Fibromyalgia Fibra (fiber) - PowerPoint Presentation

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