Fibromyalgia
last authored:
last reviewed:
Introduction
Diffuse pain syndrome. Above and below waist.
Disability.
The Case of...
Causes and Risk Factors
50% no cause
25% anxiety/depression
25% physical event (ie, MSK trauma)
Pathophysiology
Perception of pain is amplified in terms of response.
Allodynia
Decreased descending inhibition system "your normal inhibitory system is not functioning" can be heko
Diffuse noxious inhibitory control (DNIC) is functioning less. Some question of NA in this.
Decreased DNIC is not seen in depression.
Central sensitivity appears to be important.
No apparent tissue damage or inflammation
Decreased 5-HT and NA
Signs and Symptoms
- history
- physical exam
History
Assess dsisability; ie degree of impact on lives.
Understand the pain.
Assess for depression and anxiety.
Fibromyalgia Impact Questionnaire (FIQ and FIQR)
- widespread pain index (>7/19)
- symptom severity scale (>5/12)
FIBRO
Fatigue
Insomnia
Blues
Rigidity
Ow
Survey Criteria
Insomnia is very important; over 90% of patients have disordered sleep
restless leg syndrome
rigidity and stiffness: over 75% of patients; appears to be lack of activity
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Fibromyalgia is a diagnosis of exclusion.
CBC, ESR
CRP, ANA, RF
TSH
serum Ca and phosphate
CK
Diagnostic Imaging
Differential Diagnosis
Neurological
- MS
- peripheral neuropathy
Drugs
- statins
Treatments
Patient self-care is central to this.
Make a plan for addressing the complexities of symptoms, emotional state, disability, and social situation.
It is important to have someone who is able to provide the time.
Understanding
Education
Discuss the emotional connection and its impact on physical symptoms.
Motivational interviewing can be very helpful; ask questions such as "what have you been doing this week to improve/avoid your symptoms?"
Group therapy
Lifestyle
Sleep hygiene
Exercise: getting started is the hardest, but exercise is very important.
Avoidance of alcohol, caffeine, drugs
chewing gum (Mohri et al, 2005)
spiritual values (Wiech et al, 2008).
Medications
TCAsL amitrpytiline, cyclobenzaprine
SNRIs and NSRIs: duloxitine
gabapentinoids - pregabalin, gabapentin
gabapentin, pregabalin, nortryptiline
modest evidence
- tramadol
- sodium oxybate
- dopamine agonists
- SSRIs (high dose)
- nabilone
weak evidence
- growth hormone
- 5-HT
- tropistron
- 5-adenosyl-L-methionine
no evidence
- opiods
- steriods
- NSAIDs
- benzodiazepines
- guanfensein
Consequences and Course
Resources and References
Topic Development
authors:
reviewers:
 |