2.1 Cs Exam3: Fibromyalgia

Front 1

what gender is diagnosed w/ fibromyaglia most often? what is the median age at onset?

Back 1

women (7:1)
29-37 yoa

Front 2

what is the criteria for classification of fibromyalgia?

Back 2

widespread pain from their head to their toes

> 3months,

pain in 11/18 tender points sites on digital palpation

Front 3

what are the three possible causes of fibromyalgia?

Back 3

1) genetic predisposition: 1st relative --> 8x increase
2) polymorphisms: in pain receptors, neurotransmitters, and metabolism or transport of monoamines
3) specific stressors temporally association: infectious, emotional, trauma

Front 4

what are the five most common symptoms in pts w/ fibromyalgia?

Back 4

*muscular pain- 100%
fatigue- 96
insomia-86
*joint pains- 72
*headaches-60

(*leg cramps-42)

Front 5

How do tenderpoint in fibromyalgia differ from tenderpoints in a healthy individual?

Back 5

they are very symmetric in FM and the are reproducible.

(knees. lat epicondyle (elbow), upper buttox, cervical, superior hamstring, upper scapula, chest)

Front 6

Man w/ chronic widespread pain w/o tenderness. Dx

Back 6

FM

Front 7

what are the regional sxs and syndromes related to FM?

(these are not indicative of FM)

Back 7

tension/ migraine headaches, affective disorders, TMJ disorders, IBS, cognitive difficulties, vestibular complaints, non-cardiac chest pain, non-dermatomal paresthesias.

Front 8

what are the constitutional sxs of FM?

Back 8

weight fluctuation
night sweats
weakness
sleep disturbance

Front 9

what is the main theory behind the association of sleep and FM?

Back 9

these pts are unable to get into stage 4 non-REM sleep. That sleep disturbance may correlate w/ fatigue & weakness, but overall UNKNOWN mechanism

Front 10

what are the four objective discoveries associated in the pathogenesis of FM?

Back 10

reduced thalamic blood flow
increased blood flow to areas of pain perception
3 fold higher substance P in CSF
hyperactivity of HPA axis and sympathetic NS.

(overall inconclusive UNKNOWN path)

Front 11

what are the psychological abnormalitis assoc with FM?

Back 11

30% w/ depression, anxiety, somatization and hypochondriasis
high prevalence of sexual and physical abuse and eating disorders.

Front 12

what hormone may be related to the increase in post exertional pain?

Back 12

growth hormone

Front 13

how can anti-depressants be useful in FM?

Back 13

it can block the reuptake of serotonin and norepi allowing more of these chemicals to get to the nerve that they are supposed to stimulate.

Front 14

To treat central pain, BOTH the descending & ascending systems must be addressed.

The descending system of central pain is under the control of what 6 chemicals?

Back 14

serotonin, N-epi, opiates, GABA, dopamine, cannabinoids

Front 15

the ascending system of central pain is under the control of what 5 chemicals?

Back 15

substance P, glutamate, CGRP (calcitonin-gene related polypeptide), neurotensin, NGF (nerve growth factor

(there are fewer meds to act on the ascending system than the descending system)

Front 16

what factors should be evaluated for FM?

Back 16

patient's knowledge of FM
pt's pain (both peripheral and central)
decline in physical condition
psychological distress
any nonrestorative sleep
associated syndromes

Front 17

what other syndromes can FM overlap w/?

Back 17

RA, SLE, SS, Hypothyoid, obstructive sleep apnea.

Front 18

which pharmacologic therapies have the strongest evidence for FM?

Back 18

tricyclics (help w/ sleep*)

dual reuptake inhibitors (duloxetine & milnacipran- FDA approved)

alpha 2 delta ligans (pregabalin- FDA approved)

Front 19

what are the nonpharmacologic txs for FM? which four have the strongest evidence for them?

Back 19

pt eduction- pts need to take an active role
aerobic exercise
acupuncture
cognitive behavioral therapy- focus on wellness
OMM

**CV exercises, CBT, pt education, and multidisciplinary therapy.

Front 20

which pharmacologic therapies are not effective in txing FM?

Back 20

opioids, NSAIDs, CS, Benzodiazepines, melatonin, guaifenesin, DHEA.

Front 21

T/F

NSAIDs, although worthless in txing FM by themselves, might have a synergistic effect w/ other drugs.

Back 21

true

Front 22

which antidepressants work the best in FM pts? why?

Back 22

(SNRIs) noreepi antidepressants (milnacipran & duloxetine)

becuasse norepi is better for fatigue and sleep than serotonin.

Front 23

what are the adverse effects of duloxetine?

Back 23

Nausea, dry mouth, constipation, decreased appetite, sleepiness, increased sweating

Front 24

what are the adverse effects of milnacipran?

Back 24

N/V, cephalgia, constipation, insomnia, dizziness, palpitations, hyperhidrosis, HTN, xerostomia, anxiety

Front 25

what does pregabalin bind to? what does it reduce the release of?

Back 25

binds to alph 2 delta subunit of voltage-gated calcium channel; reduces release of neurotransmitters

Front 26

what are the adverse effects of pregabalin (anti-convulsant)?

Back 26

dizziness, sleepiness, blurred vision, weight gain, dry mouth, peripheral edema

*level 4 narcotic

Front 27

what are the three drugs now FDA approved and are used as SNRIs for FM?

Back 27

duloxetine, milnacipran, and pregabalin

Front 28

what three medications do you tx FM pts w/ in order to better their non-restorative sleep?

Back 28

tricyclics, short-acting hypnotics, muscle relaxants.