects

Question 27

FM: withdrawal of these can increase sx

Answer 27

- corticosteroids - immunosuppressive drugs - narcotics