Fibromyalgia lecture2010
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This document provides information about fibromyalgia including its definition, symptoms, diagnosis, treatment, and prognosis. Fibromyalgia is defined as a chronic pain condition characterized by widespread muscle aches, pain and tenderness in at least 11 of 18 tender points. It predominantly affects women and has no known cause but may involve abnormalities in how the brain processes pain signals. Treatment involves lifestyle modifications like exercise, stress management and adequate sleep, along with medications to reduce pain and improve symptoms. While there is no cure for fibromyalgia, treatment can help manage symptoms and many people are able to lead active lives.
Fibromyalgia lecture2010
- 1. Fibromyalgia
- 2. Bridgit Finley, PT, DPT, M.Ed., OCS bfinley@ptcentral.org www.ptcentral.org 579-1600 Check us out on Facebook
- 3. Objectives State the ACR clinical definition of FM. Identify 5 or more overlapping co-morbidities. Outline the risk factors. Describe the non-pharmacologic approach to treatment. Review the prognoses for FM patients.
- 4. Pre Test FM is caused by a virus? 3-6% of the population has FM? FM is progressive and fatal? FM is diagnosed with a blood test? Exercise has been shown to decrease FM symptoms? False True False False True
- 5. Introduction Fibromyalgia – what is it? Be skeptical if you read something that says it will “cure” symptoms. Patients need to understand their symptoms so that they can begin to take control and manage their pain.
- 6. Overview Common condition characterized by long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissue. A chronic pain state. Nerve stimuli causing pain (reduced pain threshold). Symptoms: fatigue, morning stiffness, sleep problems, headaches, depression and anxiety.
- 7. Definition of Fibromyalgia “Chronic and widespread pain located at 11 or more of 18 tender points.” American College of Rheumatology, 1990. In 1908, Gowen first described FMS.
- 8. Fibromyalgia A common and complex chronic pain disorder that affects people physically, mentally and socially. It is a syndrome rather than a disease. A syndrome is a collection of signs and symptoms that occur together without an identifiable cause.
- 9. Disease A disease, which is a medical condition with specific cause or causes and recognizable signs and symptoms. Fibromyalgia is a set of symptoms not caused by a disease. Tissue pathology with distinctive symptoms and a causative agent. Tuberculosis, causing a chronic cough, tubercle bacillus is causative agent and can be cured.
- 10. Science of Fibromyalgia Tends to be treated rather dismissively by Medical Community. Controversy – not disease process, can’t be cured. Problem with doctors is that it can not be understood according to the classic medical model. This model is used with all medical training.
- 11. What is the problem? It is not a primary psychological disorder. As in many chronic conditions, psychological factors may play a role. May “up regulate” the central nervous system. Abnormal pain transmission response Disordered sensory processing.
- 12. What is the problem? The stimuli causing pain originates mainly in the muscles. Skeletal muscle metabolism – decrease blood flow which causes chronic fatigue and weakness. Hence the increased pain with strenuous exertion.
- 13. Causes The bottom line – unknown Sleep disturbances, which are common in FB patients, may actually cause the condition. Pilot studies have shown a possible inherited tendency toward the disease. Very preliminary.
- 14. Perception of Pain Pain is a universal experience that serves the vital function of triggering avoidance. Cardinal symptom of FM is widespread body pain. Tender points at musculoskeletal junction. Amplification of nervous system.
- 15. Pain is Personal Some 30 years ago, Melzeck and Wall proposed that pain is a complex integration of noxious stimuli, and cognitive factors. In other words, the emotional aspects of having a chronic pain state and one's rationalization of the problem may both influence the final experience of pain.
- 16. Description A chronic musculoskeletal syndrome characterized by widespread: musculoskeletal aches and pain stiffness in the muscle tissue, ligaments, and tendons soft tissue tenderness general fatigue sleep disorders gastrointestinal disorders depression
- 17. FMS affects the neck, shoulders, chest, legs, and lower back symptoms similar to those of chronic fatigue syndrome and myofascial pain syndrome.
- 18. Epidemiology 10 million US 3-6% of population ~ 80% are women highest incidence women 20 to 55 years of age Genetic component Among siblings and mothers and daughters Incidence rises with age, by 80 years old – 8% of the population.
