FIBROMYALGIA Chronic central pain disorder that cause widespread pain
Causes
Neuroendocrine and neurotransmitter dysfunction
abnormal cytokine function
HPA axis dysfunction
High substance P
Decreased blood flow to thalamus
decreased serotonin and tryptophan
Genetic?
Diagnostic studies often hard to establish
Interprofessional Care
Drug therapy
Pregabalin (Lyrica)
Duloxetine (Cymbalta)
other medications related to sx experienced
Clinical Manifestations
Widespread burning, fluctuating pain (head, facial, TMJ)
Fatigue
Sleep disturbance
Morning stiffness
Cognitive changes: memory issues, migraine, headache
Numbness/tingling in hands/feet
Restless leg syndrome
Irritable bowel syndrome - constipation/diarrhea
Anxiety/depression
Urination frequency/urgency
If 11 out of 18 tender points test positive for sensitivity, this would help make a diagnosis of fibromyalgia
Treatment of symptoms
Patient education
Rest
Complementary therapies (ex: massage, yoga)
Supportive care and motivation
Lifestyle modifications (sugar, caffeine, alcohol)
Rule out other disorders, Low ANA titer (not technically diagnostic), muscle biopsy (non-specific moth eaten appearance and fiber atrophy
Pain in 11/18 tender points and pain for greater than 3 months
Relaxation strategies: biofeedback, imagery, meditation, cognitive behavioral therapy, psychologic counseling
Low or medium CRP and ESR values
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Widespread body pain that does not show joint damage on Xrays
Difficult to diagnosis; therefore rule out other disorders to narrow down.
3 months or >
Limit intake of sugar, caffein and alcohol. vitamin and mineral supplements.