Fibromyalgia
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Fibromyalgia

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

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

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Fibromyalgia Fibromyalgia Presentation Transcript

  • Fibromyalgia
    • Bridgit Finley, PT, DPT, M.Ed., OCS
    • [email_address]
    • www.ptcentral.org
    • 579-1600
  • 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.
  • 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.
  • Fibromyalgia
    • A common and complex chronic pain disorder that affects people physically, mentally and socially.
    • It is a syndrome rather than a 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.
    • A syndrome is a collection of signs and symptoms that occur together without an identifiable cause.
  • 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.
    • Tissue pathology with distinctive symptoms and a causative agent.
      • Tuberculosis, causing a chronic cough, tubercule bacillus is causative agent and can be cured.
  • 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 muscles.
      • Skeletal muscle metabolism – decrease blood flow
      • Hence the increased pain with strenuous exertion.
  • 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.
    • 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.
  • 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
    • affects the neck, shoulders, chest, legs, and lower back
    • symptoms similar to those of chronic fatigue syndrome and myofascial pain syndrome.
  • Significance
    • 10 million US  3-6% of population
    • ~ 80% are women
    • highest incidence  women 20 to 40 years of age
    • Genetic component
      • Among siblings and mothers and daughters
    • Incidence rises with age, by 80 years old – 8% of the population.
  • Risk Factors
    • Age  more common in young adults, increases with age
    • Gender  more common in women
    • Genetic  familial patterns suggest the disorder may be inherited
    • 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 develop FA
  • 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
  • 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
  • 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
    • 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
  • Signs and Symptoms
    • symptoms may be constant or intermittent for years
    • common symptoms include:
      • sleep disorders  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
      • heightened sensitivity to odors, loud noises, bright lights, various foods, medicines, changes in weather
      • 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
      • post-exertional malaise and muscle pain
      • morning stiffness (waking up stiff and achy)
  • Trigger Points
    • Main points of pain in Fibromyalgia patients
      • Neck
      • Back
      • Shoulders
      • Pelvic Girdle
      • Hands
      • Knees
      • Elbows
      • Hips
  • 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.
    • Exclusion of other conditions  chronic fatigue syndrome and myofascial pain syndrome
  • 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.
  • Rule Out other Conditions
    • Cancer
    • Cervical & Lumbar DDD
    • Chronic Fatigue
    • Depression
    • Hypothyroidism
    • Irritable Bowel Syndrome
    • Rheumatoid Arthritis
    • Sleep Disorders
  • 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
  • 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
  • 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
  • Nutrition
    • Avoid sugar
    • Avoid caffeine
    • Limit alcohol
    • Maintain proper body weight
  • 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 -
    • 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
  • Treatment
    • Exercise  low-impact aerobic activity and strength training.
      • 25-60% HHR, 3days/week, 20-30 minutes
      • Significant decrease in the Fibromyalgia Impact Questionnaire
      • ACSM Guidelines are too strenuous
    • Physical Therapy  Modalities
      • Manual therapy
      • Stretching
      • C-V
  • 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.
  • Support Groups
    • National Fibromyalgia Association
      • www.fmaware.org
    • Podcasts
    • Walk of FAME (Fibromyalgia Awareness Means Everything)
    • Emotional/Social Support and Education
  • TED Talks
    • Use your brain to control pain.
    • Pain