Lecture 9 (3/3) Flashcards
what is fibromyalgia?
Considered a rheumatic condition
- a condition that affects the joints and/or soft tissues, causing chronic pain
- significant pain and fatigue
- generally diagnosed by a rheumatologist
But not a form of arthritis
- no inflammation or damage to joints, muscles, or tissues
- but does produce pain in soft tissues around joints and in skin and organs throughout body
- other symptoms too: cognitive (“fibro fog”), numbness and tingling
when and who does fibromyalgia affect?
- women (6:1 or 7:1 ratio)
- Increase with age
- Chronic widespread pain
- PLUS fatigue
- No nerve damage
- used to think it could be identified by “tender points”
how did doctors start believing women with fobromyalgia?
- Imaging studies showed that their brain agreed with their pain description
- Brain lighting up to much lower pressures
what are the 2 competing theories of fibromyalgia?
increased ascending transmission OR decreased descending inhibition (to explain too much pain)
explain Decreased Conditioned Pain Modulation in Fibromyalgia
- Study showing that compared to normal women fibro women have impaired conditioned pain modulation
- Done by cold pressure test (conditioned stimulus)
explain fibro and nociceptor endings
Take biopsies of skin and stain them
- Fibro have lower density of nociceptor endings as if they have neuropathy that is selectively affecting very small fibers like nerve ends
- Serves as example of just because we can’t see something in our scans, it doesn’t mean there isn’t a problem
- Saying things are due to psychosocial factors is giving up on treatment
what is idiopathic?
don’t know the cause of
why does IBS people have lower heat pain threshold?
Because IBS peeps also might have fibro
- why they got diagnosed with IBS and not fibro: They went to a specialist first and minimized or completely ignored other parts of the body in pain
what are the 4 types of headache?
- sinus: pain is behind browbone and/or cheekbones
- cluster: pain is in and around one eye
- tension: pain is like a band squeezing the head
- migraine: pain, nausea, and visual changes
how long do migraines last?
4-72 hours
difference between tension and migraines
Tension: activity wont make it any worse
Migraine: pulsating, more severe, unilateral, activity makes it worse, photo and phono phobia (sensitivity to light and sound)
- What makes them particularly disabling
- Nausea and vomiting
explain the 4 stages of migraines
STAGE 1: prodome - early photo and phono phobia, irritability, etc.
STAGE 2: aura - occurs right before headache starts
STAGE 3: headache itself
STAGE 4: postdrome- Headache gone, but more like a hangover
what are migraine triggers?
- Highest for stress
- debate over triggers – since it never happens in the lab when they try to recreate triggers, leading researcher to believe triggers to be a nocebo
- Nitroglycerin (TNT) will 100% give a migraine within an hour of injection
what is the cause of migraines?
Vasodilation or Neuronal?
- we still don’t know
what is an aura caused by?
- Caused by cortical spreading depression – wave of electrical excitability that starts at back of brain and waves forward
- How do they know? The speed that aura moves is the same speed that cortical depression moves
- Debated: whether it doesn’t or does cause pain
- Only 20% of migraines get auras
