Fibromyalgia Syndrome (FMS

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MiniMini-Med School 2007 Raymond H. Flores, MD, FACR Department of Medicine Division of Rheumatology & Clinical Immunology

OUTLINE
What is Fibromyalgia (FMS)? What causes it? Who gets it? How is it diagnosed? How is it treated? What are some of the common misconceptions about the syndrome?

fatigue and muscle tenderness (tender points) (tender .What is Fibromyalgia (FMS)? A clinical syndrome characterized by widespread muscular pain (usually chronic).

poor sleep almost always .) Additional symptoms are common and include: .What is FMS? (cont.cognitive and memory problems ³fibro fog´ .irritable bowel syndrome .headaches .numbness and tingling in fingers and toes .

What is FMS? (cont.dry eyes and dry mouth .restless leg syndrome .) .irritable bladder .morning stiffness .anxiety and depression Symptoms including pain may wax and wane over time .temporomandibular joint (TMJ) disorder .

What causes FMS? Cause is unknown Abnormally high levels of Substance P in spinal fluid in some patients Substance P important in transmission and amplification of pain signals to and from brain ³Volume control´ is turned up too high in brain¶s pain centers .

What causes FMS? (cont) Familial tendency to develop FMS suggests genetic role Can be triggered by physical. repetitive injuries and certain diseases Patients with Rheumatoid arthritis and SLE (Lupus) are more likely to develop FMS . emotional or environmental stressors such as car accidents.

) Other conditions such as Lyme disease and obstructive sleep apnea (OSA) have been associated with FMS Sleep deprivation with disruption of deltadeltawave sleep (non-REM stage IV) is (nonassociated with day-time fatigue and dayfibromyalgia syndrome .What causes FMS? (cont.

Who gets FMS? Affects as many as 1 in 50 Americans Most common in middle-aged women middleMen and children may also develop the disorder Patients with RA. SLE and Ankylosing spondylitis are more likely Women who have a family member with FMS are more likely to develop it .

widespread (1990)««.How is FMS diagnosed? A diagnosis is made by evaluation of symptoms and presence of tender points American College of Rheumatology Classification Criteria for Fibromyalgia (1990)««.widespread pain for at least 3 months and pain in 11 out of 18 tender point sites on digital palpation .

and axial skeleton (cervical spine. or low back) ± Pain in 11 of 18 tender point sites on digital palpation with approximate force of 4 kg. above and below the waist. on both sides of the body. .ACR classification criteria: fibromyalgia Both criteria must be satisfied ± History of widespread pain for more than 3 months. thoracic pain. Presence of second clinical disorder does not exclude diagnosis of fibromyalgia. anterior chest.

Fibromyalgia: tender points (diagram) .

) X-rays. Hypothyroidism and Polymyalgia Rheumatica (PMR) . SLE. blood tests. muscle biopsies are all normal Objective ³markers of inflammation´ such as ESR (erythrocyte sedimentation rate) are normal Must be distinguished from other common diffuse pain conditions such as RA.How is FMS diagnosed? (cont. specialized scans such as nuclear medicine and CT.

as there is no definitive treatment cure for fibromyalgia .How is FMS treated? Fibromyalgia is a chronic condition managed with both medications and physical modalities Medication therapy is largely symptomatic.

Dual reuptake inhibitors such as venlafaxine (EFFEXOR).) Current studies suggest that the best pharmacologic treatment for treating pain and improving sleep disturbance includes: .How is FMS treated? (cont.Tricyclic compounds such as cyclobenzaprine (FLEXERIL) and amitriptyline (ELAVIL) . duloxetine (CYMBALTA) and tramadol (ULTRAM) .

Recent studies have shown that the antiantiepileptics (seizure meds) gabapentin (NEURONTIN) and pregabalin (LYRICA) have been effective .SSRIs/ antidepressants such as fluoxetine (PROZAC). paroxetine (PAXIL) and sertraline (ZOLOFT) for depression and pain ..

.NSAIDs (non-steroidal anti-inflammatory drugs) (nonantisuch as ibuprofen and naproxen are generally ineffective .Long acting opioids (narcotics) generally are not of great benefit either .Benzodiazepines such as diazepam (VALIUM) and clonazepam (KLONIPIN) may be useful for patients with restless leg syndrome or very severe sleep disturbance who have not responded to other therapies .

N. The US Food and Drug Administration has not yet approved any medications to treat FMS .B.

Therapeutic massage .Acupuncture .Myofascial release therapy .Other Therapies for FMS Complementary and alternative therapies have been used although not well studied in FMS .

Support group . SelfNational Fibromyalgia Assn. Arthritis Foundation.Other Therapies for FMS Patient Self-Management Self. including deep breathing and meditation .e. .Establish routine for going to bed and waking up .Self-education i.Schedule time to relax.Cognitive Behavioral Therapy (CBT) .Aerobic exercise on regular basis .

Common Misconceptions Eleven (11) out of 18 tender points needed to make the diagnosis of FMS (2005 ACR Classification Criteria) FALSE Tenderness can be widespread without tender points .

The major symptom in FMS is pain FALSE A variety of neurologic abnormalities may be described including numbness and tingling of the extremities. irritable bowel symptoms. etc. . cognitive and memory problems.

although psychologic factors including depression may be the major determinant of pain in others . it¶s in the ³patient¶s head´ FALSE A real condition with severe physical effects in some.It¶s not a real illness.

aggressive treatment can prevent physical deconditioning and loss of function .The prognosis is ³hopeless´ FALSE Early.

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