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Flashcards in 4- Fibromyalgia (Sandhouse) Deck (24)
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1

A 35 year old female patient presents with chronic aching pain in her cervical, shoulder, pectoral and lumbosacral regions. She also complains of chronic headache, disturbed sleep and generalized fatigue. When questioned, she describes swelling, numbness and morning stiffness. On examination you find no evidence of joint swelling, warmth or deformity. You find multiple tender areas over her neck, back and upper extremities. What could she have?

Fibromyalgia

2

define fibromyalgia

A common syndrome in which a person (usually women) has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues.

3

What is the etiology (cause) of fibromyalgia

Unknown, though evidence points towards dysregulation of pain processing in CNS

4

What are the primary symptoms of fibromyalgia?

- Widespread pain
- Fatigue
- Sleep Disturbances
- Difficulty with Memory
- Morning stiffness

5

In fibromyalgia, what are the key areas for pain?

neck
shoulders
elbows
hips
knees
back

6

In fibromyalgia, how does fatigue present?

begins on rising from bed, feeling more tired when they wake up than when going to bed

7

What type of sleep do patients with fibromyalgia have?

Does not reach stage 4 for prolonged periods (AKA "alpha delta sleep")

Constant interruptions of sleep with awake-like brain activity

8

How does morning stiffness present for patients with fibromyalgia?

- lasts all day long
- Limits activities, but does not diminish with activity

9

What are aggravating factors for fibromyalgia?

- changes in temperature/weather
- non-restorative sleep
- physical and mental fatigue
- excessive physical activity
- physical inactivity
- anxiety
- stress

10

What are the specific point criteria necessary for the diagnosis of fibromyalgia?

Widespread pain in all four quadrants of the body (minimum of 3 months) w/ tenderness in 11 of 18 standard tenderpoints on palpation

11

What are the two main types of fibromyalgia?

Primary and secondary fibromyalgia

12

What characterizes primary fibromyalgia?

fibromyalgia w/ no coexisting disease/disorders

13

What characterizes secondary fibromyalgia?

fibromyalgia w/ present coexisting disorder

14

What is the differential diagnosis for fibromyalgia? (i.e. what other diseases need to be ruled out)

Chronic Fatigue Syndrome
Hypothyroidism
Lyme Disease
SLE
RA
HIV

15

What are the lab findings of fibromyalgia?

Negative in primary FMS

16

True or False: Fibromyalgia is a diagnosis of exclusion

False.

Fibromyalgia is NOT a diagnosis of exclusion

17

A patient presents with diabetes and widespread sprain. You treat the patient for diabetes, and the widespread pain still exists. What is the patient presenting with?

Secondary fibromyalgia

18

Besides FMS, what are other screening labs that should be asked for when contemplating fibromyalgia?

CBC with diff
Chem profile
ESR (Erythroid sedimentation rate)
ANA (antinuclear antibodies) [determines autoimmune disorder]
RF (Rheumatoid factor) [determines rhumatory arthritis]
Thyroid profile [checks for hyothyroidism]

19

How do you treat fibromyalgia?

Diagnose first! then Treatment is management of the pain, sleep, psychological support, and OMT

20

What are possible treatments that can be used for pain management?

Drugs (Analgesics, low dose antidepresseants, specific FDA approved drugs for FMS), local anesthetic injections, acupuncture, exercise

21

What are the three medications that are FDA approved for FMS?

Pregabalin (brand name: Lyrica)

Duloxetine (brand name: Cymbalta)

Milnapracin (Brand name: Savella) [3x as selective for norepinephrine (NE) vs. seratonin], note: can increase BP due to effect of NE, induce HTN

22

What are possible treatments to be used for sleep management?

Improved sleep hygiene
Medications

23

What OMT may help treat fibromyalgia?

Counterstrain (correlation of tenderpoints)
Myofascial release
Lymphatic techniques
Stretching

24

Which form of OMT does not directly effective in treating myalgia?

HVLA