- What substances enhance Pain?
* What substances decrease Pain?
• Enhance: Glutamate, Substance P, Nerve growth factor
• Decrease: Norepinephrine, Opioids, GABA, Serotonin,
Dopamine
• T/F: Pain is different that Nociceptive pain?
• True - not associated with inflammation
- What does FM pain present like?
* What is the pain a result of?
- widespread musculoskeletal pain with no cause.
* Pain as a result of Abnormal CNS or PNS function (central pain disorder, Hyperalgesia, Allodynia)
What type of pain
• CNS pain
• Neuroactive neurotransmitters
• Central Sensitization/Centralized Pain
- (FM, IBS, TMJD, Tension HA)
• What is Noxious Stimuli in FM patients?
- Heat, Electrical, Pressure.
* Painful at lower threshold
• What is CNS dysfunction associated with?
Sleep and mood disturbances
• What is the first 3 steps of FM tx?
1) Confirm Diagnosis
2) Education
3) Eval and tx comorbidities
• What medication will most FM patients be on?
• Tricyclic Antidepressants, Antidepressants, or anticonvulsants
• What are non-pharm Tx for FM?
• Education • Tai Chi / Yoga (graded exercies) • CBT CAM (chiropractic, acupuncture, massage) • CNS neurostim
• What are pharm Tx for FM?
MD GAPC
- Amitriptyline
- Cyclobenzaprine
- Duloxetine
- Milnacipran
- Gabapentin
- Pregabalin
- Only a _____ of patients experience substancial improvement with FM medication.
- ______ benefit is seen in pain and sleep
- Minority
* Moderate
- How does Amitriptyline work?
* What are ADEs?
- Blocks NET and SET channels
* Dry mouth, constipation, weight gain, Cardiotoxic in older patients
- How does Cyclobenzaprine work?
* What are ADEs?
- Skeletal muscle relaxant
* Dry mouth, constipation, AMS, muscle weakness, blurred vision
- How is Duloxetine used?
* What are ADEs?
- SNRI with breakfast
* N/V dry mouth
- What is Milnacipran for?
* What are ADEs?
- SNRI severe fatigue and pain
* Nausea, HA, Constipation
- What does Gabapentin do?
* What are ADEs?
- Improve sleep - binds to Alpha 2 delta voltage gated Calcium Channels. - reduce Glutamate, similar to GABA
- Peripheral Edema, Dizziness, Ataxia, Dry mouth, Tremor, Blurred vision
Which tx are less recognized for FM.
• Due to Safety Concerns
• Not approved by US
- Hydroxybutyrate
* Cannabinoids
Which tx should never be used for FM?
- NSAIDs
* Opioids
