Fibromyalgia: Difference between revisions
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== Definition/Description == | == Definition/Description == | ||
Fibromyalgia is a syndrome characterized by widespread chronic unabated pain in addition to a host of several additional co-morbidities that can severely impact and disrupt a person’s daily life. The symptoms associated with fibromyalgia stem from abnormal sensory processing believed to originate in the muscle and ultimately lead to the chronic pain and paresthesias experienced by those with the disorder.<ref name="one">National Fibromyalgia Association Website. About Fibromyalgia. Available at: http://www.fmaware.org/site/PageServer?pagename=fibromyalgia_affected. Accessed 3/1/2010.</ref> | Fibromyalgia is a syndrome characterized by widespread chronic unabated pain in addition to a host of several additional co-morbidities that can severely impact and disrupt a person’s daily life. The symptoms associated with fibromyalgia stem from abnormal sensory processing believed to originate in the muscle and ultimately lead to the chronic pain and paresthesias experienced by those with the disorder.<ref name="one">National Fibromyalgia Association Website. About Fibromyalgia. Available at: http://www.fmaware.org/site/PageServer?pagename=fibromyalgia_affected. Accessed 3/1/2010.</ref> | ||
== Prevalence == | == Prevalence == | ||
The prevalence of fibromyalgia ranges from 2-6% of the population.< | The prevalence of fibromyalgia ranges from 2-6% of the population.<ref name="one" /><ref name="two">Centers for Disease Control and Prevention Website. Fibromyalgia. Available at: http://www.cdc.gov/arthritis/basics/fibromyalgia.htm. Accessed on 3/1/2010</ref> Fibromyalgia is more prevalent among women and the vast majority of those with fibromyalgia are women. Below are the prevalence and percentage of fibromyalgia patients distributed between the sexes: | ||
Prevalence: Women (3.4%) Men (0.5%) < | Prevalence: Women (3.4%) Men (0.5%)<ref name="two" /><br>Percentage of Fibromyalgia Patients: Women (75-90%) Men (10-25)<ref name="one" /> | ||
Although most diagnoses of fibromyalgia are made during middle-age, prevalence of the disorder increases with age. < | Although most diagnoses of fibromyalgia are made during middle-age, prevalence of the disorder increases with age.<ref name="two" /><br><br> | ||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
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Those with fibromyalgia can present with a host of symptoms that can make diagnosing the disorder difficult. Below is an extensive but not exclusive list of common patient symptoms and presentations created from several sources: | Those with fibromyalgia can present with a host of symptoms that can make diagnosing the disorder difficult. Below is an extensive but not exclusive list of common patient symptoms and presentations created from several sources: | ||
*Morning stiffness < | *Morning stiffness<ref name="two" /><ref name="three">Fibromyalgia Network Website. Available at: http://www.fmnetnews.com. Accessed on 3/1/2010.</ref> | ||
*Tingling or numbness in hands and feet | *Tingling or numbness in hands and feet<ref name="two" /><ref name="three" /> | ||
*Headaches, migraines | *Headaches, migraines<ref name="two" /><ref name="three" /><ref name="four">The American Fibromyalgia Syndrome Association, Inc. Website. What is Fibromyalgia. Available at: http://afsafund.org/fibromyalgia.html. Accessed on: 3/1/2010.</ref> | ||
*<sup></sup>Constipation, diarrhea < | *<sup></sup>Constipation, diarrhea<ref name="two" /><ref name="three" /><ref name="four" /> | ||
*Thinking and memory abnormalities (“fibro fog”) < | *Thinking and memory abnormalities (“fibro fog”)<ref name="two" /><ref name="three" /><ref name="four" /><ref name="five">Fibrocenter.com Website. Available at: http://fibrocenter.com. Accessed on: 3/1/2010.</ref> | ||
*Painful menstrual periods < | *Painful menstrual periods<ref name="two" /><ref name="three" /><ref name="four" /> | ||
*Fatigue < | *Fatigue<ref name="three" /><ref name="four" /><ref name="five" /> | ||
*Trouble sleeping | *Trouble sleeping<ref name="three" /><ref name="four" /><ref name="five" /> | ||
*Jaw Pain < | *Jaw Pain<ref name="three" /><ref name="four" /> | ||
*Abnormal muscle pain and malaise after exercise | *Abnormal muscle pain and malaise after exercise<ref name="three" /><ref name="four" /> | ||
*Dizziness or lightheadedness | *Dizziness or lightheadedness<ref name="three" /><ref name="four" /> | ||
*Skin and chemical sensitivities | *Skin and chemical sensitivities<ref name="three" /><ref name="four" /> | ||
