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
Image Source: https://www.medicalnewstoday.com/articles/321532
 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 Image Source: https://www.google.com/search?q=Risk+factors+of+Fibromyalgia+ibs+ra&tbm=isch&ved=2ahUKEwiYgvyW1aTzAhXUA50JHXT_CuYQ2-

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● Hypothyroidism

● 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/

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