fibromyalgia + chronic fatigue

Question 1

what is fibromyalgia?

Answer 1

Soft tissue disorder that causes chronic musculoskeletal pain

Question 2

what is another name for fibromyalgia?

Answer 2

AKA fibrositis (bad term, because of lack of inflammation)

Question 3

why are migraines + IBS similar to fibromyalgia

Answer 3

they’re both neurosensitivity disorders

Question 4

Second most common “rheum” illness after OA

Answer 4

fibromyalgia (even though its not a rheum disorder at all!)

Question 5

who gets fibromyalgia?

Answer 5

women in industrialized countries

Question 6

fibromyalgia explained as a pain sensitivity syndrome

Answer 6

Generalized sensitivity to multiple stimuli “central sensitivity syndrome”
Generalized lowering of the pain perception threshold

Question 7

3 parts of clinical presentation of fibromyalgia

Answer 7

1. 50% occur after an event (trauma, illness etc)
2. Pain and fatigue
3. Allergic and vestibular symptoms also prominent

Question 8

define allodynia and hyperalgesia

Answer 8

allodynia: pain with stimuli that should not cause pain, such as gentle touching
hyperalgesia: amplification of pain experienced from peripheral stimuli that are expected to be painful

Question 9

what is the pain from FM aggravated by?

Answer 9

Aggravated by exertion, stress, lack of sleep and weather changes

Question 10

what is the fatigue like with FM?

Answer 10

Non-restorative sleep - wake up tired

• worse after activity
• accompanied with memory difficulties

Question 11

4 subjective symptoms of FM (kinda weeds)

Answer 11

Heat and cold intolerance
Large fluctuations in weight
Subjective sensation of weakness
Sensation of swelling over joints

Question 12

what are the “allergic” symptoms that come with FM?

Answer 12

More adverse drug reactions

More rhinitis and nasal congestion

Question 13

ears & eye symptoms of FM

Answer 13

eyes: High incidence of sicca symptoms: Dry eye and mouth. ocular dysmotility , Exaggerated nystagmus
ears: dizzy , Low frequency sensorineural hearing loss

Question 14

cardinal sign of FM on physical exam

Answer 14

Tender triggers or tender points

Question 15

what is the classifcation of “tender points” and what is the mean value for the normal population?

Answer 15

4 kg of pressure is applied (enough to blanch examiner’s nail), delivered at 1 kg/sec rate
Mean value in normal population 1-4

Question 16

what are the 2 problems with the “tender points” measurement ?

Answer 16

Not a good measure of tenderness

Nobody knows how to do 4 kg pressure, 1 kg/sec

Question 17

labs in FM ?

Answer 17

ALL NORMAL

Question 18

differential for FM - what things should you check for? (kinda weeds)

Answer 18

CBC: anemia or infection
thyroid: hypothyroidism
creatine phosphate: inflammatory myopathies
ESR: inflammatory d/o or occult malignancy
ANA: SLE
rheumatoid factor: RA

Question 19

is FM considered a disability by social security?

Answer 19

yes, but you can have FM and not meet the criteria

Question 20

american college of rheumatology criteria: how many trigger points do you need for FM dx? (2010/2016 vs now?)

Answer 20

2010/2016: 11/18

now: less strict but w/ specific criteria

Question 21

american college of rheumatology 2016 criteria for FM: WSI + SSS

Answer 21

WPI ≥7 + SSS score ≥5
Or
WPI 4–6 and SSS score ≥9.

Question 22

what is WSI ? how is it scored?

Answer 22

widespread pain index: where theyve had pain in the last week (score 0-19)

Question 23

what is SSS? how is it score?

Answer 23

3 symptoms:Fatigue, Waking unrefreshed, Cognitive Sx
- severity of each symptoms ranked 0-3
(no problem - severe)
ALSO considering somatic symptoms

Total: 12

Question 24

primary txt for FM

Answer 24

non-pharm: CBT, aerobic exercise, PT (start low go slow)

+ EDUCATE Pt

Question 25

what does CBT for RM include (kinda weeds)

Answer 25

Relaxation training
Activity pacing
Pleasant activity scheduling
Visual imagery 
Distraction strategies

Question 26

aerobic exercise for FM

Answer 26

give analgesic + antidepressive effect

• low impact
• pain will get worse immediately after workout (exacerbated by weight gain)

Question 27

what kind of physical modalities can be offered for FM ?

Answer 27

dry needle trigger point “injections”

Question 28

2 meds for FM

Answer 28

Amitriptyline and cyclobenzaprine (helps sleep)

Question 29

what med to avoid for FM?

Answer 29

narcotics (b/c its a chronic illness- can’t take this for long)

Question 30

As the illness of FM progresses… what happens to txt?

Answer 30

less responsive to treatment (but tends to improve by itself eventually)

Question 31

what is chronic fatigue syndrome?

Answer 31

FM but primary complaint is fatigue

Question 32

various unrelated infectious diseases like EBV- mono, lyme, etc. lead to a state of prolonged fatigue… so what makes it chronic fatigue syndrome ?

Answer 32

If the condition is accompanied by cognitive difficulties, the disease is termed CFS

Question 33

clinical presentation of CFS

Answer 33

Sudden onset in previously active person
Unbearable fatigue
Associated symptoms of HA, sore throat, tender nodes, muscle and joint aches

Question 34

CFS CDC Dx criteria: fatigue that is… (4)

Answer 34

New
Not from exertion
Not better with rest
Causes reduction in occupational, social, or personal activity

Question 35

“additional” symptoms with CFS

Answer 35

4+ in 6 months... 
Trouble concentrating
Sore throat 
Tender lymph nodes 
Myalgias 
Arthralgias 
HA
Non restorative sleep 
Postexertion malaise

Question 36

txt for CFS (3 part)

Answer 36

1. Symptomatic meds: Same as for FM, antidepressants (perhaps NSAIDs)
2. balance rest + exercise
3. CBT

Question 37

prognosis of CFS

Answer 37

Doesn’t progress, and most slowly improve

Question 38

overall FM vs CFS

Answer 38

CFS: FATIGUE, mild fever or chills and sore throat
Fibromyalgia: PAIN better with heat or massage, worse by sitting or standing