*Deep, aching, throbbing, shooting, radiating, stabbing pain | *Deep, aching, throbbing, shooting, radiating, stabbing pain<ref name="four" /><ref name="five" /> | ||
*Non-cardiac chest pain, heart palpitations, shortness of air, profuse sweating < | *Non-cardiac chest pain, heart palpitations, shortness of air, profuse sweating<ref name="four" /> | ||
*Feeling of swollen extremities < | *Feeling of swollen extremities<ref name="four" /> | ||
*Sensitivities to all the senses (loud noises, bright lights, some foods, odors, etc…) < | *Sensitivities to all the senses (loud noises, bright lights, some foods, odors, etc…)<ref name="four" /> | ||
*Feelings of depression, anxiety < | *Feelings of depression, anxiety<ref name="five" /> | ||
<br> | <br> | ||
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[Chart courtesy of Fibrocenter.com. Available at http://fibrocenter.com/fibromyalgia-symptoms.aspx.] | [Chart courtesy of Fibrocenter.com. Available at http://fibrocenter.com/fibromyalgia-symptoms.aspx.] | ||
The following have been associated with aggravating the above symptoms < | The following have been associated with aggravating the above symptoms:<ref name="four" /> | ||
*Changes in weather | *Changes in weather | ||
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<br> | <br> | ||
In addition to the above physical symptoms associated with fibromyalgia, the patient’s quality of life of is also a consideration as quality of life outcome measures can add to the clinical presentation. It has been reported that those with fibromyalgia have scored the lowest on 7 of 8 subscales on the SF-36 outcome measure in contrast to patients with other chronic diseases.< | In addition to the above physical symptoms associated with fibromyalgia, the patient’s quality of life of is also a consideration as quality of life outcome measures can add to the clinical presentation. It has been reported that those with fibromyalgia have scored the lowest on 7 of 8 subscales on the SF-36 outcome measure in contrast to patients with other chronic diseases.<ref name="two" /> More information on the SF-36 is available at [http://www.sf-36.org http://www.sf-36.org/]. The same source revealed that fibromyalgia patients reported an average score of 4.8/10 with 1 being the lowest and 10 being the highest regarding their perceived “present quality of life.”<ref name="two" /> | ||
== <sup><br></sup>Associated Co-morbidities == | == <sup><br></sup>Associated Co-morbidities == | ||
Those with fibromyalgia are likely to present with several co-morbidities. In fact, the vast majority of those with the disorder report the presence of overlapping conditions. Because the presence of additional disorders is so common in those with fibromyalgia it is important that a diagnosis of fibromyalgia not be overlooked given the presence of additional co-morbidities that are more predictable and much easier to diagnose. Below is a list of common co-morbidities associated with fibromyalgia: | Those with fibromyalgia are likely to present with several co-morbidities. In fact, the vast majority of those with the disorder report the presence of overlapping conditions. Because the presence of additional disorders is so common in those with fibromyalgia it is important that a diagnosis of fibromyalgia not be overlooked given the presence of additional co-morbidities that are more predictable and much easier to diagnose. Below is a list of common co-morbidities associated with fibromyalgia: | ||
*'''Gulf War Syndrome''' | *'''Gulf War Syndrome<ref name="four" />''' | ||
*'''Depression, anxiety< | *'''Depression, anxiety<ref name="five" />''' | ||
Adults with fibromyalgia are 3.4 times more likely to suffer from depression than those without the disorder.< | Adults with fibromyalgia are 3.4 times more likely to suffer from depression than those without the disorder.<ref name="two" /> | ||
*'''Interstitial Cystitis''' | *'''Interstitial Cystitis<ref name="five" />''' | ||
*'''Dysregulation Spectrum Syndrome(DSS)''': A term developed by Dr. Muhammad Yunis to include and describe the most common co-morbidities associated with fibromyalgia and how they are all inter-related. DSS includes the following: < | *'''Dysregulation Spectrum Syndrome(DSS)''': A term developed by Dr. Muhammad Yunis to include and describe the most common co-morbidities associated with fibromyalgia and how they are all inter-related. DSS includes the following:<ref name="three" /> | ||
