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Flashcards in Fibromyalgia Deck (42):

What are common chronic pain syndromes in children and adults?

Kids- amplified musculoskeletal pain syndrome
Adults- fibromyalgia


What are characteristics of chronic pain syndromes?

there are common characteristics among syndromes.

syndromes may move from one symptom complex to another or have characteristics of multiple syndromes


What is cause of AMPS?

unknown etiology
can be related to injury, illness, or psychological distress


What are hallmark signs of AMPS?

increasing pain over time, heightened pain intensity, absence of other causes

Pain may be diffuse or localized to one body part


What patient populations get AMPS?

pre to adolescent girls (mean age 12-13 yrs)
higher socioeconomic status
presence of psychological distress


What is presentation of AMPS during assessment?

Pain is not restricted to dermatome or peripheral nerve
can have autonomic dysfunction
multiple joints/muscles involved
multiple painful points
report numbness or weakness
normal neurological exam
normal blood work and radiographs


What is fibromyalgia?

chronic musculoskeletal pain syndrome of unknown etiology


Who gets fibromyalgia?

prevalence 2-10%
female to male ratio 8:1
Mean age is 30-60 years


What are hallmark signs of fibromyalgia?

widespread pain over 3 months with tender points
some characteristics of associated symptoms


Where are the tender points for fibromyalgia?

Lower cervical
Second rib
Lateral epicondyle
Greater trochanter


What are some associated symptoms of fibromyalgia?

fatigue, anxiety, depression, sleep, concentration, morning stiffness, headache, numbness/tingling, temperature sensitivity


What was the old diagnostic criteria for fibromyalgia?

American college of rheumatology (1990)
History of widespread pain over 3 months
presence of tender points (11 out of 18)
Bilateral side pain, involving upper and lower body
No standard labs
Rule out other conditions


What is the new diagnostic criteria for fibromyalgia?

Part 1: widespread pain index (WPI)
Part 2: symptom severity (SS)


What is the WPI?

scored from 0-19
check each area you feel pain in over the past week


What do SS scores mean?

2a: score for fatigue, waking unrefreshed and cognitive symptoms, 0-no problem, 3=severe problem
2b: other symptoms, no symptoms=0, 1-10=1, 11-24=2, >25=3


How do you get diagnosed with FM?

WPI >7 and SS >5
WPI 3-6 and SS >9
Presence of symptoms for 3 months
R/O other pain conditions


What is difference between the two criteria from American college of rheumatology?

Tender points have been removed and replaced by a symptom checklist
inclusive of comprehensive assessment


What is pathology behind FM?

Unknown etiology


What are predisposing factors for FM?

rheumatic conditions
environmental factors
traumatic events


What is a possible pathophysiologic model of FM?

muscles, CNS, endocrine


What happens with the muscles in FM?

Abnormalities in muscle fibers: decreased type1, atrophy in type 2, muscle tetany
Abnormalities in muscle energy metabolism: low oxidative enzymes


What happens with the CNS in FM?

Altered endogenous opioid activity: decreased opioid receptors in pain inhibitory pathways

Altered neurotransmitters and neuropeptides: decreased serotonin, increased substance P and glutamate


What happens with the endocrine system in FM?

Imbalance of many hormones: growth hormone cortisol, important for muscle healing

Immune system: elevated immune markers


What occurs in neuroendocrine system with FM?

abnormality in hypothalamus-pituitary-adrenal gland axis (HPA)

fatigue and sleep disturbance


What is the psychological aspect of chronic pain?

patient focuses on pain

patient presents with emotional distress and verbalizes anxiety, depression and frustration

suffering of pain is present in absence of pain severity

demonstrate avoidance of physical activity due to fear of injury/harm


What is the biopsychological model of chronic pain?

Dynamic interaction between physiological, psychological, and social factors that propagates clinical pain presentation


What is part of PT eval for chronic pain?

Patient profile: female, middle age, recreational
Body chart and location
Agg/Easing factors
24 hour behavior: sleep
Special questions
Current and past history: trauma, psychological
Family history: genetics
Associated signs and symptoms: sleep issues


What are parts of objective assessment for chronic pain?

Pain assessment: VAS, body posture, facial expression, motor behavior, standard pain questionnaires
Joint assessment
Muscle palpation
Tender point assessment
Neurological examination
Psychological assessment: depression and anxiety questionnaire
Functional tests: short form 36, fibromyalgia impact questionnaire


What are goals for PT interventions for chronic pain?

Goal is to improve function
Less focus on pain assessment
Create patient-centered achievable functional goals
Acknowledge small gains
Have open discussion about discharge planning with patient
Recognize need for other health care providers
Be empathetic


What treatment is best for chronic pain?

Interdisciplinary treatment approach is best: combination of medications, physical activity, and cognitive behavior therapy


What is first line of treatment for medical interventions?

Medications: NSAIDS, antidepressants, simple analgesics
Exercise: low impact


What is second line of treatment for medical interventions?

Cognitive behavioral program
Structured exercise program
Physical medicine and rehab program
Trigger point injections
Pain management program


What types of exercise do chronic patients need to do?

Aerobic exercise: low impact, gradual increase to moderate intensity, 30 minutes
Strengthening: low reps, low weight, concentric exercises
Flexibility: not effective when done alone


What are the principles behind exercise for chronic pain?

Minimize muscle microtrauma
Minimize central pain
Emphasize on low-moderate intensity exercise and consistency
Exercise program must be individualized
Encourage self-efficacy


What can we educate our patients on for chronic pain?

FM condition
Life-style changes
Importance of exercises
Pain education/neuroscience education
Self-management: improve sleep, reduce pain and stress, energy consumption


What are alternative therapies for chronic pain?

yoga, acupuncture, energy therapies, body mind relaxation, quigong movement therapy, tai chi

These have mixed results


What treatments have strong evidence for treating FM?

Amitriptyline, cyclobenzaprine, aerobic exercises, CBT, pt education, multidisciplinary treatment


What treatments have moderate evidence for FM treatment?

tramadol, serotonin inhibitors, pregabalin, strength training, acupuncture, biofeedback


What are weak evidences for FM?

growth hormone, serotonin, massage, e-stim, US


What treatments have no evidence for treating FM?

opioids, corticosteroids, NSAIDs, benzodiazepine, trigger points, flexibility exercises


What is prognosis for people with FM?

Negative predictors: depression, pain related anxiety, kinesiophobia or movement avoidance
Positive predictors: acceptance of condition, lack of anxiety and depression


What is a simple explanation of chronic pain you can give your patient?

Painful signals go from pain nerves to SC to the brain
Abnormal reflex in SC to neurovascular nerves
Nerves make blood vessels smaller causing lack of oxygen and build up of acid that causes intense pain
Pain goes back to the SC across abnormal reflexes back to neurovascular nerves resulting in viscous cycle of pain