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Information on Firbromyalgia presented to senior University of Oklahoma Health and Sport Science Majors.

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  1. 1. Fibromyalgia
  2. 2. <ul><li>Bridgit Finley, PT, DPT, M.Ed., OCS </li></ul><ul><li>[email_address] </li></ul><ul><li> </li></ul><ul><li>579-1600 </li></ul>
  3. 3. Introduction <ul><li>Fibromyalgia – what is it? </li></ul><ul><li>Be skeptical if you read something that says it will “cure” symptoms. </li></ul><ul><li>Patients need to understand their symptoms so that they can begin to take control and manage their pain. </li></ul>
  4. 4. Overview <ul><li>Common condition characterized by long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissue. </li></ul><ul><li>A chronic pain state. </li></ul><ul><li>Nerve stimuli causing pain (reduced pain threshold). </li></ul><ul><li>Symptoms: fatigue, morning stiffness, sleep problems, headaches, depression and anxiety. </li></ul>
  5. 5. Fibromyalgia <ul><li>A common and complex chronic pain disorder that affects people physically, mentally and socially. </li></ul><ul><li>It is a syndrome rather than a disease. </li></ul><ul><li>A disease, which is a medical condition with specific cause or causes and recognizable signs and symptoms. </li></ul><ul><ul><li>Fibromyalgia is a set of symptoms not caused by a disease. </li></ul></ul><ul><li>A syndrome is a collection of signs and symptoms that occur together without an identifiable cause. </li></ul>
  6. 6. Science of Fibromyalgia <ul><li>Tends to be treated rather dismissively by Medical Community. </li></ul><ul><ul><li>Controversy – not disease process, can’t be cured. </li></ul></ul><ul><li>Problem with doctors is that it can not be understood according to the classic medical model. </li></ul><ul><ul><li>This model is used with all medical training. </li></ul></ul><ul><li>Tissue pathology with distinctive symptoms and a causative agent. </li></ul><ul><ul><li>Tuberculosis, causing a chronic cough, tubercule bacillus is causative agent and can be cured. </li></ul></ul>
  7. 7. What is the problem? <ul><li>It is not a primary psychological disorder. </li></ul><ul><li>As in many chronic conditions, psychological factors may play a role. </li></ul><ul><li>May “up regulate” the central nervous system. </li></ul><ul><ul><li>Abnormal pain transmission response </li></ul></ul><ul><li>Disordered sensory processing. </li></ul>
  8. 8. What is the problem? <ul><li>The stimuli causing pain originates mainly in the muscles. </li></ul><ul><ul><li>Skeletal muscle metabolism – decrease blood flow </li></ul></ul><ul><ul><li>Hence the increased pain with strenuous exertion. </li></ul></ul>
  9. 9. Perception of Pain <ul><li>Pain is a universal experience that serves the vital function of triggering avoidance. </li></ul><ul><li>Cardinal symptom of FM is widespread body pain. </li></ul><ul><li>Tender points at musculoskeletal junction. </li></ul><ul><li>Amplification of nervous system. </li></ul><ul><li>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. </li></ul>
  10. 10. Description <ul><li>a chronic musculoskeletal syndrome characterized by widespread: </li></ul><ul><ul><li>musculoskeletal aches and pain </li></ul></ul><ul><ul><li>stiffness in the muscle tissue, ligaments, and tendons </li></ul></ul><ul><ul><li>soft tissue tenderness </li></ul></ul><ul><ul><li>general fatigue </li></ul></ul><ul><ul><li>sleep disorders </li></ul></ul><ul><ul><li>gastrointestinal disorders </li></ul></ul><ul><ul><li>depression </li></ul></ul><ul><li>affects the neck, shoulders, chest, legs, and lower back </li></ul><ul><li>symptoms similar to those of chronic fatigue syndrome and myofascial pain syndrome. </li></ul>
