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

Fibromyalgia

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Fibromyalgia