Patients need to make sense of the pain. It is a somewhat respectable diagnosis within the last 10 years.
Most patients need to be reassured that their symptoms are the product of a real disease.
Was that painful, how would your rate the pain 0-10. If average pain score &gt; 6/10.
Bridgit Finley, PT, DPT, M.Ed., OCS
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State the ACR clinical definition of FM.
Identify 5 or more overlapping co-morbidities.
Outline the risk factors.
Describe the non-pharmacologic approach to
Review the prognoses for FM patients.
FM is caused by a virus?
3-6% of the population
FM is progressive and
FM is diagnosed with a
Exercise has been shown
to decrease FM
Fibromyalgia – what is it?
Be skeptical if you read something that says it will
Patients need to understand their symptoms so that
they can begin to take control and manage their pain.
Common condition characterized by long-term,
body-wide pain and tender points in joints, muscles,
tendons, and other soft tissue.
A chronic pain state.
Nerve stimuli causing pain (reduced pain threshold).
Symptoms: fatigue, morning stiffness, sleep
problems, headaches, depression and anxiety.
Definition of Fibromyalgia
“Chronic and widespread pain located at 11
or more of 18 tender points.”
American College of Rheumatology,
In 1908, Gowen first described FMS.
A common and complex chronic pain disorder that
affects people physically, mentally and socially.
It is a syndrome rather than a disease.
A syndrome is a collection of signs and symptoms
that occur together without an identifiable cause.
A disease, which is a medical condition with specific
cause or causes and recognizable signs and
Fibromyalgia is a set of symptoms not caused by a
Tissue pathology with distinctive symptoms and a
Tuberculosis, causing a chronic cough, tubercle
bacillus is causative agent and can be cured.
Science of Fibromyalgia
Tends to be treated rather dismissively by Medical
Controversy – not disease process, can’t be cured.
Problem with doctors is that it can not be understood
according to the classic medical model.
This model is used with all medical training.
What is the problem?
It is not a primary psychological disorder.
As in many chronic conditions, psychological factors
may play a role.
May “up regulate” the central nervous system.
Abnormal pain transmission response
Disordered sensory processing.
What is the problem?
The stimuli causing pain originates mainly in the
Skeletal muscle metabolism – decrease blood flow
which causes chronic fatigue and weakness.
Hence the increased pain with strenuous exertion.
The bottom line – unknown
Sleep disturbances, which are common in FB
patients, may actually cause the condition.
Pilot studies have shown a possible inherited
tendency toward the disease. Very preliminary.
Perception of Pain
Pain is a universal experience that serves the vital
function of triggering avoidance.
Cardinal symptom of FM is widespread body pain.
Tender points at musculoskeletal junction.
Amplification of nervous system.
Pain is Personal
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.
A chronic musculoskeletal syndrome characterized
musculoskeletal aches and pain
stiffness in the muscle tissue, ligaments, and tendons
soft tissue tenderness
affects the neck, shoulders, chest, legs, and lower
symptoms similar to those of chronic fatigue
syndrome and myofascial pain syndrome.
10 million US 3-6% of population
~ 80% are women
highest incidence women 20 to 55 years of age
Among siblings and mothers and daughters
Incidence rises with age, by 80 years old – 8% of the
Age more common in young adults, increases with
Gender 10 x more common in women
Genetic familial patterns suggest the disorder may
Often follows a trauma infectious or stress
Sleep disorders unknown whether sleep difficulties
are a cause or a result of fibromyalgia
Rheumatic Disease RA or Lupus more likely to
produces vague symptoms that may be associated
with diminished blood flow to certain parts of the
brain and increased amounts of substance P
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
several other possible causes:
autonomic nervous system dysfunction
chronic sleep disorders
emotional stress or trauma
immune or endocrine system dysfunction
upper spinal cord injury
viral or bacterial infection
Signs and Symptoms
vary, depending on stress level, physical activity, time
of day, and the weather
pain primary symptom
pain and tenderness in specific trigger points when
pressure is applied
aching, burning, throbbing, or move around the body
muscle tightness, soreness, and spasms
S & S Continued
unable to carry out normal daily activities even
though muscle strength is not affected
pain often worse in morning, improves throughout
day, worsens at night
symptoms may be constant or intermittent for years
sleep disorders/fatigue restless leg syndrome, sleep apnea
gastrointestinal abdominal pain, bloating, gas, cramps,
alternating diarrhea and constipation, IBS
numbness or tingling sensations
chronic headaches may include facial and jaw pain (TMJ)
frequent urination, strong urge to urinate, painful urination
sensation of swelling (edema) in hands and feet even though
cognitive or memory impairment
Co-morbidities and FM
Post-exertional malaise and muscle pain
Numbness and Tingling
Dizziness or Light-headedness
Increased chemical, mechanical, and thermal
Main points of pain
in Fibromyalgia patients
No laboratory tests
Must rely on patients self reported symptoms
3 month history
Exam based on American College of Rheumatology
Estimated that it takes an average of five years to get
To receive a diagnosis of FM
widespread pain in all four quadrants of their body for a
minimum of three months
at least 11 of the 18 specified tender points when
pressure is applied.
Fibromyalgia Damages Your Joints
Increase pain has not been correlated with any joint or
It is important to understand that activity is good for
your joints and will help patients with Fibromyalgia
Fibromyalgia is not fatal
You look fine, so nothing is wrong with you.
Pain is cultural
Our society does not really want to know “How are
You were diagnosed with fibromyalgia because your
doctor couldn’t find anything wrong with you.
American College of Rheumatology
Avoid caffeine – this will improve your sleep
Maintain proper body weight
Limit processed food
Chocolate is OK and may release serotonin
Goal reduce pain, improve sleep, and relieve
antidepressant agents relieve sleep disorders, reduce
muscle pain, treat depression
small doses of aspirin or acetaminophen relief of
pain and muscle stiffness
Trigger point injections injection of local
anestheticand/or corticosteroid into a tender point
and then stretching involved muscle
local anesthetic blood flow to the muscle
Exercise low-impact aerobic activity and strength
Improved Fitness – symptoms are decreased with
25-60% HHR, 3days/week, 20-30 minutes
Significant decrease in the Fibromyalgia Impact
ACSM Guidelines are too strenuous
No cure – lifelong condition. Very rare for them to
develop lupus or MS
Better ways to diagnose and treat the chronic pain
disorder continue to be developed.
FDA – new medications
Clinical studies demonstrate that can reduce
Does not shorten life span.
National Fibromyalgia Association
Walk of FAME (Fibromyalgia Awareness Means
Emotional/Social Support and Education
There is no cure for FM?
FM has been shown to
shorten a persons life
FM will cause joint
FM is a disease?
FM has an unknown
34 yo female with
diagnosis of FM
Wants to be start an
Goals are to loose
weight and be able to
What questions will you
What exercises are
Do you feel comfortable
working with the client?
Use your brain to control pain.