  11. 11. Significance <ul><li>10 million US  3-6% of population </li></ul><ul><li>~ 80% are women </li></ul><ul><li>highest incidence  women 20 to 40 years of age </li></ul><ul><li>Genetic component </li></ul><ul><ul><li>Among siblings and mothers and daughters </li></ul></ul><ul><li>Incidence rises with age, by 80 years old – 8% of the population. </li></ul>
  12. 12. Risk Factors <ul><li>Age  more common in young adults, increases with age </li></ul><ul><li>Gender  more common in women </li></ul><ul><li>Genetic  familial patterns suggest the disorder may be inherited </li></ul><ul><li>Often follows a trauma  infectious or stress </li></ul><ul><li>Sleep disorders  unknown whether sleep difficulties are a cause or a result of fibromyalgia </li></ul><ul><li>Rheumatic Disease  RA or Lupus more likely to develop FA </li></ul>
  13. 13. Pathophysiology <ul><li>unknown etiology </li></ul><ul><li>produces vague symptoms that may be associated with diminished blood flow to certain parts of the brain and increased amounts of substance P </li></ul><ul><li>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 </li></ul>
  14. 14. Pathophysiology <ul><li>several other possible causes: </li></ul><ul><ul><li>autonomic nervous system dysfunction </li></ul></ul><ul><ul><li>chronic sleep disorders </li></ul></ul><ul><ul><li>emotional stress or trauma </li></ul></ul><ul><ul><li>immune or endocrine system dysfunction </li></ul></ul><ul><ul><li>upper spinal cord injury </li></ul></ul><ul><ul><li>viral or bacterial infection </li></ul></ul>
  15. 15. Signs and Symptoms <ul><li>vary, depending on stress level, physical activity, time of day, and the weather </li></ul><ul><li>pain  primary symptom </li></ul><ul><li>pain and tenderness in specific trigger points when pressure is applied </li></ul><ul><li>aching, burning, throbbing, or move around the body (migratory) </li></ul><ul><li>muscle tightness, soreness, and spasms </li></ul><ul><li>unable to carry out normal daily activities even though muscle strength is not affected </li></ul><ul><li>pain  often worse in morning, improves throughout day, worsens at night </li></ul>
  16. 16. Signs and Symptoms <ul><li>symptoms may be constant or intermittent for years </li></ul><ul><li>common symptoms include: </li></ul><ul><ul><li>sleep disorders  restless leg syndrome, sleep apnea </li></ul></ul><ul><ul><li>gastrointestinal  abdominal pain, bloating, gas, cramps, alternating diarrhea and constipation, IBS </li></ul></ul><ul><ul><li>numbness or tingling sensations </li></ul></ul><ul><ul><li>chronic headaches  may include facial and jaw pain </li></ul></ul><ul><ul><li>heightened sensitivity to odors, loud noises, bright lights, various foods, medicines, changes in weather </li></ul></ul><ul><ul><li>frequent urination, strong urge to urinate, painful urination (dysuria) </li></ul></ul><ul><ul><li>sensation of swelling (edema) in hands and feet even though not present </li></ul></ul><ul><ul><li>cognitive or memory impairment </li></ul></ul><ul><ul><li>post-exertional malaise and muscle pain </li></ul></ul><ul><ul><li>morning stiffness (waking up stiff and achy) </li></ul></ul>
  17. 17. Trigger Points <ul><li>Main points of pain in Fibromyalgia patients </li></ul><ul><ul><li>Neck </li></ul></ul><ul><ul><li>Back </li></ul></ul><ul><ul><li>Shoulders </li></ul></ul><ul><ul><li>Pelvic Girdle </li></ul></ul><ul><ul><li>Hands </li></ul></ul><ul><ul><li>Knees </li></ul></ul><ul><ul><li>Elbows </li></ul></ul><ul><ul><li>Hips </li></ul></ul>
  18. 18. Diagnosis <ul><li>No laboratory tests </li></ul><ul><li>Must rely on patients self reported symptoms </li></ul><ul><ul><li>3 month history </li></ul></ul><ul><li>Exam based on American College of Rheumatology criteria. </li></ul><ul><li>Estimated that it takes an average of five years to get diagnosed. </li></ul><ul><li>Exclusion of other conditions  chronic fatigue syndrome and myofascial pain syndrome </li></ul>
