Opp - Fibromyalgia - Mcclay

Front 1

Define Fibromyalgia

Back 1

Chronic muskuloskeletal pain, prolonged morning stiffness, and fatigue associated with multiple tender points

Front 2

T/F: Fibromyalgia is usually associated with trauma

Back 2

FALSE. Its usually a hreadual onset without trauma

Front 3

t/F: Fibromyalgia is specific, localized musckuloskeletal pain

Back 3

FALSE, its DIFFUSE pain

Morning stiffness will last longer than that of rheumatoid arthritis, into the day

Front 4

What is a condition a pt suffering from the chronic, diffuse pain associated with fibromyalgia could obtain?

Back 4

Depression, secondary to the chronic pain

Front 5

KNOW*** What are the criteria for diagnosing fibromyalgia?

Back 5

1. History of widespread pain (=pain in L and R sides of body, and pain above or below the waist)
2. Axial skeletal pain MUST BE PRESENT (cervical spine, anterior chest, thoracic spine, or low back)

Front 6

What are the fibromyalgia tender points?

Back 6

"GGLLOSTS - K"
Gluteal
Greater Trochanter
Lateral Epicondyle
Low Cervical (C5-C7)
Occipital
Supraspinatus
Trapezius
Second Rib
Knee

Front 7

What are the fibromyalgia control points?

Back 7

"FFAT"

Forearm
Forehead
Ant. Thigh
Thumbnail

Front 8

What were the two most important variables in the 2010 American College of Rheumatology's study regarding fibromyalgia?

Back 8

Widespread pain index (WPI)

Symptom Severity Scale (SSS)

Front 9

KNOW*** be able to distinguish. Whats the difference between Fibromyalgia and Myofascial pain syndrome?

Back 9

Fibromyalgia occurs in women waaaayyy more than men. Its more diffuse, and usually has fatigue

Front 10

What are the 3 major types of fibromyalgia syndrome?

Back 10

Primary = unknown cause, most common
Secondary = occurs w/ other problems
Post-traumatic = for ex after accident

Front 11

Whats the cause of fibromyalgia syndrome?

Back 11

unknown

But probably an aberration of central pain mechanisms like: 1. Neuroendocrine system 2. immune system

Front 12

Although the cause of fibromyalgia is unknown, pts seem to have central sensitization - define this

Back 12

Heightened sensitivity of neurons

Like when something that normally doesn't hurt a person does, for ex. a sheet brushin over toes (=allodynia)

Hyperalgesia = an abnormally heightened response to pain

Front 13

T/F: First degree relative of a pt. with fibromyalgia are 8.5 times more likely to have fibromyalgia that relatives of pts. with rheumatoid arthritis

Back 13

TRUE

Front 14

T/F: Diagnosing fibromyalgia is a clinical diagnosis, one of exclusion

Back 14

TRUE

Rule out other things by doing a bunch of other tests (CBC, Sed Rate or ESR, ANA, Rheumatoid factor for RA, CK for muscular disease, and thyroid profile)

Front 15

What blood test result may be positive in 10-15% of cases of fibromyalgia?

Back 15

Antinuclear Abs

Front 16

Even though most fibromyalgia pts pain improves within 5 years, what can you do to help them?

Back 16

Reduce aggravating factors: cold or humid weather, non-restorative sleep, physical or mental fatigue, excess physical activity, anxiety/stress

Front 17

What are some of the alleviating factors of fibromyalgia?

Back 17

warm, dry weather
hot showers/baths
restful sleep
moderate activity

Front 18

What is one thing you can do to aid in stress reduction in pts with fibromyalgia?

Back 18

Reassure them

Their problem is real
Its not Life-threatening

Front 19

Whats the GOLD STANDARD for fibromyalgia treatment?

Back 19

Life style changes - get rid of aggravating factors

(alcohol, diet, exercise, caffeine, smoking, stress reduction)

Front 20

What are some meds you can give for fibromyalgia?

