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MC II Exam 3 > Fibromyalgia > Flashcards

Fibromyalgia Flashcards

1
Q

Define fibromyalgia (FMS)

A

Chronic non-inflammatory, non-autoimmune diffuse central pain-processing syndrome

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2
Q

True or false, FMS is inflammatory

A

False

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3
Q

True or false, FMS is an autoimmune disease

A

False

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4
Q

What are the cardinal manifestations of FMS?

A 
Diffuse tenderness on physical examination
Fatigue
Disturbed mood
General somatic hyperawareness
Poor sleep
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5
Q

True or false, FMS is a disease of the MSK system

A

False

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6
Q

What are the diagnostic criteria for FMS?

A

Widespread pain index score > 7 based
Symptom severity scale >5 based on fatigue, cognitive, non-restorative sleep, general presence of somatic symptoms, and exclusion of other medical conditions that could account for pain.

No tender point exam required.

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7
Q

Who is the typical patient with FMS?

A

Middle-aged women

An alternative diagnosis should be strongly considered in men, and persons that develop symptoms after the age of 55

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8
Q

What is secondary FMS?

A

Can develop in those with lupus or RA
More likely to develop with longer uncontrolled disease state or longer time to treat
Risk in overtreating RA/lupus rather than recognizing 2 FMS

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9
Q

What is the etiology of FMS?

A

Unknown, but evidence has accumulated which argues strongly that FMS is a central pain processing disorder. This hypothesis is supported by CSF, genetic and functional MRI studies.

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10
Q

True or false, central sensitization appears to play a role in FMS

A

True

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11
Q

How do substance P levels compare between the typical pt and the typical pt with FMS?

A

2-3x higher in pts with FMS

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12
Q

True or false, genetics appear to play a major role in FMS?

A

True

Patients 8.5x more likely to have a relative with FMS compared to RA patients

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13
Q

What gene appears to play a role in FMS and what is the mechanism?

A

COMT
Associated with pain tolerance
Association with low COMT and TMD

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14
Q

How do FMS pts compare to typical pts with respect to pressure stimulus?

A

At same pressure, pts with FMS have substantially higher pn; In order to achieve same pn levels, typical pts required far more pressure to be applied

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15
Q

How does brain activity compare btwn FMS pts and controls during application of pressure?

A

FMS pts showed activation in primary somatosensory cortex, secondary somatosensory cortex, and anterior cingulate cortex

No overlap in brain activity btwn groups with low-level pressure

Some overlapping activity in somatosensory cortex btwn groups at same pn level, but no ACC activation in control group

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16
Q

Name some disorders that could present like FMS

A

Endocrine: Hypothyroidism, adrenal insufficiency, Cushing’s syndrome, hyperparathyroidism, and hypovitaminosis D,
GI: Hepatitis C, celiac sprue
Sleep disorders: OSA
Psychiatric: Major depressive disorder
Neurologic: MS, myotonic dystrophy type 2
Hematologic: Anemia
Rheumatologic: RA, connective tissue diseases, spondyloarthropathies

17
Q

What is the typical pt presentation for FMS?

A

Pain from “head to toe” or “everywhere.”
Pan-positive Review of systems for sensory phenomenon
Fatigue
Difficulty falling asleep and non-restorative sleep
Depression
Physical examination and labs should be normal.

18
Q

What are the principles of FMS tx?

A 
Not just meds
Start low, go slow
Change only one medication at a time
Avoid opiods
NSAIDs don’t work
Target the central neurologic mechanisms of FMS
19
Q

True or false, opioids are effective for treating FMS

A

False

20
Q

Why are opioids ineffective for treating FMS?

A

Receptors already saturated in pts with FMS – antagonists may actually help

21
Q

What types of meds may help treat FMS?

A

NE, 5HT supplementation, GABA and substance antagonists

22
Q

True or false, NSAIDs are effective for treating FMS

A

False

23
Q

True or false, cognitive behavioral therapy is effective in treating FMS?

A

True, studies show it can help

24
Q

What sorts of non-medical tx are used for FMS and what are the effects?

A

Aerobic training superior to resistance training for pain benefit in women with FMS.

Moderate-intensity resistance training improves functional status, pain, tenderness and muscle strength

Flexibility training was helpful in terms of pain and functional status, but less than aerobic or resistance training.

25
Q

True or false, the evidence shows high efficacy of non-medical tx for pts with FMS

A

False, at this point the evidence is low quality

26
Q

What sorts of pts with FMS may benefit from pool therapy?

A

Those with comorbid depression and/or anxiety

27
Q

True or false, supervised group exercise is recommended for pts with FMS?

A

True, may improve adherence

28
Q

What is a reasonable goal for someone with severe pn, disability, and deconditioning from FMS?

A

A reasonable goal for homebound, disabled and deconditioned FMS is to walk 20 minutes, 5 days a week.

To reach this objective and reduce post-exertional pain, start with “homework” of 1-5 minutes of walking and gradually increase over weeks to reach goal.

29
Q

Why is a formal diagnosis of FMS important to patients?

A

The FMS dx alleviates patients’ stress about mysterious underlying conditions.

Patients can’t get better if they are constantly trying to prove that they are sick.

30
Q

True of false, pharmacologic management is the key to treating FMS

A

False, they should not be the focal point of treatment

MC II Exam 3 (8 decks)

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