''' -Chronic Fatigue Syndrome (CFS) <br> -Multiple Chemical Sensitivity Syndrome (MCS) <br> -Myofascial Pain Syndrome (MPS) <br> -Periodic Limb Movement during Sleep (PLMS) <br> -Restless Legs Syndrome <br> -Irritable Bowel Syndrome (IBS)<br> -Irritable Bladder<br> -Primary Dysmenorrhea<br> -Migraines <br> -Tension Headaches<br> -Temporomandibular Joint Dysfunction (TMJD)'''<br><br> | ''' -Chronic Fatigue Syndrome (CFS) <br> -Multiple Chemical Sensitivity Syndrome (MCS) <br> -Myofascial Pain Syndrome (MPS) <br> -Periodic Limb Movement during Sleep (PLMS) <br> -Restless Legs Syndrome <br> -Irritable Bowel Syndrome (IBS)<br> -Irritable Bladder<br> -Primary Dysmenorrhea<br> -Migraines <br> -Tension Headaches<br> -Temporomandibular Joint Dysfunction (TMJD)'''<br><br> | ||
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*[http://www.ambiencr.com/ Ambien], [http://www.lunesta.com/ Lunesta] and other sleep aids are prescribed to help with the sleep disorders common in those with fibromyalgia | *[http://www.ambiencr.com/ Ambien], [http://www.lunesta.com/ Lunesta] and other sleep aids are prescribed to help with the sleep disorders common in those with fibromyalgia | ||
*[http://www.drugs.com/amitriptyline.html Amitriptyline], [http://www.drugs.com/cyclobenzaprine.html Cyclobenzaprine] and others are prescribed to improve sleeping patterns, decrease pain and improve the effectiveness of the immune system. | *[http://www.drugs.com/amitriptyline.html Amitriptyline], [http://www.drugs.com/cyclobenzaprine.html Cyclobenzaprine] and others are prescribed to improve sleeping patterns, decrease pain and improve the effectiveness of the immune system. | ||
*Opiods ([http://www.drugs.com/oxycontin.html Oxycontin/Oxycodon], [http://www.drugs.com/vicodin.html Vicodin], [http://www.drugs.com/demerol.html Demerol], etc...) are prescribed to modulate moderate to severe pain.<br> | *Opiods ([http://www.drugs.com/oxycontin.html Oxycontin/Oxycodon], [http://www.drugs.com/vicodin.html Vicodin], [http://www.drugs.com/demerol.html Demerol], etc...) are prescribed to modulate moderate to severe pain.<br> | ||
== Diagnostic Tests/Lab Tests/Lab Values == | == Diagnostic Tests/Lab Tests/Lab Values == | ||
A diagnosis of fibromyalgia is generally made based upon the results of a physical examination and ruling out other similar conditions. It takes an average of 5 years from the time a person begins experiencing symptoms to the time they are diagnosed with fibromyalgia.<sup> | A diagnosis of fibromyalgia is generally made based upon the results of a physical examination and ruling out other similar conditions. It takes an average of 5 years from the time a person begins experiencing symptoms to the time they are diagnosed with fibromyalgia.<ref name="five" /><sup></sup>First, a candidate for the diagnosis has to be diagnosed with chronic pain. Chronic pain is described as pain that lasts for at least three months, pain that is both above and below the waist and pain that is present on both sides of the body.<ref name="five" /> In addition to the presence of chronic pain, as defined above, a patient should have at least 11 of 18 tender points illustrated below: | ||
[[Image:Paindiagram.jpg|center]][Diagram courtesy of MayoClinic.com. Available at [http://mayoclinic.com/health/medical/IM02372 http://mayoclinic.com/health/medical/IM02372]] | |||
<br> | |||
'''Administering the Physical Exam''': To determine whether or not a patient has any of the tender points illustrated above, a clinician will palpate the specified areas of the body with a force that is described as the amount of pressure that “causes the nail bed to blanch or start to become white”. If the patient reports pain, that point is deemed positive for one of the eighteen tender points. < | '''Administering the Physical Exam''': To determine whether or not a patient has any of the tender points illustrated above, a clinician will palpate the specified areas of the body with a force that is described as the amount of pressure that “causes the nail bed to blanch or start to become white”. If the patient reports pain, that point is deemed positive for one of the eighteen tender points.<ref name="three" /> | ||
== Causes == | == Causes == | ||
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The etiology of fibromyalgia is still being researched and exactly what causes the disorder remains unknown. There are, however, several potential causes and risk factors that are currently associated with the condition. | The etiology of fibromyalgia is still being researched and exactly what causes the disorder remains unknown. There are, however, several potential causes and risk factors that are currently associated with the condition. | ||
