Fibromyalgia Flashcards
What is FMS?
Chronic, non-inflammatory, non-autoimmune syndrome of diffuse pain. Central pain processing disorder
What are cardinal signs of FMS
-diffuse tenderness, fatigue, disturbed mood, somatic hypersensitivity/sensitive to other sensory modalities, impaired sleep
What was required for diagnosis under the ACR 1990 classification?
11/18 diffuse tender points above and below waist
What is now used for diagnosis?
requires widespread pain index over 7, symptom severity scale over 5, should be tender, general presence of somatic symptoms, non-restorative sleep, fatigue, cognitive involvement
tender points no longer used widely
(ACR 2010 criteria?)
FMS is most common in what population?
Middle-aged women–about 2% of women in US have it
What is secondary FMS?
Secondary to lupus, RA, or other inflammatory disease–present in 20% of people with these conditions, and risk increases the longer it takes to get primary condition under control
What physiological changes.causes of FMS are supported by the research?
- Increased substance P
- May be genetic link–COMT (catecholamine o-methyl transferase) different haplotypes=low pain sensitivity or pain sensitive
- psychological component
- more oxygen uptake in areas of brain responsible for pain=those areas of brain are more active
Goal of medications in FMS
- increase neurotransmitters that increase descending inhibition (NE, seratonin) or decrease substance P or GABA
- Decrease pain, work on sleep, deal with depression (high dose antidepressents)–>decreased fatigue
- Opiods and NSAIDS don’t work
Best exercise evidence
aerobic>resistance>stretching
- Aerobic most pain benefit
- resistance (moderate) improves functional status, pain, tenderness, and strength
- stretching improves pain and functional status
- warm water good
exercise goal (reasonable for homebound)
20 minutes 5 days per week
