Fibromyalgia Flashcards Preview

PT Across the LIFESPAN > Fibromyalgia > Flashcards

Flashcards in Fibromyalgia Deck (18)
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1
Q

Chronic widespread pain disorder (> 3 months) with associated tender points, stiffness, fatigue with disrupted sleep, cognitive difficulties and multiple other S & S’s (anxiety, depression, ADL function problems

A

Fibromyalgia

2
Q

Leads to whole body hypersensitivity to pain with increased responsiveness to peripheral stimuli

A

Central sensitization in fibromyalgia

3
Q

what is the effect of excess excitatory NT (substance P)

A

Increased activity of pain facilitatory pathways

4
Q

one of the believed causes of fibromyalgia is central sensitization.

How does central sensitization occur?

A
  • Central sensitization:
    • Too much excitatory NT (substance p)
    • Too little inhibitory NT (serotonin)
    • Maintained enhancement of temporal summation of second pain (C fibers)
    • Altered endogenous opioid analgesic activity

Leads to whole body hypersensitivity to pain with increased responsiveness to peripheral stimuli

5
Q

In fibromyalgia, dysfunction of hypothalamic-pituitary-adrenal axis (HPA axis)

A

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

6
Q

Biopsychosocial model in fibromyalgia

A
  • No specific cause but multifactorial etiology:
  1. Psychological variables
  2. Sociocultural variables
  3. Biological variables
7
Q

Name 3 of the S & S in fibromyalgia

A
  • Widespread pain (dull ache) on both sides of body, above & below
    the waist
    • Allodynia
    • Hyperalgesia
  • Muscle stiffness, especially in the morning
  • Paresthesias
  • Headache
  • General fatigue
  • Nonrestorative sleep, (waking unrefreshed)
  • Hypersensitivity to cold/heat
8
Q

Diagnosis of fibromyalgia:

A
  1. History
  2. Physical Examination
  3. Lab Tests: to rule out other conditions
9
Q

Original diagnostic criteria of fibromyalgia criteria (American College of Rheumatology 1990)

A
  • Widespread pain in all 4 quadrants of body for at least 3 consecutive months
  • Tenderness in at least 11 of 18 specific points
10
Q

Updated Diagnostic Criteria (ACR 2010); Fibromyalgia DX if 3 conditions met:

(must know this!)

A
  1. Widespread pain index (WPI) > 7 AND Symptom severity scale (SS scale) > 5
    • WPI = pain in 19 body areas
    • OR WPI: 3-6 AND SS scale > 9
  2. Symptoms present at similar level for at least 3 months
  3. Patient does not have another disorder that would explain the pain
11
Q

What is the Fibromyalgia Impact Questionnaire?

How is scored?

A
  • a measure of disease impact in patients with fibromyalgia.
  • Higher scores indicate greater impact of fibromyalgia on functioning.
12
Q

Name 2 PT interventions for patient with fibromyalgia

A

Multimodal Approach

  • Patient education:
    • Identification of triggers of flare-ups
    • Activity mgmt
    • Lifestyle changes
  • Physical exercise:
    • Aerobic
    • Strengthening
    • Stretching
    • Aquatic
    • Yoga
    • Tai chi
  • Mind-Body
    • Meditation
    • Relaxation therapies
  • Passive interventions:
    • Manual threapy
    • Dry needling
    • Massage
    • TENS
    • MFR
13
Q

Name some exercise recommendations for patients with fibromyalgia

A
  • Start slow and set realistic goals
  • Get an understanding of the pt exercise tolerance
  • Modify the program in times of stress
  • Progress exercise intensity, duration and frequency gradually according to patient tolerance
14
Q

3 drugs approved by FDA for treatment of fibromyalgia

A
  • Lyrica ( pregablin )
    Decreases pain, improves sleep
  • Cymbalta (duloxetine)
    Decreases pain, fatigue & sleep problems
  • Savella (milnacipran)
    Decreases pain, fatigue & sleep problems
15
Q

Fybromyalgia prognosis

A
  • Chronic relapsing condition
    • Rarely see full reversal of allodynia & hyperalgesia
  • Strong evidence for successful management of fibromyalgia with patient education, aerobic and strengthening exercise
16
Q

One of most commonly diagnosed pediatric amplified pain syndromes

A

Juvenile Fibromyalgia

17
Q

Juvenile Fibromyalgia intervention:

A

better outcomes with cognitive-behavioral therapy and exercise than with medications

  • Intensive PT/OT program
18
Q

Juvenile Fibromyalgia, prognosis

A

Children & adolescents with FM more likely to have favorable outcome as compared to adults with FM