Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
21 Cards in this Set
- Front
- Back
|
Chronic musculoskeletal pain, prolonged morning stiffness, and fatigue associated with multiple tender points. This defines?
|
Fibromyalgia syndrome
|
|
|
Pt presents to your office with pain that has had a gradual onset with no trauma. She has diffuse MSK pain and morning stiffness lasting longer than RA. Upon palpation you find bilateral tenderpoints and the pt seems to be fatigued with signs of depression. What are you thinking
|
Fibromyalgia syndrome
|
|
|
According to the American College of Rheumatology, what are criteria for diagnosis of Fibromyalgia?
OBJECTIVE (in 2 lectures) |
widespread pain (R & L side of body, above and below the waist)
AXIAL SKELETAL PAIN MUST BE PRESENT (cervical spine, anterior chest, thoracic spine, or low back) 11-18 points tender |
|
|
3 types of fibromyalgia syndrome?
|
Primary
Occurs for unknown reasons. Most common type Secondary (Concomitant) Occurs in patients with well recognized chronic problems i.e. rheumatoid arthritis, hypothyroidism, etc. Post-traumatic Occurs in setting of acute injury in which fibromyalgia signs and symptoms slowly develop. |
|
|
deprivation of what stage of sleep can lead to worse fibromyalgia?
|
Stage 4 (Non-REM) Sleep Deprivation
|
|
|
in a fibromyalgia study, when they deprived controls of stage 4 non-REM sleep they all got symptoms. What group didn't?
|
Runners
aka exercise is important |
|
|
Fibromyalgia is a diagnosis of exclusion
|
all other tests are normal
|
|
|
tx options for fibromyalgia? (non OMT)
|
lifestyle changes (eliminate aggravating factors)
Alcohol Caffeine - binds opioid receptors Smoking Stress reduction Medications Low dose antidepressants - improves stage 4 sleep Cyclobenzaprine (Flexeril) HS NSAIDs at analgesic dosage Acetaminophen Tramadol (Ultram) |
|
|
Pts with fibromyalgia syndrome respond best to what kind of OMT?
** |
indirect OMT
(HVLA will flare symptoms) |
|
|
first OMT tx used for fibromyalgia should be?
|
MFR to transverse diaphragm restrictions first
Pelvic diaphragm Thoracic diaphragm Thoracic inlet Suboccipital region Tentorium Cerebelli |
|
|
sicker pts should receive more/less OMT?
|
LESS
Smaller dose needed for optimal therapeutic effect. |
|
|
What mental technique can be used to help relieve symptoms of fibromyalgia?
|
pleasant imagery
|
|
|
What is the cornerstone of tx for Fibromyalgia syndrome?
*** |
Exercise is the cornerstone of treatment.
80% of fibromyalgia patients are not physically fit. |
|
|
Burning pain in the upper or lower extremities associated with:
Swelling Decreased range of motion Vasomotor instability Trophic skin changes Patchy bone demineralization |
Complex Regional Pain Syndrome I
(CRPS I) |
|
|
A syndrome that usually develops after an initiating noxious event not limited to a single peripheral nerve injury.
Continuing pain, allodynia or hyperalgesia; pain is disproportionate to the inciting event. Evidence at some time of edema, changes in skin blood flow or abnormal sudomotor activity in the painful region. what is this? |
Complex Regional Pain Syndrome I
(CRPS I) |
|
|
Reflex Sympathetic Dystrophy (RSD)
is another name for? |
Complex Regional Pain Syndrome I = CRPS I
|
|
|
what does Complex Regional Pain Syndrome I normally follow?
|
60% follow major or minor trauma (sprain, strain, crush injuries)
50% of cases follow fracture immobilization. |
|
|
proposed CRPS etiology is most likely due to what?
|
Not clearly established - assumed to be sympathetic origin.
Afferent C fibers become hyperactive. Dorsal horn sensitization resulting in sympathetic fiber stimulation of peripheral nerves. |
|
|
What are the 3 stages CRPS I?
** |
Stage I- acute
--weeks to 3 months after injury --Severe burning/aching pain (allodynia; perception of non-painful stimuli as painful) --patchy osteoporosis and hot extremities Stage II- dystrophic 3-6 months after injury Persistence of pain and disability Hyperesthesias - extreme, constant pain Skin pale, cyanotic, cool, doughy Hyperhidrosis Nails brittle and rigid Patchy osteoporosis on x-ray Subcutaneous tissue atrophy – muscle wasting Decreased range of motion Stage III- Atrophic > 6 months after injury: Signs and symptoms come and go. Generally irreversible Pain spreads proximally May decrease but more commonly becomes intolerable Skin cool, pale, cyanotic, tight and glossy Loss of muscle tone Fascia becomes thickened. Flexion contractures Loss of ROM Ankylosis |
|
|
Which stage of CRPS is generally irreversible?
*was in red |
Stage III-- Atrophic
Pain spreads proximally May decrease but more commonly becomes intolerable Skin cool, pale, cyanotic, tight and glossy Loss of muscle tone Fascia becomes thickened. Flexion contractures Loss of ROM Ankylosis |
|
|
2 key diagnostic tests for fibromyalgia?
|
Three phase bone scan
Sympathetic neural blockade |