*'''Heredity''': Current research indicates that those with a family history of fibromyalgia are more likely to develop the condition than those without a genetic predisposition.< | *'''Heredity''': Current research indicates that those with a family history of fibromyalgia are more likely to develop the condition than those without a genetic predisposition.<ref name="two" /><ref name="five" /> | ||
*'''Stressful and/or Traumatic Events''': Psychological stress including but not limited to post traumatic stress disorder in addition to a myriad of other stressful events has been linked to the onset of fibromyalgia. < | *'''Stressful and/or Traumatic Events''': Psychological stress including but not limited to post traumatic stress disorder in addition to a myriad of other stressful events has been linked to the onset of fibromyalgia.<ref name="two" /><ref name="five" /> | ||
*'''Bodily Injury''': The onset of fibromyalgia has been linked with repetitive injuries as well as severe motor vehicle accidents and war injuries. < | *'''Bodily Injury''': The onset of fibromyalgia has been linked with repetitive injuries as well as severe motor vehicle accidents and war injuries.<ref name="two" /><ref name="five" /> | ||
*'''Infection''': Several infections have been potentially associated with the onset of fibromyalgia including hepatitis C, the Epstein-Barr virus, parovirus and [http://www.physio-pedia.com/index.php5?title=Lyme_Disease Lyme disease]. < | *'''Infection''': Several infections have been potentially associated with the onset of fibromyalgia including hepatitis C, the Epstein-Barr virus, parovirus and [http://www.physio-pedia.com/index.php5?title=Lyme_Disease Lyme disease].<ref name="two" /><ref name="five" /> | ||
*'''Disease''': The presence of autoimmune disorders has been associated with fibromyalgia, including [http://www.physio-pedia.com/index.php5?title=Rheumatoid_Arthritis Rheumatoid arthritis] and [http://www.physio-pedia.com/index.php5?title=Systemic_Lupus_Erythematosus Lupus]. < | *'''Disease''': The presence of autoimmune disorders has been associated with fibromyalgia, including [http://www.physio-pedia.com/index.php5?title=Rheumatoid_Arthritis Rheumatoid arthritis] and [http://www.physio-pedia.com/index.php5?title=Systemic_Lupus_Erythematosus Lupus].<ref name="two" /><ref name="five" /><br><br> | ||
== Systemic Involvement == | == Systemic Involvement == | ||
Revision as of 21:24, 2 March 2010
Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description[edit | edit source]
Fibromyalgia is a syndrome characterized by widespread chronic unabated pain in addition to a host of several additional co-morbidities that can severely impact and disrupt a person’s daily life. The symptoms associated with fibromyalgia stem from abnormal sensory processing believed to originate in the muscle and ultimately lead to the chronic pain and paresthesias experienced by those with the disorder.[1]
Prevalence[edit | edit source]
The prevalence of fibromyalgia ranges from 2-6% of the population.[1][2] Fibromyalgia is more prevalent among women and the vast majority of those with fibromyalgia are women. Below are the prevalence and percentage of fibromyalgia patients distributed between the sexes:
Prevalence: Women (3.4%) Men (0.5%)[2]
Percentage of Fibromyalgia Patients: Women (75-90%) Men (10-25)[1]
Although most diagnoses of fibromyalgia are made during middle-age, prevalence of the disorder increases with age.[2]
Characteristics/Clinical Presentation[edit | edit source]
Those with fibromyalgia can present with a host of symptoms that can make diagnosing the disorder difficult. Below is an extensive but not exclusive list of common patient symptoms and presentations created from several sources:
- Morning stiffness[2][3]
- Tingling or numbness in hands and feet[2][3]
- Headaches, migraines[2][3][4]
- Constipation, diarrhea[2][3][4]
- Thinking and memory abnormalities (“fibro fog”)[2][3][4][5]
- Painful menstrual periods[2][3][4]
- Fatigue[3][4][5]
- Trouble sleeping[3][4][5]
- Jaw Pain[3][4]
- Abnormal muscle pain and malaise after exercise[3][4]
- Dizziness or lightheadedness[3][4]
- Skin and chemical sensitivities[3][4]
- Deep, aching, throbbing, shooting, radiating, stabbing pain[4][5]
- Non-cardiac chest pain, heart palpitations, shortness of air, profuse sweating[4]
- Feeling of swollen extremities[4]
- Sensitivities to all the senses (loud noises, bright lights, some foods, odors, etc…)[4]
- Feelings of depression, anxiety[5]
The percentage of people with fibromyalgia who have reported specific symptoms is illustrated below:
[Chart courtesy of Fibrocenter.com. Available at http://fibrocenter.com/fibromyalgia-symptoms.aspx.]
