Fibromyalgia

Fibromyalgia
Presentation by:Anna Mae Smith, MPAS, PA-C
Lock Haven University

Myofascial pain

* Minor tear in muscle that causes a localized irritation - trigger point
* Fibromyalgia - widespread myofascial (soft tissue) pain

Diffuse aching, stiffness & fatigue
Fibromyalgia Syndrome

* Most common rheumatic cause of chronic diffuse pain
* Generalized pain & symptom pain amplification syndrome
* Extremely common pain phenomenon occurring in a defined pattern & reproduced by pressure on "trigger points"

EPIDEMIOLOGY

* Incidence/Prevalence in USA: 3 in 100
* Predominant age: 18-70
* Predominant sex: Female > Male

DIfferential
* Hypothyroidism
* Psychogenic rheumatism
* Muscle strain/sprain
* Muscle disease
* Polymyalgia rheumatica
* Temporal arteritis

SIGNS & SYMPTOMS

* Typically insidious in onset
* Diffuse soft tissue pain
* Pain is increased in the morning, with weather changes, anxiety, stress
* Pain improved by mild physical activity or vacations (stress-relieving situations)
* Non-restorative sleep, with early morning awakening in an unrefreshed state.
* Abnormal non-rapid eye movement (non-REM) stage IV sleep
* Generalized fatigue or tiredness
* Anxiety
* Chronic headache
* Irritable bowel syndrome
* Tension headaches
* Subjective, non-confirmable complaints of swelling or numbness, not associated with objective neurologic findings
* Depression
* Reduced physical endurance
* Decreased social interaction
* Paresthesias – normal nerve studies
* Sensation of swollen hands!

Trigger Points

* Temporalis - above the ear
* Anterior to tragus of ear
* Scalenus capitis
* Sternocleidomastoid
* Low anterior neck
* Pectoralis minor
* Manubriosternal
* Anterior and posterior axillary folds
* Trapezius ridge
* Upper rhomboids
* Lower rhomboids
* Iliac crest
* Mid-buttocks
* Mid-rectus femoris
* Mid-vastus lateralis
* Quadriceps insertion - at the patella
* Humeral epicondyles


LABS

* ESR
* CBC
* TFT

TREATMENT

Prognosis

* With resolution of sleep disturbance, may resolve totally
* Aggressive physical therapy is critical in those who do not respond
* Approximately 5% do not respond to any form of therapeutic intervention.
Hypnosis may be attempted in that group.

FIBROMYALGIA .ppt