Se está descargando su SlideShare. ×
Próxima SlideShare
Cargando en...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.

Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply



Published on

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.

0 comentarios
3 Me gusta
  • Sea el primero en comentar

Sin descargas
reproducciones totales
En SlideShare
De insertados
Número de insertados
Me gusta
Insertados 0
No embeds

Denunciar contenido
Marcada como inapropiada Marcar como inapropiada
Marcar como inapropiada

Seleccione la razón para marcar esta presentación como inapropiada.

No notes for slide


  • 1. Fibromyalgia
  • 2.
    • Bridgit Finley, PT, DPT, M.Ed., OCS
    • [email_address]
    • 579-1600
  • 3. 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.
  • 4. 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.
  • 5. 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.
  • 6. 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.
  • 7. 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.
  • 8. 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.
  • 9. 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.
  • 10. 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.
  • 11. 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.
  • 12. 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
  • 13. 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
  • 14. 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
  • 15. 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
  • 16. 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)
  • 17. Trigger Points
    • Main points of pain in Fibromyalgia patients
      • Neck
      • Back
      • Shoulders
      • Pelvic Girdle
      • Hands
      • Knees
      • Elbows
      • Hips
  • 18. 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
  • 19. 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.
  • 20. Rule Out other Conditions
    • Cancer
    • Cervical & Lumbar DDD
    • Chronic Fatigue
    • Depression
    • Hypothyroidism
    • Irritable Bowel Syndrome
    • Rheumatoid Arthritis
    • Sleep Disorders
  • 21. 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
  • 22. 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
  • 23. 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
  • 24. Nutrition
    • Avoid sugar
    • Avoid caffeine
    • Limit alcohol
    • Maintain proper body weight
  • 25. 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
  • 26. 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
  • 27. 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.
  • 28. Support Groups
    • National Fibromyalgia Association
    • Podcasts
    • Walk of FAME (Fibromyalgia Awareness Means Everything)
    • Emotional/Social Support and Education
  • 29. TED Talks
    • Use your brain to control pain.
    • Pain