2. Bridgit Finley, PT, DPT, M.Ed., OCS
bfinley@ptcentral.org
www.ptcentral.org
579-1600
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3. Objectives
State the ACR clinical definition of FM.
Identify 5 or more overlapping co-morbidities.
Outline the risk factors.
Describe the non-pharmacologic approach to
treatment.
Review the prognoses for FM patients.
4. Pre Test
FM is caused by a virus?
3-6% of the population
has FM?
FM is progressive and
fatal?
FM is diagnosed with a
blood test?
Exercise has been shown
to decrease FM
symptoms?
False
True
False
False
True
5. Introduction
Fibromyalgia – what is it?
Be skeptical if you read something that says it will
“cure” symptoms.
Patients need to understand their symptoms so that
they can begin to take control and manage their pain.
6. Overview
Common condition characterized by long-term,
body-wide pain and tender points in joints, muscles,
tendons, and other soft tissue.
A chronic pain state.
Nerve stimuli causing pain (reduced pain threshold).
Symptoms: fatigue, morning stiffness, sleep
problems, headaches, depression and anxiety.
7. Definition of Fibromyalgia
“Chronic and widespread pain located at 11
or more of 18 tender points.”
American College of Rheumatology,
1990.
In 1908, Gowen first described FMS.
8. Fibromyalgia
A common and complex chronic pain disorder that
affects people physically, mentally and socially.
It is a syndrome rather than a disease.
A syndrome is a collection of signs and symptoms
that occur together without an identifiable cause.
9. Disease
A disease, which is a medical condition with specific
cause or causes and recognizable signs and
symptoms.
Fibromyalgia is a set of symptoms not caused by a
disease.
Tissue pathology with distinctive symptoms and a
causative agent.
Tuberculosis, causing a chronic cough, tubercle
bacillus is causative agent and can be cured.
10. Science of Fibromyalgia
Tends to be treated rather dismissively by Medical
Community.
Controversy – not disease process, can’t be cured.
Problem with doctors is that it can not be understood
according to the classic medical model.
This model is used with all medical training.
11. What is the problem?
It is not a primary psychological disorder.
As in many chronic conditions, psychological factors
may play a role.
May “up regulate” the central nervous system.
Abnormal pain transmission response
Disordered sensory processing.
12. What is the problem?
The stimuli causing pain originates mainly in the
muscles.
Skeletal muscle metabolism – decrease blood flow
which causes chronic fatigue and weakness.
Hence the increased pain with strenuous exertion.
13. Causes
The bottom line – unknown
Sleep disturbances, which are common in FB
patients, may actually cause the condition.
Pilot studies have shown a possible inherited
tendency toward the disease. Very preliminary.
14. Perception of Pain
Pain is a universal experience that serves the vital
function of triggering avoidance.
Cardinal symptom of FM is widespread body pain.
Tender points at musculoskeletal junction.
Amplification of nervous system.
15. Pain is Personal
Some 30 years ago, Melzeck and Wall proposed that
pain is a complex integration of noxious stimuli, and
cognitive factors. In other words, the emotional
aspects of having a chronic pain state and one's
rationalization of the problem may both influence the
final experience of pain.
16. Description
A chronic musculoskeletal syndrome characterized
by widespread:
musculoskeletal aches and pain
stiffness in the muscle tissue, ligaments, and tendons
soft tissue tenderness
general fatigue
sleep disorders
gastrointestinal disorders
depression
17. FMS
affects the neck, shoulders, chest, legs, and lower
back
symptoms similar to those of chronic fatigue
syndrome and myofascial pain syndrome.
18. Epidemiology
10 million US 3-6% of population
~ 80% are women
highest incidence women 20 to 55 years of age
Genetic component
Among siblings and mothers and daughters
Incidence rises with age, by 80 years old – 8% of the
population.
19. Risk Factors
Age more common in young adults, increases with
age
Gender 10 x more common in women
Genetic familial patterns suggest the disorder may
be inherited
Often follows a trauma infectious or stress
20. Risk Factors
Sleep disorders unknown whether sleep difficulties
are a cause or a result of fibromyalgia
Rheumatic Disease RA or Lupus more likely to
develop FA
21. Pathophysiology
unknown etiology
produces vague symptoms that may be associated
with diminished blood flow to certain parts of the
brain and increased amounts of substance P
substance P thought to be a sensory
neurotransmitter involved in the communication of
pain, touch, and temperature from body to brain.
