Fibromyalgia - Weber State University

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22 Φεβ 2014 (πριν από 3 χρόνια και 5 μήνες)

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Justin Hogge

Fibromyalgia

Definition of Fibromyalgia


A common clinical syndrome of generalized musculoskeletal
pain, stiffness, and chronic aching characterized by
reproducible tenderness or palpation of specific anatomical
sites, generally referred to as tender points.


Dr. Joe M. Elrod

Tender Points



Tender Point Count and Intensity Can vary from day to day


The degree of tender points tends to predict functional
limitation.

But
, the correlation is very far from perfect.


Individuals
with less than 11 of 18
of these tender points may
still have severe functional limitations. (Chronic Pain
Syndrome.)



The cut
-
off between “fibromyalgia” and “chronic pain
syndrome” is somewhat arbitrary


Epidemiology


An estimated 5 to 10 million people in the United States are
diagnosed with Fibromyalgia.


80
-
90 percent of diagnosed fibromyalgics are said to be
women between 20 and 55 years of age but the number of
younger people with fibromyalgia is growing.

Symptoms


Anxiety and/or panic attacks


Cardiovascular problems (dizziness, palpitations)


Chronic fatigue and low energy


Chronic widespread aches and pains


Depression


Gastrointestinal disturbances/irritable bowl syndrome


Intolerance to cold temperatures


Irritable bladder syndrome


Memory and concentration problems “Fibro Fog”


Neck and back pain

Symptoms continued


Pelvic pain in women (painful menstruation)


Poor circulation (cold hands and feet)


Sleep disturbances and/or restless leg syndrome


Stiffness (especially in the morning)/muscle twitching


Subjective soft tissue swelling or
paresthesia

in hands, arms, feet
or legs


Tension headaches and/or
migrains

What causes Fibromyalgia?


Cause is
unknown


Abnormally high levels of Substance P in spinal fluid in some
patients


Substance P important in transmission and amplification of
pain signals to and from brain


“Volume control” is turned up too high in brain’s pain centers


What causes Fibromyalgia (
cont
)


Familial tendency to develop FMS suggests
genetic
role


Can be triggered by physical, emotional or environmental
stressors such as car accidents, repetitive injuries and certain
diseases


Patients with Rheumatoid arthritis and SLE (Lupus) are more
likely to develop FMS


How is Fibromyalgia diagnosed?


A diagnosis is made by evaluation of symptoms and presence
of
tender
points


American College of Rheumatology Classification Criteria
for Fibromyalgia (1990)…….
widespread
pain for at least
3 months
and


pain in
11

out of
18

tender

point

sites on digital palpation


How is Fibromyalgia diagnosed (
cont
)


X
-
rays, blood tests, specialized scans such as nuclear
medicine and CT, muscle biopsies are all
normal procedures.


Objective “markers of inflammation” such as ESR
(erythrocyte sedimentation rate) are
normal procedures.


Must be distinguished from other common diffuse pain
conditions

How is Fibromyalgia treated?


Fibromyalgia is a chronic condition managed
with
medications,
and physical
and nutritional modalities



Medication therapy is largely symptomatic, as there is no
definitive treatment cure for fibromyalgia


How is Fibromyalgia treated?
(Medications)


Current studies suggest that the best pharmacologic
treatment for treating pain and improving sleep disturbance
includes
:


Antidepressants


-

Tricyclic
compounds such as cyclobenzaprine (FLEXERIL)
and amitriptyline (ELAVIL)


-

Dual reuptake inhibitors such as venlafaxine (EFFEXOR),
duloxetine (CYMBALTA) and tramadol (ULTRAM
)
effect
norepinephrine & serotonin


How is Fibromyalgia treated?
(Medications)

SSRIs/ antidepressants such as fluoxetine (PROZAC),
paroxetine (PAXIL) and sertraline (ZOLOFT) for depression
and pain


-

Recent studies have shown that the anti
-
epileptics (seizure
meds) gabapentin (NEURONTIN) and
pregabalin

(LYRICA)
have been effective


Other Therapies for Fibromyalgia


Acupressure/Acupuncture


Balneotherapy

(Therapeutic baths)


Biofeedback (Power of the mind)


Collagen
Hydrolysat

(Food supplement)


Magnet therapy


Meditation/visual imaging


Therapeutic massage


Prolotherapy

(injection of dextrose &
Sarapin

into joints or
trigger points)


Effects of Fibromyalgia on Exercise


Pain associated with basic activities of daily living, general
fatigue, and altered perception of exertion make it hard for
individuals with FM to stay physically active.


M
orning stiffness, exaggerated delayed
-
onset muscle soreness
(DOMS) and difficulty with use of the arms in elevated
positions associated with FM limit the type of activities that
can be done.

Exercise with Fibromyalgia


The irony here is that even though exercise can make you feel
worse short term, the lack of it can make your symptoms
more severe long term, as well as inviting more health
problems. The key is moderation and pacing. Numerous
studies demonstrate that even small amounts of exercise, as
little as 6 minutes per day, can lessen pain and fatigue.

Effects of medications on Exercise


Lyrica

(
antiepileptics
)


Has been known to cause clumsiness, but other than that has no
significant effects on exercise.


Neurontin (
antiepileptics
)


Can cause dizziness and blurred vision so not recommended if
doing activities requiring quick reaction time, but most exercise
is ok.


Antidepressants


No significant effects on exercise.




Effects (acute) of exercise on patient


Exercise causes acute pain and exhaustion with patients
diagnosed with fibromyalgia (more so than individuals
without fibromyalgia)

Effects (chronic) of exercise on patient


Exercise has been shown to decrease symptoms including,
pain, stiffness, fatigue, depression, and insomnia with
fibromyalgia patients long term.

Exercise Testing


Functional


Lifting
-
specific activities


Flexibility


Sit and reach Goniometry


Endurance


6 and 12 min walk


Strength


Handgrip


Isotonic


Aerobic


Cycle

Fibromyalgia Video

Summary


Fibromyalgia is a chronic condition that
affects
5


10 million
Americans.


Doctors
diagnose fibromyalgia based on a patient's symptoms
and physical exam.


Patients
experience pain and stiffness in the muscles, but
there are no measurable findings on X
-
rays or lab tests.


While
fibromyalgia does not damage the joints or organs, the
constant aches and fatigue can have a significant impact on
daily life.


References


http://
arthritis.about.com/od/fibromyalgia/a/fibro_facts.htm


Clark, S.R. et al. “Exercise for patients with fibromyalgia: risks versus benefits.”
Curr

Rheumatol

Rep. 3 no. 2 (April 2001): 135
-
140


Wolfe F. et al. “The American College of Rheumatology 1990 criteria for the
classification of fibromyalgia: report of the multicenter criteria committee.”
Arthritis Rheumatology.
(1990)


www.Fibrocenter.com


Dunne, F.J. and C.A. Dunne “Fibromyalgia syndrome and psychiatric disorder.”
British
Jounal

of Hospital Medicine
. (1995)


Webmd.com/fibromyalgia


Medline


Dr. Joe M. Elrod “Reversing Fibromyalgia” Woodland Publishing. 2
nd

ed. 2002