Back 20

Pregabalin
Antidepressants
NSAIDS
Acetominophen
etc

Front 21

What type of OMT technique do fibromyalgia pts respond best to?

Back 21

gentle, indirect OMT

Front 22

Can you do HVLA in fibromyalgia pts?

Back 22

NOOOOOOOO

(use indirect techniques)

HVLA will result in a flare up of symtpms

Front 23

List some indirect OMT techiques that can be used to treat fibromyalgia

Back 23

Transverse diaphragm restriction
cranial
rib raising
lymphatic pump

Front 24

If you over-dose with OMT, what can happen to fibromyalgia pts?

Back 24

Their symptoms can flare up for several days

Front 25

Whats the cornerstone of fibromyalgia treatment?

Back 25

The gold standard for fibromyalgia treatment is lifestyle changes, and one of the most important of these is exercise, because 80% of pts with fibromyalgia are fatties. FACT.

So Exercise is the "cornerstone" of treatment

Front 26

Define Complex Regional Pain Syndrome Type 1

Back 26

Burning pain in the upper or lower extremities associated with swelling, dec. ROM, vasomotor instability, skin nutrition changes, patchy bone demineralization

In Type 1 there is NO definable nerve lesion

Front 27

KNOW*** What is the burning pain of the upper and lower extremity associated with in regional pain syndrome?

Back 27

Swelling
Dec. ROM
Vasomotor instability
Nutrition skin changes (due to vasculature)
Patchy bone demineralization

Front 28

What are some of the most common findings in pts with regional pain syndrome (note: could be good clues in question stem)

Back 28

Weakness
Radicular pain
Temp. difference in extremities
exaggerated response to painful stimuli
extremity edema
Hyperhidrosis

Front 29

What percent of cases of regional pain syndrome follow a major or minor trauma?

Back 29

60%

Front 30

Whats the cause of regional pain syndrome?

Back 30

Unknown, but may be of sympathetic origin

(constant CNS stimulation = pain)

Front 31

What are the three stages of regional pain syndrome?

Back 31

Stage 1 = Acute
Stage 2 = Dystrophic
Stage 3 = Atrophic

Front 32

Define Stage 1, Acute stage, of regional pain syndrome

Back 32

weeks to 3 months after injury

severe burning, aching pain, allodynia, perception of non-painful stimulus as painful
Hypersensitivity to light touch
extremities hot, edematous
skin red and blotchy
Hyperhidrosis (=sweating)
Patchy osteoporosis on x-ray 3 weeks after injury

Front 33

Define Stage 2 of regional pain syndrome, Dystrophic stage

Back 33

3-6 months after injury

persistence of pain and disability
skin pale, cyanotic, cool doughy
Hyperhidrosis
nails brittle/rigid
subcu tissue atrophy
Dec. ROM

Front 34

Define stage 3 of regional pain syndrome, the Atrophic stage

Back 34

Greater than 6 months after injury

signs and symptoms come and go
Pain spreads proximally

skin cool, pale, cyanotic etc
loss of muscle tone
fascia becomes thick
Flexion- loss of contractures - loss of ROM
Ankylosis

Front 35

How do you diagnose regional pain syndrome?

Back 35

Mostly a clinical diagnosis
Thermography = sig. temp differences in extremities

patchy osteoporosis on x-ray
three phase bone scan
Sympathetic neural blockade = stellate neural ganglion block for upper extremities
Epidural steroid injection for lower extremities

Front 36

KNOW*** What is the most important thing in treatment of regional pain syndrome?

Back 36

EARLY TREATMENT

Precention is the best treatment - treat pain early

Be suspicious if pain persists

Front 37

Besides early treatment, What are some other treatments for regional pain syndrome

Back 37

Aggressively treat somatic dysfunction and facilitated segments after trauma

OMT

Physical Therapy

Neural Blockade

Trigger pt. injection

TENS unit

Meds

Front 38

What are some additional treatments that cna help address regional pain syndrome?

Back 38

Smoking cessation
Acupuncture
Biofeedback
Spinal Cord stimulators
Surgery