- 19. Risk Factors Age more common in young adults, increases with age Gender 10 x more common in women Genetic familial patterns suggest the disorder may be inherited Often follows a trauma infectious or stress
- 20. Risk Factors Sleep disorders unknown whether sleep difficulties are a cause or a result of fibromyalgia Rheumatic Disease RA or Lupus more likely to develop FA
- 21. Pathophysiology unknown etiology produces vague symptoms that may be associated with diminished blood flow to certain parts of the brain and increased amounts of substance P substance P thought to be a sensory neurotransmitter involved in the communication of pain, touch, and temperature from body to brain. Lowers the threshold of synaptic excitability
- 22. Pathophysiology several other possible causes: autonomic nervous system dysfunction chronic sleep disorders emotional stress or trauma immune or endocrine system dysfunction upper spinal cord injury viral or bacterial infection
- 23. Signs and Symptoms vary, depending on stress level, physical activity, time of day, and the weather pain primary symptom pain and tenderness in specific trigger points when pressure is applied aching, burning, throbbing, or move around the body (migratory) muscle tightness, soreness, and spasms
- 24. S & S Continued unable to carry out normal daily activities even though muscle strength is not affected pain often worse in morning, improves throughout day, worsens at night symptoms may be constant or intermittent for years
- 25. Co-morbidities sleep disorders/fatigue restless leg syndrome, sleep apnea gastrointestinal abdominal pain, bloating, gas, cramps, alternating diarrhea and constipation, IBS numbness or tingling sensations chronic headaches may include facial and jaw pain (TMJ) frequent urination, strong urge to urinate, painful urination (dysuria) sensation of swelling (edema) in hands and feet even though not present cognitive or memory impairment
- 26. Co-morbidities and FM Post-exertional malaise and muscle pain Morning Stiffness Numbness and Tingling Dizziness or Light-headedness Increased chemical, mechanical, and thermal sensitivities.
- 27. Trigger Points Main points of pain in Fibromyalgia patients Neck Back Shoulders Pelvic Girdle Hands Knees Elbows Hips
- 28. Diagnosis No laboratory tests Must rely on patients self reported symptoms 3 month history Exam based on American College of Rheumatology criteria. Estimated that it takes an average of five years to get diagnosed.
- 29. To receive a diagnosis of FM Medical History widespread pain in all four quadrants of their body for a minimum of three months at least 11 of the 18 specified tender points when pressure is applied.
- 30. Rule Out other Conditions Cancer Cervical & Lumbar DDD Chronic Fatigue Depression Hypothyroidism Irritable Bowel Syndrome Hypothyroidism Polymyalgia Lyme Disease Viral hepatitis Rheumatoid Arthritis Sleep Disorders
- 31. Myth Fibromyalgia Damages Your Joints Increase pain has not been correlated with any joint or muscle damage. It is important to understand that activity is good for your joints and will help patients with Fibromyalgia control pain. Fibromyalgia is not fatal True
- 32. Myth You look fine, so nothing is wrong with you. Pain is cultural Our society does not really want to know “How are you?” You were diagnosed with fibromyalgia because your doctor couldn’t find anything wrong with you. American College of Rheumatology
- 33. Treatment Pain Management Lifestyle adjustment avoid nonessential activities Good Nutrition Stress Management Use of relaxation techniques meditation, biofeedback Exercise Sleep Management Avoid caffeine Regular sleep routine
- 34. Nutrition Avoid sugar Avoid caffeine – this will improve your sleep Limit alcohol Maintain proper body weight Limit processed food Chocolate is OK and may release serotonin
- 35. Pain Management Goal reduce pain, improve sleep, and relieve associated symptoms Medication antidepressant agents relieve sleep disorders, reduce muscle pain, treat depression small doses of aspirin or acetaminophen relief of pain and muscle stiffness Lyrica/cymbalta/Savella -
- 36. Pain Management Trigger point injections injection of local anestheticand/or corticosteroid into a tender point and then stretching involved muscle local anesthetic blood flow to the muscle corticosteroids inflammation
- 37. Treatment Exercise low-impact aerobic activity and strength training. Improved Fitness – symptoms are decreased with aerobic exercise. 25-60% HHR, 3days/week, 20-30 minutes Significant decrease in the Fibromyalgia Impact Questionnaire ACSM Guidelines are too strenuous
- 38. Physical Therapy Physical Therapy Modalities Manual therapy Stretching C-V Home Program Capsaicin creams Massage tools Rice bags Warm clothes Pillows - Beds
- 39. Prognosis No cure – lifelong condition. Very rare for them to develop lupus or MS Better ways to diagnose and treat the chronic pain disorder continue to be developed. FDA – new medications Clinical studies demonstrate that can reduce symptoms. Does not shorten life span.
- 40. Support Groups National Fibromyalgia Association www.fmaware.org Podcasts Walk of FAME (Fibromyalgia Awareness Means Everything) Emotional/Social Support and Education
- 41. Post Test There is no cure for FM? FM has been shown to shorten a persons life span? FM will cause joint damage? FM is a disease? FM has an unknown etiology? True False False False True
- 42. Case Study 34 yo female with diagnosis of FM Wants to be start an exercise program Goals are to loose weight and be able to sleep better What questions will you ask her? What exercises are appropriate? Do you feel comfortable working with the client?
- 43. TED Talks Use your brain to control pain. Pain
- 44. Questions