myo muscle algos pain Functional Somatic Syndromes syndromes with physical symptoms that are poorly explained Fibromyalgia Chronic Fatigue Syndrome Tempromandibular disorder Irritable bowel syndrome ID: 691330
Download Presentation The PPT/PDF document "Fibromyalgia Fibra (fiber)" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Fibromyalgia
Fibra
(fiber)
myo
(muscle)
algos
(pain)Slide2
Functional Somatic Syndromes
syndromes with physical symptoms that are poorly explained…
Fibromyalgia
Chronic Fatigue Syndrome
Tempromandibular
disorder
Irritable bowel syndrome
Tension Headaches
Especially with FM, tests such as physical exams or imaging (X-Ray/MRI) may show no positive result correlated to symptoms. There are no definite biomarkers that can indicate FM currently.Slide3
History
In 1904, the term
“
fibrositis
” was coined in a talk on Lumbago, defining symptoms of soft tissue rheumatism
1976, a paper coined the term “fibromyalgia syndrome” differentiating the symptoms from other inflammatory arthritic disease
Fibromyalgia became a catch-all for non-specific muscular pains and remains controversial to this day
Two sets of diagnosis criteria have been published by the ACR, one in 1990, and one in 2010Slide4
Epidemiology
Present in 2-8% of the population
More common in females
Ratios range from 7:1 – 9:1
Female:Male
prevalence
Societal factors may influence this statistic Slide5
Genetics
Polygenic inheritance likely
Early research shows correlation to mutations in several neurotransmitter pathways
Serotoninergic
Dopaminergic
Catecholaminergic
Mutations in these pathways are also common in depression
Patients with serotonin 2A (5-HT2A) receptor 102T/C polymorphisms have also been shown to be more susceptible to fibromyalgiaSlide6
Symptoms
Chronic widespread pain
Fatigue
Sleep disturbance
Weakness
Paresthesias
Nerve Pain
Cognitive dysfunction
Anxiety/depressionSlide7
Cause
Central Sensitization Theory - Ineffective descending inhibition of the central nervous system causing an abnormal modulation of sensory inputs
Increased sensitivity to normally painless stimuli
Pain neurons are overactive
Fibromyalgia is often co-morbid with neuropathic pain and major depressive disorder, as these syndromes share similar genetic abnormalities.
Psychological stress or illness can trigger FM, as these individuals often have abnormal inflammatory and stress pathwaysSlide8
Diagnosing Criteria
1990
1) widespread pain in combination with
2) tenderness at 11 or more of the 18 specific tender point sites.Slide9
Tender pointsSlide10
Diagnosing Criteria
2010
1. Widespread pain index (WPI) greater than or equal to 7, symptom severity score (SS) greater than or equal to 5, or WPI 3-6 and SS greater than or equal to 9
2. Symptoms have been present at a similar level for at least 3 months
3. This patient does not have a disorder that would otherwise explain the painSlide11
Updated Tender Points (WPI) Slide12
WPI (range of 0 – 19)
1 point awarded to pain in the following regions:
Shoulder girdle left/right
Upper arm left/right
Lower arm left/right
Hip left/right
Upper leg left/right
Lower leg left/right
Jaw left/right
Chest
Abdomen
Upper Back
Lower Back
NeckSlide13
SS scale score
Four symptoms graded on a scale of 0 – 3, summed, maximum score of 12
Fatigue
Waking Unrefreshed
Cognitive Symptoms (fog, memory impairment, etc.)
General Somatic Symptoms
Scale 0 -3
0 = no problem/no symptoms
1 = slight or mild problems/few symptoms
2 = moderate, considerable problems/moderate number of symptoms
3 = severe:
pervasie
, continuous, life disturbing problems/a great deal of symptomsSlide14
Treatment
Sleep
Exercise
Diet
Cognitive Therapy – accepting the illness
Medications:
Duloxetine –
SNRI shown to reduce pain, fatigue, and improve mental performance
Milnacipran
–
SNRI similar to duloxetine, significant side-effects
Pregabalin
(Lyrica) –
GABA inhibitor which acts to increase extracellular GABA Slide15
Treatment
Opioids have not been approved by the FDA for FM
German study from 2012 advised against the use of strong opioids, did not recommend for or against use of weak opioids
Canadian study from 2012 advise against strong opioids, recommended the use of tramadol if other non-opioid medications fail
The European League Against Rheumatism, in 2008, recommended tramadol, but no strong opioids from FM pain
Muscle relaxants are often used, but not yet approved by the FDA to treat FM Slide16
Treatment
Recent meta-analysis on E-
Stim
published in
Pain Physician
, February 2017 shows
Low quality evidence for the effectiveness of electric stimulation (non-invasive/TENS) on reducing pain
Moderate quality evidence of the effectiveness of electric acupuncture (invasive needling) on reducing pain
Clinical trial on dry needling published in
Pain Physician
, February 2017 show
Reduced pain in myofascial trigger points on thoracic and lumbar muscles in FM patents from dry needling