Fibromyalgia is a commonly encountered disorder characterized by chronic widespread musculoskeletal pain, stiffness, paresthesia, disturbed sleep, and easy fatigability along with multiple painful tender points, which are widely and symmetrically distributed. Fibromyalgia affects predominantly women in a ratio of 9:1 compared to men. This disorder is found in most countries, in most ethnic groups, and in all types of climates. The prevalence of fibromyalgia in the general population of a community in the United States using the 1990 American College of Rheumatology (ACR) classification criteria (see below) was reported to be 3.4% in women and 0.5% in men. Contrary to some previous reports, fibromyalgia was not found to be present mainly in young women but, rather, to be most prevalent in women 50 years. The prevalence increased with age, being 7.4% in women between the ages of 70 and 79. Although not common, fibromyalgia also occurs in children. The reported prevalence of fibromyalgia in some rheumatology clinics has been as high as 20%. Most patients present with fibromyalgia between the ages of 30–50 years.
The American College of Rheumatology Criteria – Fibromyalgia
1. History of widespread pain. Pain is considered widespread when all of the following are present:
a. Pain in the left side of the body
b. Pain in the right side of the body
c. Pain above the waist
d. Pain below the waist
e. Axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back)
2. Pain on digital palpation in at least 11 of the following 18 tender point sites (see Fig. 329-1):
a. Occiput: bilateral, at the suboccipital muscle insertion
b. Low cervical: bilateral, at the anterior aspect of the intertransverse spaces at C5–7
c. Trapezius: bilateral, at the midpoint of the upper border
d. Supraspinatus: bilateral, at the origin, above the scapular spine near the medial border
e. Second rib: bilateral, at the second costochondral junction, just lateral to the junction on the upper surface
f. Lateral epicondyle: bilateral, 2 cm distal to the epicondyle
g. Gluteal: bilateral, in the upper outer quadrant of the buttock
h. Greater trochanter: bilateral, posterior to the trochanteric prominence
i. Knee: bilateral, at the medial fat pad proximal to the joint line
Digital palpation should be performed with a moderate degree of pressure. For a tender point to be considered positive, the subject must state that the palpation was painful. “Tender” is not to be considered painful.
Patients should be informed that they have a condition that is not crippling, deforming, or degenerative, and that treatment is available. The initial step in treatment is to improve the quality of sleep. The use of tricyclics such as amitriptyline (10–50 mg), nortriptyline (10–75 mg), and doxepin (10–25 mg) or a pharmacologically similar drug, cyclobenzaprine (10–40 mg), 1–2 h before bedtime will give the patient restorative sleep (stage 4 sleep), resulting in clinical improvement. Patients should be started on a low dose, which is increased gradually as needed. Side effects of these tricyclics and cyclobenzaprine limit their use; these include constipation, dry mouth, weight gain, drowsiness, and difficulty thinking. Trazodone or zolpidem also improves sleep quality. In patients with restless leg syndrome, clonazepam may be effective. Depression and anxiety should next be treated with appropriate drugs and, when indicated, with psychiatric counseling. Duloxetine, a serotonin/norepinephrine reuptake inhibitor, has shown benefit for the management of symptoms associated with fibromyalgia in patients with or without major depressive disorder.
Fluoxetine, sertraline, paroxetine, citalopram, or other newer selective serotonin reuptake inhibitors can be used as antidepressants. Other useful antidepressants are trazodone and venlafaxine. Alprazolam and lorazepam are effective for anxiety. Patients may also benefit by regular aerobic exercises, which are started after patients begin to have improved sleep and less pain and fatigue. Exercise should be of a low-impact type and begun at a low level. Eventually the patient should be exercising 20–30 min, 3–4 days a week. Regular stretching exercises are also very important. Salicylates or other nonsteroidal anti-inflammatory drugs (NSAIDs) only partially improve symptoms. Glucocorticoids have been of little benefit and should not be used in these patients. Opiate analgesics should be avoided. For pain, acetaminophen or tramadol may be useful. Also, gabapentin (300–1200 mg/d in divided doses) may reduce pain. Local measures such as heat, massage, injection of tender sites with steroids or lidocaine, and acupuncture provide only temporary relief of symptoms. Other therapies that may help to varying degrees include biofeedback, behavioral modification, hypnotherapy, and stress management and relaxation response training. Life stresses should be identified and discussed with the patient, and the patient should be provided with help on how to cope with these stresses. Patients may benefit from a multidisciplinary team approach involving a mental health professional, a physical therapist, and a physical medicine and rehabilitation specialist. Group therapy may be beneficial. Patients should be well educated about their disorder and taught the importance of self-help. There are patient support groups in many communities. While treatment of fibromyalgia is effective in some patients, others continue to have chronic disease, which is relieved only partially if at all.
Fibromyalgia PowerPoint 1
Fibromyalgia PowerPoint 2 – FMS
Fibromyalgia PowerPoint 3 – Tender Points
Fibromyalgia PowerPoint 4
Fibromyalgia PowerPoint 5 – Social Implications
Fibromyalgia PowerPoint 6 – Treatment
Fibromyalgia PowerPoint 7 – Micro Nutrient theraphy.
Fibromyalgia PowerPoint 8 – Pharma Theraphy
Fibromyalgia PowerPoint 9 – Cognitive Function Challenge
Fibromyalgia PowerPoint 10 – pain & Symptom Management
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