Paper presented under the Open Week UAlg Definition of Fibromyalgia • The word fibromyalgia comes from the

Greek fibromyalgia - Algia my fibro, and means algia • "pain in the fibrous tissues of muscles." What is Fibromyalgia? • It is a chronic painful syndrome that affects the musculoskeletal system in a diffuse and is associated with the presence of standardized tender points. - First described in 1843 as a type of arthritis in 1843 "with points located hi ghly painful" and known as - Fibrosistis. Fibrosistis • Patients are often classified as neurotics and hypochondriacs - derived from t he fact that the complaints were not sustained by organic lesions observed. • Th e American College of Reumathology (ACR) established the diagnosis in 1990. • Re cognized in 1990 as Fibromyalgia, Fibromyalgia and separate diseases Rheumatolog y since 1993. • In Portugal, was not recognized as a chronic disabling Portugal in February 2005. Diagnosis The diagnosis is made by finger pressure, exerting a force 4kgf/cm2 on the point s shown in Fig. When the patient has pain response in at least 11 of the 18 poin ts standard, it is considered that one is faced with a case of fibromyalgia. The diagnosis is generally established by medical specialty, including rheumatologi sts, physiatrists and psychiatrists. (URL: ~ hunter / fms.htm, 1998) Etiopathogenesis • The base aetiopathogenic of fibromyalgia is still unknown. It is thought that are involved: - Factors that influence the measurement of pain. • This can be suggested by the lowering of pain threshold observed against painf ul processes; • The repetitive, repetitive • In chronic arthritis, chronic • The stress situations (surgery or trauma), • Processes • Psychological disorders an d infectious. psychological Symptoms (Wolf, 1990) Signs / Symptom Patients% Diffuse pain Soreness in at least 11 of 18 points tendon Fatigue Muscle stiffnes s morning Sleep Disorders (absence of phase IV sleep, deep sleep, insomnia.) Par esthesia (subjective feeling of swelling of the fingers and toes) Headache Anxie ty Syndrome pre Sicca-menstrual syndrome (dry mouth and eyes) Depression Irritab le Bowel previous urinary infections Raynaud's phenomenon (hands and feet are nu mb, white, and cold) 97.6 90.1 81.4 77.0 74.6 62.8 52.8 47.8 40.6 35.8 31.5 29.6 26.3 16.7 Role of Technical Nursing • In terms of Health care: Health - Adopt an attitude sympathetic, empathic and consistent manner congruent nice Do not make value judgments, not to stigmatize the sick. value - Educating for Health, on patients with Fibromyalgia: Health • hygienic care (personal hygiene:> likelihood of urinary tract infections, body care) • Care Food, Food • Advise to have a regular physical activity (moderate) • advise taking medication prescribed by a doctor; • Need for more frequent con sultations: dentistry and ophthalmology frequent; ophthalmology • Measurement of blood pressure, and blood glucose (blood screening for hypoglycemia)

