Fibromyalgia

Question 1

Epidemiology

Answer 1

Women more than men

Usually dx in women aged 20-50 years old

• Peak prevalence in women 60-70
• Can occur at any age

Question 2

Pathophysiology

Answer 2

Central sensitization

Dysfunction of HPA axis

Other biochemical changes seen in FM

Question 3

Central Sensitization

Answer 3

Excess excitatory NT (substance p)

Low levels of inhibitory NT (serotonin)

Maintained enhancement of temporal summation of second pain

Altered endogenous opioid analgesic activity

Question 4

Dysfunction of HPA axis

Answer 4

Neuroendocrine abnormalities

Involved in stress adaptation response system - influences pain processing via dorsal horn glucocorticoid receptors and GABA NT

Abnormal function of stress response system may be triggered by acute physical or emotional event

Question 5

Other biochemical changes

Answer 5

Low ATP in RBCs

Increase nerve growth factor

Decreased growth hormone

Question 6

Biologic variables

Answer 6

Genetics
Sex
Sleep deprivation
Trauma/tissue injury
Stress
Infection
Arthritis
Surgery
Exposure to toxins

Assoc with RA, SLE, Ankylosing spondylitis, CFS, CRPS

Question 7

FM Clinical Presentation

Answer 7

WIdespread pain (dull ache) on both sides of body, above and below the waist

Mm stiffness, especially in am

HA

Thinking and memory problems

General fatigue

Poor sleep, waking unrefreshed

Paresthesias

Depression/Anxiety

Pain/cramps in abdomen or pelvis

IBS

Irritable bladder syndrome

TMJ pain

TTP

Question 8

Diagnosis

Answer 8

Lab test to rule out other conditions

New research may have ID’d bio marker to distinguish FM from arthritis

History

Physical Examination

Question 9

Differential Dx

Answer 9

Joint disorders
Inflammatory disorders
Neurological disorders
Soft tissue trauma
Disc related pain
Referred visceral pain
Lupus
Mechanical stresses
Nutritional, metabolic, endocrine
Psychological
Infectious diseases

Question 10

Updated Dx Criteria

Answer 10

WPI and SS considered

Symptoms present at similar level for at least 3 mos

Pt does not have another disorder that would explain the pain

Question 11

Widespread Pain Index

WPI

Answer 11

19 body areas

Question 12

Symptom Severity Scale

SS Scale

Answer 12

Fatigue, waking unrefreshed, cognitive symptoms

Somatic symptoms in general (IBS, cramps in abdomen and pelvis)

Question 13

FM Impact Questionnaire

FIQ

Answer 13

Measure of disease impact in Pts with FM

One of the most freq used tools in evaluation of FM

Originally developed in 1991

Several minor revisions

Question 14

FIQR Domains

Answer 14

Function

Overall impact on functioning and symptom severity

Symptoms

Question 15

FIQR

Answer 15

All questions relate to past 7 days

0-10 (10 the worst)

Question 16

Total FIQR

Answer 16

Sum of 3 domain scores

Total score = 100

Question 17

FIQ total score interpretation

Answer 17

0-38 Mild effect

39-58 Moderate effect

59-100 Severe effect

Question 18

Pt education

Answer 18

Nature of disease process and symptoms

Activity management

Lifestyle change - nutrition, sleep, stress management

Question 19

Physical Exercise

Answer 19

Aerobic
Strengthening
Stretching
Aquatic
Yoga
Tai chi

Question 20

Exercise planning

Answer 20

Start slow

Get an understanding of exercise tolerance

Modify program in times of stress

Set realistic goals with the patient for specific exercise and overall activity

Question 21

Mind-Body Intervention

Answer 21

Cognitive-behavioral therapy

Mindfulness meditation

Biofeedback

Relaxation therapies

Question 22

Passive Interventions

Answer 22

Manual therapy
Dry needling
Massage
MFR
TENS

Question 23

Pharmacotherapy

Answer 23

Lyrica
Cymbalta
Savella

Question 24

Lyrica

Answer 24

Decreases pain

Improves sleep

Question 25

Cymbalta

Answer 25

Decreases pain, fatigue, and sleep problems

Question 26

Savella

Answer 26

Decreases pain, fatigue, and sleep problems

Question 27

Prognosis

Answer 27

Chronic relapsing condition Strong evidence for successful management of FM with patient education, aerobic, and strengthening exercise

Question 28

Chronic relapsing condition

Answer 28

Not progressive or life-threatening Rarely see full reversal of allodynia and hyperalgesia Symptoms can show significant improvement with continued, multifactorial treatment

Question 29

Juvenile FM

Answer 29

Occurs in children and adolescents Most frequently 13-15 One of the most commonly diagnosed pediatric amplified pain syndromes

Question 30

Juvenile FM Clinical Presentation

Answer 30

``` Widespread pain Fatigue Sleep disturbances Poor memory Other somatic complaints ```

Question 31

JFM Intervention

Answer 31

Pt and family/parent education Physical exercise Cognitive-behavioral therapy Medication - may not be used as much in children

Question 32

JFM Important Goals

Answer 32

Return to normal activity (sports and social activities) Maintain/increase aerobic conditioning

Question 33

JFM Research

Answer 33

Better outcomes with cognitive-behavioral therapy and exercise than with meds Physically active JFM Pts appear to better maintain ability to modulate pain as compared to less active patients

Question 34

Intensive PT/OT Program sans pain level results

Answer 34

At one year follow-up, 33% with no pain

Question 35

JFM Prognosis

Answer 35

Often see improvement in signs and symptoms Children and adolescents with FM more likely to have favorable outcome as compared to adults with FM 80% of children with JFM had persistent symptoms into adulthood

Question 36

Fibromyalgia (FM) FM Syndrome

Answer 36

Chronic widespread pain disorder (greater than or equal to 3 mos) with associated tender points, stiffness, fatigue with disrupted sleep, cognitive difficulties, and multiple other Sx/sy (Anxiety, depression, ADL function problems)