Fibromyalgia

Bersano, Harris, Phillips, Prins

 What is Fibromyalgia?
“Chronic, widespread musculoskeletal pain and
associated fatigue, sleep disturbances, and other
cognitive and somatic symptoms”

Image source: https://bodyharmonypt.com/orthopedic-conditions/fibromyalgia/

 Populations at Risk
● Women are more at risk to have Fibromyalgia compared to men

● Middle-aged individuals

● Patients with lupus, rheumatoid arthritis, or ankylosing spondylitis

● Genetic predisposition

○ Non-hereditary genetic component

○ Clusters in families

● Cause is unknown

○ Stressful or traumatic events, such as car accidents

Image Source: https://www.medicalnewstoday.com/articles/321532
○ Repetitive injuries

○ Illnesses such as viral infections

● United States among the highest prevalence

 Signs and Symptoms
● Generalized chronic musculoskeletal pain
o A chief complaint of “I hurt all over”
● Hyperalgesia (increased sensitivity to pain)
● Psychosomatic symptoms
o Fatigue
o Sleep Disturbances
o Anxiety
o Depression
o Cognitive dysfunction
o Headache
o Gastrointestinal Disorders

Image Source: https://creakyjoints.org/about-arthritis/fibromyalgia/fibromyalgia-symptoms/signs-of-fibromyalgia/

 Risk Factors
● Increased pain regulation and process in the brain

● Generalized pain

○ ≥4 of 5 body regions (upper left, upper right, lower

left, lower right, axial)

● No tissue damage

● Rheumatoid arthritis

● Inflammatory back conditions

● Hypothyroidism Image Source:

https://www.google.com/search?q=Risk+factors+of+Fibromyalgia+ibs+ra&tbm=isch&ved=2ahUKEwiYgvyW1aTzAhXUA50JHXT_CuYQ2-cCegQIABAA&oq=Risk+factors+of+Fibromya
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wP9P6rsA4&bih=836&biw=1460&rlz=1C1CHZN_enUS928US936#imgrc=zMK-4jv_UQgZ1M

● Irritable bowel syndrome

 Genetics
● Studies have mostly focused on neurotransmitters
○ Catecholamines
○ Serotonin
● With advanced technology
○ Novel target genes
○ Genome-wide sequencing scanning
○ Micro RNAs
■ Post-transcriptional inhibition of gene expression
● Serotoninergic Candidate Genes
○ Deletion in SLC6A4
○ Decrease Serotonin
● Catechol-O-methyltransferase gene polymorphism
○ Val158Met polymorphism
○ Reduced pain inhibition
● Guanosine triphosphate cyclohydrolase
○ Increased enzyme activity
○ Increased pain sensitivity
●
Transmission & Incidence
Unknown cause

● Possible genetic link

● Stressful or traumatic event

● Repetitive injuries

● Illness

● United states among the highest prevalence

Image source: https://www.myfibroteam.com/resources/what-causes-fibromyalgia

 Mortality Rates
• Overall similar to the general population

• May be increased due to suicide rates and injuries

Image Source: https://countingmyspoons.com/2016/09/relationship-stress-depression-fibromyalgia/

 Daily impacts of Fibromyalgia
• Higher rates of depression

• Increased hospitalization

• Higher rates of other rheumatic conditions

• Pain with ADLs

Image Source: https://www.spineuniverse.com/conditions/fibromyalgia/who-treats-fibromyalgia

 Considerations and Implications
for Physical Therapists
● Physical therapists should alway be on the lookout for any combination of the symptoms.
○ Especially if persistent for more than 3 months.
● PT is a non-pharmaceutical treatment for fibromyalgia symptoms.
○ Aerobic Exercises
○ Resistance Exercises
○ Flexibility Exercises
○ Aquatic Therapy
○ Massage therapy
○ Electrical Stimulation
● Therapist need to be aware of the patients pre existing conditions or
there prior medical history.

Image Source:https://www.spineuniverse.com/conditions/fibromyalgia/physical-therapy-fibromyalgia
 Goal of Physical Therapy
● The main purpose of treatment is to address pain

management because there is no cure for

Fibromyalgia

○ Condition weaker muscles

○ Reduce overloading of muscular system

○ Reduce fatigue of postural muscles

● Emphasize exercise and living a relatively healthy

lifestyle Image Source: https://creakyjoints.org/about-arthritis/fibromyalgia/fibromyalgia-treatment/medication-exercise-diet/

 Prevention
● No known prevention criteria

● Current recommendations:

○ Reducing stressful or traumatic events

○ Reducing repetitive injuries

○ Reducing exposure to viral infections

○ Maintaining a healthy body weight

Image Source: https://rheum.med.ufl.edu/2013/07/08/are-body-weight-and-lack-of-physical-activity-risk-factors-for-fibromyalgia/

 Clinical Questions
1. What is the chief complaint from a patient with fibromyalgia?

a. “I feel numbness in my feet”

b. “I hurt all over”

c. “I get headaches all the time”

d. “I’m always hungry and want to eat”

2. What disease or condition commonly mimics fibromyalgia?

a. Rheumatoid arthritis

b. Type 1 Diabetes

c. Alzheimer's

d. Asthma
 Sources
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