- Taking the patient to experience healthier behaviors and improved quality of l ife, despite suffering a life of chronic disabling disease. Characterization • Most patients with fibromyalgia are: - Female (80-90%): • More prevalent in women between 35 and 50 years. • Age of onset is between 20 and 40 years - It may appear near the two years or from 65. - In men the symptoms are different - Reaches all: races and ethnicities, ages a nd social classes (between 3 and 5% of population) Etiology • It is believed that there is an interplay of genetic, neuro-endocrine, psychol ogical and genetic neuro-endocrine disturbances of sleep predisposes individuals with Fibromyalgia. • The term "dysfunctional syndrome" was proposed to better u nderstand the mechanisms involved in chronic pain syndromes in which there is no detectable Iesa tissue. tissues • In cases of Fibromyalgia stand out peripheral and central mechanisms. central Peripheral Mechanisms A-Muscle Abnormalities • Changes in structure and function of muscle tissue (Changes in lipid content and cellular glycogen and mitochondrial alterations, r eduction in local micro-circulation). conjunctive, involves the reduction of ene rgy content of muscle tissue, causing fatigue, spasm, and pain) pain • Amendment metabolic (hypoxia of muscles and tissue B - Mechanisms Nocicetivos and Neuro-vascular • Receivers nociceptive (reduced levels of serotonin and endorphins,€Increased levels of substance P). Central Mechanisms A - Change of Neuroendocrine Mechanisms - Interaction between the Neuro-Endocrine mechanisms involved in sleep-wake cycl e and the Immune System. Immune - Changes in sleep-wake cycle, (a change in slee p-wake rhythms organic: Secretion of neuro-hormones - cortisol, serotonin, prolactin, serotonin and cortisol biological somatomedin C). C • Variation in the levels of plasma cortisol is <in fibromyalgia or rheumatoid a rthritis than in normal individuals. • Reduction in plasma concentrations of try ptophan and + 9 amino acids translates into:> the affinity of imipramine binding to receptors on platelets (Tryptophan, a precursor of serotonin, tryptophan is involved in Stage IV sleep and acts as a neurotransmitter in the descending trac ts of pain ; Role of Technical Analysis of Clinical and Public Health, Pharmacy and Radiology • At the level of research - Develop 100% efficient techniques in medical diagnosis: • Histopathological Examination (Clinical analysis of blood, urine, feces) • Exa ms: Radiology, electromyography, ultrasound, ultrasound sonography PoliRadiológi cos electromyographic (detection of slow wave sleep and reduced quantity intrusi on of alpha waves in these stages of sleep), Electroencephalogram (EEG) Computer ized Axial Tomography (CT), scintigraphy (scanner), Proton Emission Tomography ( PET) and - Drug effective: effective

• Delete diffuse musculoskeletal pain and tendon Points • • • (Malaise, fatigue, spasms, tremors and paraesthesia) Stabilize Sleep (insomnia, fatigue, impaired memory, perception and vision); Eradication of emotional disor der (apathy, depression, depressed mood, depression, suicidal tendencies, anxiet y diffuse, tremors); Regulate hormone levels (in women, pre-menstrual syndrome); • Reducing pain and enhancing the welfare and quality of life of these patients. life Treatment of Fibromyalgia 1. Diagnosis and reassurance of patient 2. Avoid aggravating factors (eg, cold, humidity, narcotics, steroids, caffeine, stress, etc..) 3. Modifications to the level of work: • Adopt more correct posture, reduce sources of excessive noise a nd light, ergonomic chairs and keyboards, rhythms and decrease workload. • Adapt ing the work of the current "physical disability" of the subject: less resistanc e, strength and ability perception and memory, higher levels of stress and anxie ty. • To prevent worsening of the symptoms of widespread musculoskeletal pain, s leep is not restorative rhythms of wakefulness strongly committed, affective dis orders, urinary infections, respiratory infections, etc.. 4. Pharmacological opt ions (anxiolytics and tricyclic antidepressants) 5. Physical modalities (massage , sprays, anesthetics, heat, acupuncture, etc.). 6. Recreational aerobic exercis e (moderate physical exercise and mild) 7. Active role of the patient (to accept their limitations and learn to love each other) Chemicals that help in the Treatment of Fibromyalgia Chemical initial dose (Mg) Before bedtime (Take x hours) Maximum dose (Most often) Carisoprodol cyclobenzaprine Tradozone Alprazolam Diphenhydramine Amitriptyline 50 10 0.5 350 50 5 0 1 0 0.5 0.5 to 1 to 1 2 600 300 150 60 April 1400 Use of antidepressants • Antidepressants (amitriptyline, cyclobenzaprine): effective in combating pain, fatigue and sleep disturbance, - Significant improvement in only 30-40% of patients. patients • The effect seems to be stabilizing or even decreasing with time. time • Tricyclics, in minimal doses, are not intended to treat depression, but actual ly improving Stage IV sleep (stage non-REM). - Accordingly, individuals who report improvements in sleep also refer to decrea sing the pain. - Though the tricyclics are effective, less effective than 50% of patients take them regularly • lot (and gravity) of side effects: Side - Dry mouth, dizziness roundabouts, constipation, excessive sleepiness, hallucin ations, or even induce depression. Role of the Pharmacy Technician • At the level of health care: - Adopt an empathic attitude, consistent manner - not make value judgments and s