  19. 19. To receive a diagnosis of FM <ul><li>Medical History </li></ul><ul><ul><li>widespread pain in all four quadrants of their body for a minimum of three months </li></ul></ul><ul><ul><li>at least 11 of the 18 specified tender points when pressure is applied. </li></ul></ul>
  20. 20. Rule Out other Conditions <ul><li>Cancer </li></ul><ul><li>Cervical & Lumbar DDD </li></ul><ul><li>Chronic Fatigue </li></ul><ul><li>Depression </li></ul><ul><li>Hypothyroidism </li></ul><ul><li>Irritable Bowel Syndrome </li></ul><ul><li>Rheumatoid Arthritis </li></ul><ul><li>Sleep Disorders </li></ul>
  21. 21. Myth <ul><li>Fibromyalgia Damages Your Joints </li></ul><ul><ul><li>Increase pain has not been correlated with any joint or muscle damage. </li></ul></ul><ul><ul><li>It is important to understand that activity is good for your joints and will help patients with Fibromyalgia control pain. </li></ul></ul><ul><li>Fibromyalgia is not fatal </li></ul><ul><ul><li>True </li></ul></ul>
  22. 22. Myth <ul><li>You look fine, so nothing is wrong with you. </li></ul><ul><ul><li>Pain is cultural </li></ul></ul><ul><ul><li>Our society does not really want to know “How are you?” </li></ul></ul><ul><li>You were diagnosed with fibromyalgia because your doctor couldn’t find anything wrong with you. </li></ul><ul><ul><li>American College of Rheumatology </li></ul></ul>
  23. 23. Treatment <ul><li>Pain Management </li></ul><ul><ul><li>Lifestyle adjustment </li></ul></ul><ul><ul><ul><li>avoid nonessential activities </li></ul></ul></ul><ul><ul><li>Good Nutrition </li></ul></ul><ul><ul><li>Stress Management </li></ul></ul><ul><ul><ul><li>Use of relaxation techniques  meditation, biofeedback </li></ul></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><li>Sleep Management </li></ul></ul><ul><ul><ul><li>Avoid caffeine </li></ul></ul></ul><ul><ul><li>Regular sleep routine </li></ul></ul>
  24. 24. Nutrition <ul><li>Avoid sugar </li></ul><ul><li>Avoid caffeine </li></ul><ul><li>Limit alcohol </li></ul><ul><li>Maintain proper body weight </li></ul>
  25. 25. Pain Management <ul><li>Goal  reduce pain, improve sleep, and relieve associated symptoms </li></ul><ul><li>Medication </li></ul><ul><ul><li>antidepressant agents  relieve sleep disorders, reduce muscle pain, treat depression </li></ul></ul><ul><ul><li>small doses of aspirin or acetaminophen  relief of pain and muscle stiffness </li></ul></ul><ul><ul><li>Lyrica/cymbalta/Savella - </li></ul></ul><ul><li>Trigger point injections  injection of local anestheticand/or corticosteroid into a tender point and then stretching involved muscle </li></ul><ul><ul><li>local anesthetic   blood flow to the muscle </li></ul></ul><ul><ul><li>corticosteroids   inflammation </li></ul></ul>
  26. 26. Treatment <ul><li>Exercise  low-impact aerobic activity and strength training. </li></ul><ul><ul><li>25-60% HHR, 3days/week, 20-30 minutes </li></ul></ul><ul><ul><li>Significant decrease in the Fibromyalgia Impact Questionnaire </li></ul></ul><ul><ul><li>ACSM Guidelines are too strenuous </li></ul></ul><ul><li>Physical Therapy  Modalities </li></ul><ul><ul><li>Manual therapy </li></ul></ul><ul><ul><li>Stretching </li></ul></ul><ul><ul><li>C-V </li></ul></ul>
  27. 27. Prognosis <ul><li>No cure – lifelong condition. Very rare for them to develop lupus or MS </li></ul><ul><li>Better ways to diagnose and treat the chronic pain disorder continue to be developed. </li></ul><ul><li>FDA – new medications </li></ul><ul><li>Clinical studies demonstrate that can reduce symptoms. </li></ul><ul><li>Does not shorten life span. </li></ul>
  28. 28. Support Groups <ul><li>National Fibromyalgia Association </li></ul><ul><ul><li> </li></ul></ul><ul><li>Podcasts </li></ul><ul><li>Walk of FAME (Fibromyalgia Awareness Means Everything) </li></ul><ul><li>Emotional/Social Support and Education </li></ul>
  29. 29. TED Talks <ul><li>Use your brain to control pain. </li></ul><ul><li>Pain </li></ul>