Fibromyalgia lecture2010

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Information and updates on chronic pain associated with Fibromyalgia

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  • 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 > 6/10.
  • Fibromyalgia lecture2010

    1. 1. Fibromyalgia
    2. 2. Bridgit Finley, PT, DPT, M.Ed., OCS bfinley@ptcentral.org www.ptcentral.org 579-1600 Check us out on Facebook
    3. 3. Objectives State the ACR clinical definition of FM. Identify 5 or more overlapping co-morbidities. Outline the risk factors. Describe the non-pharmacologic approach to treatment. Review the prognoses for FM patients.
    4. 4. Pre Test FM is caused by a virus? 3-6% of the population has FM? FM is progressive and fatal? FM is diagnosed with a blood test? Exercise has been shown to decrease FM symptoms? False True False False True
    5. 5. Introduction Fibromyalgia – what is it? Be skeptical if you read something that says it will “cure” symptoms. Patients need to understand their symptoms so that they can begin to take control and manage their pain.
    6. 6. Overview 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.
    7. 7. Definition of Fibromyalgia “Chronic and widespread pain located at 11 or more of 18 tender points.” American College of Rheumatology, 1990. In 1908, Gowen first described FMS.
    8. 8. Fibromyalgia 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.
    9. 9. Disease A disease, which is a medical condition with specific cause or causes and recognizable signs and symptoms. Fibromyalgia is a set of symptoms not caused by a disease. Tissue pathology with distinctive symptoms and a causative agent. Tuberculosis, causing a chronic cough, tubercle bacillus is causative agent and can be cured.
    10. 10. Science of Fibromyalgia Tends to be treated rather dismissively by Medical Community. 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.
    11. 11. 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.
    12. 12. What is the problem? The stimuli causing pain originates mainly in the muscles. Skeletal muscle metabolism – decrease blood flow which causes chronic fatigue and weakness. Hence the increased pain with strenuous exertion.
    13. 13. Causes 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.
    14. 14. 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.
    15. 15. 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.
    16. 16. Description A chronic musculoskeletal syndrome characterized by widespread: musculoskeletal aches and pain stiffness in the muscle tissue, ligaments, and tendons soft tissue tenderness general fatigue sleep disorders gastrointestinal disorders depression
    17. 17. FMS affects the neck, shoulders, chest, legs, and lower back symptoms similar to those of chronic fatigue syndrome and myofascial pain syndrome.
    18. 18. Epidemiology 10 million US  3-6% of population ~ 80% are women highest incidence  women 20 to 55 years of age Genetic component Among siblings and mothers and daughters Incidence rises with age, by 80 years old – 8% of the population.
    19. 19. Risk Factors Age more common in young adults, increases with age Gender  10 x more common in women Genetic  familial patterns suggest the disorder may be inherited Often follows a trauma  infectious or stress
    20. 20. Risk Factors Sleep disorders  unknown whether sleep difficulties are a cause or a result of fibromyalgia Rheumatic Disease  RA or Lupus more likely to develop FA
    21. 21. Pathophysiology unknown etiology 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
    22. 22. Pathophysiology 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
    23. 23. 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 (migratory) muscle tightness, soreness, and spasms
    24. 24. 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
    25. 25. Co-morbidities 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 (dysuria) sensation of swelling (edema) in hands and feet even though not present cognitive or memory impairment
    26. 26. Co-morbidities and FM Post-exertional malaise and muscle pain Morning Stiffness Numbness and Tingling Dizziness or Light-headedness Increased chemical, mechanical, and thermal sensitivities.
    27. 27. Trigger Points  Main points of pain in Fibromyalgia patients Neck Back Shoulders Pelvic Girdle Hands Knees Elbows Hips
    28. 28. Diagnosis No laboratory tests Must rely on patients self reported symptoms 3 month history Exam based on American College of Rheumatology criteria. Estimated that it takes an average of five years to get diagnosed.
    29. 29. To receive a diagnosis of FM Medical History 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.
    30. 30. Rule Out other Conditions Cancer Cervical & Lumbar DDD Chronic Fatigue Depression Hypothyroidism Irritable Bowel Syndrome Hypothyroidism Polymyalgia Lyme Disease Viral hepatitis Rheumatoid Arthritis Sleep Disorders
    31. 31. Myth Fibromyalgia Damages Your Joints Increase pain has not been correlated with any joint or muscle damage. It is important to understand that activity is good for your joints and will help patients with Fibromyalgia control pain. Fibromyalgia is not fatal True
    32. 32. Myth You look fine, so nothing is wrong with you. Pain is cultural Our society does not really want to know “How are you?” You were diagnosed with fibromyalgia because your doctor couldn’t find anything wrong with you. American College of Rheumatology
    33. 33. Treatment Pain Management Lifestyle adjustment  avoid nonessential activities Good Nutrition Stress Management  Use of relaxation techniques  meditation, biofeedback Exercise Sleep Management  Avoid caffeine  Regular sleep routine
    34. 34. Nutrition Avoid sugar Avoid caffeine – this will improve your sleep Limit alcohol Maintain proper body weight Limit processed food Chocolate is OK and may release serotonin
    35. 35. Pain Management Goal  reduce pain, improve sleep, and relieve associated symptoms Medication antidepressant agents  relieve sleep disorders, reduce muscle pain, treat depression small doses of aspirin or acetaminophen  relief of pain and muscle stiffness Lyrica/cymbalta/Savella -
    36. 36. Pain Management 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 corticosteroids   inflammation
    37. 37. Treatment Exercise  low-impact aerobic activity and strength training. Improved Fitness – symptoms are decreased with aerobic exercise. 25-60% HHR, 3days/week, 20-30 minutes Significant decrease in the Fibromyalgia Impact Questionnaire ACSM Guidelines are too strenuous
    38. 38. Physical Therapy Physical Therapy  Modalities Manual therapy Stretching C-V Home Program Capsaicin creams Massage tools Rice bags Warm clothes Pillows - Beds
    39. 39. Prognosis 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 symptoms. Does not shorten life span.
    40. 40. Support Groups National Fibromyalgia Association www.fmaware.org Podcasts Walk of FAME (Fibromyalgia Awareness Means Everything) Emotional/Social Support and Education
    41. 41. Post Test There is no cure for FM? FM has been shown to shorten a persons life span? FM will cause joint damage? FM is a disease? FM has an unknown etiology? True False False False True
    42. 42. Case Study 34 yo female with diagnosis of FM Wants to be start an exercise program Goals are to loose weight and be able to sleep better What questions will you ask her? What exercises are appropriate? Do you feel comfortable working with the client?
    43. 43. TED Talks Use your brain to control pain. Pain
    44. 44. Questions

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