Lowers the threshold of synaptic excitability
22. Pathophysiology
several other possible causes:
autonomic nervous system dysfunction
chronic sleep disorders
emotional stress or trauma
immune or endocrine system dysfunction
upper spinal cord injury
viral or bacterial infection
23. Signs and Symptoms
vary, depending on stress level, physical activity, time
of day, and the weather
pain primary symptom
pain and tenderness in specific trigger points when
pressure is applied
aching, burning, throbbing, or move around the body
(migratory)
muscle tightness, soreness, and spasms
24. S & S Continued
unable to carry out normal daily activities even
though muscle strength is not affected
pain often worse in morning, improves throughout
day, worsens at night
symptoms may be constant or intermittent for years
25. Co-morbidities
sleep disorders/fatigue restless leg syndrome, sleep apnea
gastrointestinal abdominal pain, bloating, gas, cramps,
alternating diarrhea and constipation, IBS
numbness or tingling sensations
chronic headaches may include facial and jaw pain (TMJ)
frequent urination, strong urge to urinate, painful urination
(dysuria)
sensation of swelling (edema) in hands and feet even though
not present
cognitive or memory impairment
26. Co-morbidities and FM
Post-exertional malaise and muscle pain
Morning Stiffness
Numbness and Tingling
Dizziness or Light-headedness
Increased chemical, mechanical, and thermal
sensitivities.
27. Trigger Points
Main points of pain
in Fibromyalgia patients
Neck
Back
Shoulders
Pelvic Girdle
Hands
Knees
Elbows
Hips
28. Diagnosis
No laboratory tests
Must rely on patients self reported symptoms
3 month history
Exam based on American College of Rheumatology
criteria.
Estimated that it takes an average of five years to get
diagnosed.
29. To receive a diagnosis of FM
Medical History
widespread pain in all four quadrants of their body for a
minimum of three months
at least 11 of the 18 specified tender points when
pressure is applied.
31. Myth
Fibromyalgia Damages Your Joints
Increase pain has not been correlated with any joint or
muscle damage.
It is important to understand that activity is good for
your joints and will help patients with Fibromyalgia
control pain.
Fibromyalgia is not fatal
True
32. Myth
You look fine, so nothing is wrong with you.
Pain is cultural
Our society does not really want to know “How are
you?”
You were diagnosed with fibromyalgia because your
doctor couldn’t find anything wrong with you.
American College of Rheumatology
34. Nutrition
Avoid sugar
Avoid caffeine – this will improve your sleep
Limit alcohol
Maintain proper body weight
Limit processed food
Chocolate is OK and may release serotonin
35. Pain Management
Goal reduce pain, improve sleep, and relieve
associated symptoms
Medication
antidepressant agents relieve sleep disorders, reduce
muscle pain, treat depression
small doses of aspirin or acetaminophen relief of
pain and muscle stiffness
Lyrica/cymbalta/Savella -
36. Pain Management
Trigger point injections injection of local
anestheticand/or corticosteroid into a tender point
and then stretching involved muscle
local anesthetic blood flow to the muscle
corticosteroids inflammation
37. Treatment
Exercise low-impact aerobic activity and strength
training.
Improved Fitness – symptoms are decreased with
aerobic exercise.
25-60% HHR, 3days/week, 20-30 minutes
Significant decrease in the Fibromyalgia Impact
Questionnaire
ACSM Guidelines are too strenuous
39. Prognosis
No cure – lifelong condition. Very rare for them to
develop lupus or MS
Better ways to diagnose and treat the chronic pain
disorder continue to be developed.
FDA – new medications
Clinical studies demonstrate that can reduce
symptoms.
Does not shorten life span.
40. Support Groups
National Fibromyalgia Association
www.fmaware.org
Podcasts
Walk of FAME (Fibromyalgia Awareness Means
Everything)
Emotional/Social Support and Education
41. Post Test
There is no cure for FM?
FM has been shown to
shorten a persons life
span?
FM will cause joint
damage?
FM is a disease?
FM has an unknown
etiology?
True
False
False
False
True
42. Case Study
34 yo female with
diagnosis of FM
Wants to be start an
exercise program
Goals are to loose
weight and be able to
sleep better
What questions will you
ask her?
What exercises are
appropriate?
Do you feel comfortable
working with the client?