Fibromyalgia lecture2010

Bridgit Finley, PT, DPT, M.Ed., OCS
bfinley@ptcentral.org
www.ptcentral.org
579-1600
Check us out on Facebook

Objectives
State the ACR clinical definition of FM.
Identify 5 or more overlapping co-morbidities.
Outline the risk factors.
Describe the non-pharmacologic approach to
treatment.
Review the prognoses for FM patients.

Pre Test
FM is caused by a virus?
3-6% of the population
has FM?
FM is progressive and
fatal?
FM is diagnosed with a
blood test?
Exercise has been shown
to decrease FM
symptoms?
False
True
False
False
True

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.

Definition of Fibromyalgia
“Chronic and widespread pain located at 11
or more of 18 tender points.”
American College of Rheumatology,
1990.
In 1908, Gowen first described FMS.

Fibromyalgia
A common and complex chronic pain disorder that
affects people physically, mentally and socially.
It is a syndrome rather than a disease.
A syndrome is a collection of signs and symptoms
that occur together without an identifiable cause.

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.
Tissue pathology with distinctive symptoms and a
causative agent.
Tuberculosis, causing a chronic cough, tubercle
bacillus is causative agent and can be cured.

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.

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
which causes chronic fatigue and weakness.
Hence the increased pain with strenuous exertion.

Causes
The bottom line – unknown
Sleep disturbances, which are common in FB
patients, may actually cause the condition.
Pilot studies have shown a possible inherited
tendency toward the disease. Very preliminary.

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.

Pain is Personal
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

FMS
affects the neck, shoulders, chest, legs, and lower
back
symptoms similar to those of chronic fatigue
syndrome and myofascial pain syndrome.

Epidemiology
10 million US  3-6% of population
~ 80% are women
highest incidence  women 20 to 55 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  10 x more common in women
Genetic  familial patterns suggest the disorder may
be inherited
Often follows a trauma  infectious or stress

Risk Factors
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

S & S Continued
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
symptoms may be constant or intermittent for years

Co-morbidities
sleep disorders/fatigue  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 (TMJ)
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

Co-morbidities and FM
Post-exertional malaise and muscle pain
Morning Stiffness
Numbness and Tingling
Dizziness or Light-headedness
Increased chemical, mechanical, and thermal
sensitivities.

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.

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
Hypothyroidism
Polymyalgia
Lyme Disease
Viral hepatitis
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 – this will improve your sleep
Limit alcohol
Maintain proper body weight
Limit processed food
Chocolate is OK and may release serotonin

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 -

Pain Management
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.
Improved Fitness – symptoms are decreased with
aerobic exercise.
25-60% HHR, 3days/week, 20-30 minutes
Significant decrease in the Fibromyalgia Impact
Questionnaire
ACSM Guidelines are too strenuous

Physical Therapy
Physical Therapy  Modalities
Manual therapy
Stretching
C-V
Home Program
Capsaicin creams
Massage tools
Rice bags
Warm clothes
Pillows - Beds

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

Post Test
There is no cure for FM?
FM has been shown to
shorten a persons life
span?
FM will cause joint
damage?
FM is a disease?
FM has an unknown
etiology?
True
False
False
False
True

Case Study
34 yo female with
diagnosis of FM
Wants to be start an
exercise program
Goals are to loose
weight and be able to
sleep better
What questions will you
ask her?
What exercises are
appropriate?
Do you feel comfortable
working with the client?

TED Talks
Use your brain to control pain.
Pain

Fibromyalgia lecture2010

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (6)

Similar to Fibromyalgia lecture2010

Similar to Fibromyalgia lecture2010 (20)

More from Physical Therapy Central

More from Physical Therapy Central (12)

Recently uploaded

Recently uploaded (20)

Fibromyalgia lecture2010

Editor's Notes