tigma; - "Educate" the patient with fibromyalgia about the need to: • Take the medication prescribed by a physician, as indicated in the recipe; • D o not facilitate the acquisition of drugs other than medically prescribed (eg, d ue to likely negative effects of drug interaction). Factors Affecting and / or aggravate the symptoms Factors that aggravate cold or wet weather Poor quality sleep disorders applican ts Bad habits of consumption Trauma Stress physical and / or psychological facto rs that exaggerated Exercise improves Sleep Warm or dry repairer / restorer appl ication of heat in the affected muscles and moderate physical exercise adapted D iet balanced Role of Dietetic Technicians • In Health Education: - Provide adequate information, in each case, on eating habits and healthier die t: • Establish a balanced diet; • Restrictions and prohibitions food. - Patients with fibromyalgia have: • • • • Intolerance to hydrocarbons, hydrocarbon accumulation of phosphates in t he body, associated with hypoglycaemia, infections and respiratory insufficiency and upper airway, frequent (which causes impairment / impairment of the phonato ry apparatus. Role of Speech Therapy Technicians • In terms of health education: - Health vocal: • are frequent aphonia, hoarseness and aphonia slowed pace of speech and stutter ing slowed during periods of increased stress. • Substances / foods that harm; • Exercises tailored to each subject, vocals • Efforts to avoid. • Diagnosis and treatment of cases of speech pathology. Role of interdisciplinary Technicians Trained by ESSaF • Treat Fibromyalgia implies the involvement of a team of professionals from var ious fields of Health, a joint effort whose ultimate goal is the reduction of sy mptoms, behaviors adopted healthier, higher quality of life, in short, Health Pr omotion : Health - Nursing: Healthcare, Nursing - Clinical Analysis and Public Health, and Radiol ogy: Diagnostic Radiology Public complementary and detection at an earlier stage - Pharmacy and Clinical Analysis and Public Health: Public production of more e ffective drugs - Dietetics and Nursing: eating habits and diets tailored to the subject Nursing - Speech Therapy, Radiology and Nursing: Nursing Diagnosis and t reatment of disorders in speech. References American College of Rheumatology (1990). Criteria for the Classification of Fibr omyalgia. Report of the Multicenter Criteria Committee. Arthtitis Reumatolgy, 33 , 160-172 Angel, K. (2000). Fribromyalgia. /dmk/dmk_article_55421 Beck, A. (1982). Cognitive Therapy of Depression. Rio de Janeiro: Zahar Editores. Chaitow, L. N. D. (1995). Fibromyalgia: The Muscle Pain Epidemic - Is it ME (Myalgic Encephalomyelitis) by Another Name? (Part 1). http :// Devin, J. S., & Copel and, M. E. (1996). Fibromyalgia and Chronic Myofascial Pain Syndrome: A Survival Manual. Oakland, CA.: New Habing Publications. Edelberg, D. (2000). Questions a nd Answers about Fibromyalgia. yalgia/fibro1.htm Medeiros, N. (1998). Fibromyalgia: A Description Professional vs. Reality. NIAMS (Nation al Institute of Arthritis and Muskulosketal and Skin Diseases) (1998). Questions and Answers about Fibromyalgia.

References [Cont] Neumann, L., & Buskila, D. (1997). Quality of life and physical functioning of r elatives of fibromyalgia patients. Seminar Arthritis Rheum 26: 834-399, Nye, D. A. (1997). The Physicians Guide to Fibromyalgia Sybdrome. http://prairie.lakes.c om/ ~ roseleaf / fibro / md-faq.html Pattee, P. (1998). Fibromyalgia Treatment. St. Amand, R. P., & Craig Marek, C. (1999) What your Doctor May Not Tell You abo ut Fibromyalgia: The Revolutionary treatment that me reverse the disease. New Yo rk, NY: Warner Books. St. Amand, P. (1998). Fibromyalgia (For Patients). http:// Starlanyl, D. (1998). Fibro myalgia & Chronic Myofascial Pain Syndrome: A Survival Manual, Chapter 24. http: // Whol-ealth Library (2000). Fibromyalgia. William son, M. E. (1996). Fibromyalgia: a comprehensive approach. Wolfe, F. (1993). Fyb romyalgia: on diagnosis and certainty. Musculoskel Journal of Pain, 17, 1 (3-4). Wolfe F, Smythe HA, Yunus MB et al. (1990). The American College of Rheumatolog y 1990 Criteria for the classification of fibromyalgia. Arthritis Rheum 33, 160172.