Flashcards in Fibromyalgia Deck (42):
What are common chronic pain syndromes in children and adults?
Kids- amplified musculoskeletal pain syndrome
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?
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?
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?
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?
What are predisposing factors for FM?
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
24 hour behavior: sleep
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
Tender point assessment
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
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
What can we educate our patients on for chronic pain?
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