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37 Cards in this Set

  • Front
  • Back
what gender is diagnosed w/ fibromyaglia most often? what is the median age at onset?
women (7:1)
29-37 yoa
what is the criteria for classification of fibromyalgia?
widespread pain from their head to their toes > 3months, pain in 11 of 18 tender points sites on digital palpation
what are the three causes of fibromyalgia? Give examples of each
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
what are the five most common symptoms in pts w/ fibromyalgia?
muscular pain- 100%
fatigue- 96
insomia-86
joint pains- 72
headaches-60
what makes paresthesias of fibromyalgia different from generic parasthesias?
the parasthesia doesn't follow particular dermatomes that it should.
what is pain?
an unpleasant sensory and emotional experience associated w/ actual or potential tissue damage, or described in terms of such damage.
How do tenderpoint in fibromyalgia differ from tenderpoints in a healthy individual?
they are very symmetric in FM and the are reproducible.
what are multiple tender points often a manifestation of?
stress
Man w/ chronic widespread pain w/o tenderness. Dx
FM
what are the regional sxs and syndromes related to FM?
tension/ migraine headaches, affective disorders, TMJ disorders, IBS, cognitive difficulties, vestibular complaints, non-cardiac chest pain, non-dermatomal paresthesias.
what are the constitutional sxs of FM?
weight fluctuation
night sweats
weakness
sleep disturbance
female pt presents w/ chronic pain, >11 Tender points and stomach pain. what else would you expect concerning the stomach pain?
alternating diarrhea and constipation--> IBS v common association w/ FM.
what laboratory tests will come up abnormal in FM?
sleep eeg studies
neuroendocrine tests
vitamin D
functional MRIs
what is the main theory behind the association of sleep and FM?
these pts are unable to get into non-REM sleep. That sleep disturbance may correlate very well w/ norepi levels.
what are the four objective discovers associated in the pathogenesis of FM?
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.
what stage of sleep is disrupted in FM pts by what?
stage 4- NREM by alpha intrusion
what does the abn HPA axis in FM pts result in?
low urinary free cortisol and decreased cortisol response to CRH
what effect does FM have on CNS?
reduced blood flow to thalamus, caudate nucleus and pontine tectum makes the perceived stimuli seem very painful w/ less stimulation
what are the psychological abnormalitis assoc with FM?
30% w/ depression, anxiety, somatization and hypochondriasis
high prevalence of sexual and physical abuse and eating disorders.
what hormone may be related to the increase in post exertional pain?
growth hormone
how can anti-depressants be useful in FM?
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.
The descending system of central pain is under the control of what 6 chemicals?
serotonin, N-epi, opiates, GABA, dopamine, cannabinoids
the ascending system of central pain is under the control of what 5 chemicals?
substance P, glutamate, CGRP (calcitonin-gene related polypeptide), neurotensin, NGF (nerve growth factor
what factors should be evaluated for FM?
patient's knowledge of FM
pt's pain (both peripheral and central)
decline in physical condition
psychological distress
any nonrestorative sleep
associated syndromes
what other syndromes can FM overlap w/?
RA, SLE, SS, Hypothyoid, obstructive sleep apnea.
which pharmacologic therapies have the strongest evidence for FM?
tricyclics, dual reuptake inhibitors (duloxetine and milnacipran- FDA approved), alpha 2 delta ligans (pregabalin- FDA approved)
what are the nonpharmacologic txs for FM? which four have the strongest evidence for them?
pt eduction
aerobic exercise
acupuncture
cognitive behavioral therapy
OMM

**CV exercises, CBT, pt education, and multidisciplinary therapy.
which pharmacologic therapies are not effective in txing FM?
opioids, NSAIDs, CS, Benzodiazepines, melatonin, guaifenesin, DHEA.
T/F

NSAIDs, although worthless in txing FM by themselves, might have a synergistic effect w/ other drugs.
true
which antidepressants work the best in FM pts? why?
noreepi antidepressants like maprotiline, desipramine and nortriptyline becuasse norepi is better for fatigue and sleep than serotonin.
what are the adverse effects of duloxetine?
Nausea, dry mouth, constipation, decreased appetite, sleepiness, increased sweating
what are the adverse effects of milnacipran?
N/V, cephalgia, constipation, insomnia, dizziness, palpitations, hyperhidrosis, HTN, xerostomia, anxiety
what does pregabalin bind to? what does it reduce the release of?
binds to alph 2 delta subunit of voltage-gated calcium channel; reduces release of neurotransmitters
what are the adverse effects of pregabalin?
dizziness, sleepiness, blurred vision, weight gain, dry mouth, peripheral edema
what are the three drugs now FDA approved and are used as SNRIs for FM?
duloxetine, milnacipran, and pregabalin
what three medications do you tx FM pts w/ in order to better their non-restorative sleep?
tricyclics, short-acting hypnotics, muscle relaxants.
which muscle relaxant is used a lot by dean Forman?
cyclobenzaprine--> flexaril