Chronic Fatigue + Fibromyalgia Flashcards
(32 cards)
A state of exhaustion, lack of energy, listlessness, unable to participate in ADLs?
Fatigue
*7 million office visits per year.
What is defined as Chronic Fatigue?
Fatigue lasting more than ONE MONTH.
What other conditions are assoc. w/Chronic Fatigue?
- 67% depression and/or assoc. conditions.
- 25% idiopathic (meet some CFS criteria).
- 5% meet CFS criteria.
Clinically evaluated medically unexplained fatigue of “at least 6 months duration, mod-severe intensity at least half the time?”
Chronic Fatigue Syndrome (CFS).
Diagnostic Criteria for CFS?
- *Must have the following 3 Sx:
1. Substantial reduction or impairment in the ability to engage in pre-illness levels of ADLs.
2. Post-exertional malaise.
3. Unrefreshing sleep. - *At least 1 of 2 of the following manifestations:
1. Cognitive impairment.
2. Orthostatic intolerance or the worsening of symptoms upon assuming and maintaining upright posture.
Etiology of Chronic Fatigue Syndrome?
**Etiology unknown, multiple hypotheses:
- -Infection (EBV, Retrovirus, Lyme).
- -Immune System Differences.
- -Endo-Metabolic Dysfunction.
- -Neurally mediated hypotension.
- -Sleep deficiency.
- -Gene/DNA differences.
Common symptoms of CFS?
- -post-exertional malaise.
- -Unrefreshing sleep.
- -Brain fog.
- -Muscle/Joint pain, headache.
- -Light sensitivity and chills.
- -Stomach pain, bloating, nausea.
- -Sinus problems, swollen glands, tender LN, ST.
Differential Diagnosis of CFS and Fibromyalgia?
- Psychological disorders (depression, anxiety, personality disorders).
- Pharmacologic (AE of drowsiness, sedation, etc).
- Endo-Metabolic.
- Neoplastic - Hematologic.
- Infectious.
- Cardiopulmonary.
- IMID/CTD.
- Disturbed sleep (Nocturnal Myoclonus, RLS, OSA).
What is extremely important in evaluation of a patient for possible CFS?
Complete H and P!!!
**Objective findings are NOT found in CFS; if you do find them, explore them.
Laboratory Studies for CFS?
**NO diagnostic tests for CFS!!
- -Do a full work-up, CFS is a diagnosis of exclusion.
- -CBC, CMP, ESR/CRP, TSH, CK, UA, HIV/Hep, Mono/Lyme/RMSF.
Treatment options for a patient with CFS?
**Validate your pt – this is a real illness.
- *Symptomatic Treatment:
1. Sleep – address sleep hygiene, OTC products, low-dose TCAs.
2. Pain – NSAIDs, TCAs (NO Narcotics).
3. Depression – counseling, CBT, meds (SSRI, SNRI).
Non-Pharmacologic Treatments for CFS?
- Massage therapy.
- Acupunture.
- Self-Hypnosis.
- MODEST Regular Exercise.
A disorder of pain regulation or altered pain processing in the CNS?
Fibromyalgia
**Pain is nonarticular, chronic MSK pain.
What is Central Sensitization?
“Wind up” of the NS into a persistent state of high reactivity.
What are the 2 characteristics of central sensitization?
Allodynia – pain from a stimuli that does not normally cause pain (light feather touch).
Hyperalgesia – an enhanced sensitivity to pain.
Etiology of Fibromyalgia?
- Unknown; but possibly related to:
- -increased life stress.
- -alteration of NT metabolism.
- -abnormal levels of….serotonin, norepi, substance P found, mitochondria in muscle biopsies.
- -disturbances in stage 4 sleep.
- -neuroendo changes.
Risk factors associated with Fibromyalgia?
- -Stressful or traumatic events (PTSD).
- -Repetitive injuries.
- -Illness (eg, viral infections).
- -Certain diseases (Lupus, RA, CFS).
- -Genetic predisposition.
- -Obesity.
Epidemiology of Fibromyalgia?
- -Women account for 80-90% of cases.
- -Occurs in 5% of primary care pt’s.
- -Age of onset usually 20s-60s.
- -2dry Fibro occurs in up to 15% of all pt’s w/Rheumatic diseases (RA, Lupus, Sjogren’s).
Signs/Symptoms of Fibromyalgia?
- -MSK aches and pains.
- -Fatigue.
- -Stiffness.
- -Anxiety/Mental distress.
- -Poor sleep.
- -Headaches.
- -IBS.
- -Paresthesias.
- -Sensation of swelling (subjective).
Aggravating/Triggering Factors and Alleviating factors of Fibromyalgia?
Aggravating/Triggering:
- anxiety or stress.
- cold or humid weather.
- inflammatory or infectious disorders.
- nonrestorative sleep.
- physical inactivity or excess physical activity.
- physical/mental fatigue or trauma.
Alleviating Factors:
- warm or dry weather.
- restful sleep.
- moderate activity.
- hot showers or baths.
A chronic pain condition that affects the MSK system and is associated with degenerative disc disease?
Myofascial Pain Syndrome.
**DDx of Fibromyalgia.
Common characteristics of Myofascial Pain Syndrome?
- -Localized pain.
- *TRIGGER POINTS…unilateral, local tender points.
- -Pain resolves but often recurs.
- -Fatigue uncommon.
- -Morning stiffness uncommon.
What are some questions to ask a pt you are evaluating for Fibromyalgia?
- Location of the pain?
- Fatigue?
- Alleviating or aggravating factors?
- Stiffness?
- Current stress? Abuse?
- Non-refreshing sleep?
- Difficulty falling asleep? Staying asleep? Frequent awakenings? How much sleep per night?
What is the goal of a PE in evaluating Fibromyalgia?
To r/o systemic disease and confirm the diagnosis.
- Let your pt’s Sx guide the extent of your PE.
- Very least, complete a full MSK and brief Neuro exam; but if complaint is fatigue…complete PE is necessary.
