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Fibromyalgia (Clinical Presentation (Sleep dysfunction (Phasic alpha sleep…
Fibromyalgia
Clinical Presentation
Depressed mood
Widespread chronic pain
Severe fatigue
Sleep dysfunction
Phasic alpha sleep activity
Decreased well-being
Stiffness
Cognitive impairment
Headaches
Comorbidities
HA
MDD
Temporomandibular d/o (75%)
Multiple chemical sensitivities
Chronic pelvic pain
IBS
Treatment
TCA
pain
sleep dysfunction
fatigue
Amitriptyline
1st line for FM
Cyclobenzaprine
NSAIDs/COX-2
analgesic property
Tramadol + Serotonin/Norepinephrine
Risk of opioid-like withdrawal sx
SSRI's
mood
fatigue
AEDs + SNRI's
Only class used to treat FM
Lyrica
FDA approved
Gabapentin
NOT FDA approved
Polymyalgia Rheumatica
ONLY adults > 50 y/o
Peak incidence: 70-80 y/o
Association b/w PMR & giant cell (temporal) arteritis
New HA
Visual disturbance
Sx of PMR
Jaw claudication
Unexplained fever or anemia
Treatment: glucocorticoids
Symptoms
Aching and stiffness
Shoulders
Hip girdle
Neck
Physical + emotional triggers
Lyme disease
Physical trauma
Testing
Elevated ESR
High CRP
NOT MUSCLE DISEASE
2/2 to pain + inactivity
Pain > 3 months
Pain persists after stimuli ceases
Noxious stimuli
Pain induced by 4 kg/cm^2 of palpation pressure at > 11 of 18 anatomically defined tender points