The following have been associated with aggravating the above symptoms:[4]
- Changes in weather
- Cold environments
- Hormonal fluctuations
- Stress, depression, anxiety
- Physical over-exertion
In addition to the above physical symptoms associated with fibromyalgia, the patient’s quality of life of is also a consideration as quality of life outcome measures can add to the clinical presentation. It has been reported that those with fibromyalgia have scored the lowest on 7 of 8 subscales on the SF-36 outcome measure in contrast to patients with other chronic diseases.[2] More information on the SF-36 is available at http://www.sf-36.org/. The same source revealed that fibromyalgia patients reported an average score of 4.8/10 with 1 being the lowest and 10 being the highest regarding their perceived “present quality of life.”[2]
Associated Co-morbidities[edit | edit source]
Those with fibromyalgia are likely to present with several co-morbidities. In fact, the vast majority of those with the disorder report the presence of overlapping conditions. Because the presence of additional disorders is so common in those with fibromyalgia it is important that a diagnosis of fibromyalgia not be overlooked given the presence of additional co-morbidities that are more predictable and much easier to diagnose. Below is a list of common co-morbidities associated with fibromyalgia:
Adults with fibromyalgia are 3.4 times more likely to suffer from depression than those without the disorder.[2]
- Interstitial Cystitis[5]
- Dysregulation Spectrum Syndrome(DSS): A term developed by Dr. Muhammad Yunis to include and describe the most common co-morbidities associated with fibromyalgia and how they are all inter-related. DSS includes the following:[3]
-Chronic Fatigue Syndrome (CFS)
-Multiple Chemical Sensitivity Syndrome (MCS)
-Myofascial Pain Syndrome (MPS)
-Periodic Limb Movement during Sleep (PLMS)
-Restless Legs Syndrome
-Irritable Bowel Syndrome (IBS)
-Irritable Bladder
-Primary Dysmenorrhea
-Migraines
-Tension Headaches
-Temporomandibular Joint Dysfunction (TMJD)
Medications[edit | edit source]
Prescription medication therapies are available for those with fibromyalgia. Lyrica, Cymbalta and Savella are FDA-approved to treat the disorder. However, because fibromyalgia includes an array of co-morbidities, there are several additional prescription medication options:
- Ambien, Lunesta and other sleep aids are prescribed to help with the sleep disorders common in those with fibromyalgia
- Amitriptyline, Cyclobenzaprine and others are prescribed to improve sleeping patterns, decrease pain and improve the effectiveness of the immune system.
- Opiods (Oxycontin/Oxycodon, Vicodin, Demerol, etc...) are prescribed to modulate moderate to severe pain.
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
A diagnosis of fibromyalgia is generally made based upon the results of a physical examination and ruling out other similar conditions. It takes an average of 5 years from the time a person begins experiencing symptoms to the time they are diagnosed with fibromyalgia.[5]First, a candidate for the diagnosis has to be diagnosed with chronic pain. Chronic pain is described as pain that lasts for at least three months, pain that is both above and below the waist and pain that is present on both sides of the body.[5] In addition to the presence of chronic pain, as defined above, a patient should have at least 11 of 18 tender points illustrated below:
[Diagram courtesy of MayoClinic.com. Available at http://mayoclinic.com/health/medical/IM02372]
Administering the Physical Exam: To determine whether or not a patient has any of the tender points illustrated above, a clinician will palpate the specified areas of the body with a force that is described as the amount of pressure that “causes the nail bed to blanch or start to become white”. If the patient reports pain, that point is deemed positive for one of the eighteen tender points.[3]
Causes[edit | edit source]
The etiology of fibromyalgia is still being researched and exactly what causes the disorder remains unknown. There are, however, several potential causes and risk factors that are currently associated with the condition.
- Heredity: Current research indicates that those with a family history of fibromyalgia are more likely to develop the condition than those without a genetic predisposition.[2][5]
- Stressful and/or Traumatic Events: Psychological stress including but not limited to post traumatic stress disorder in addition to a myriad of other stressful events has been linked to the onset of fibromyalgia.[2][5]
- Bodily Injury: The onset of fibromyalgia has been linked with repetitive injuries as well as severe motor vehicle accidents and war injuries.[2][5]
- Infection: Several infections have been potentially associated with the onset of fibromyalgia including hepatitis C, the Epstein-Barr virus, parovirus and Lyme disease.[2][5]
- Disease: The presence of autoimmune disorders has been associated with fibromyalgia, including Rheumatoid arthritis and Lupus.[2][5]
Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Recent Related Research (from Pubmed)[edit | edit source]
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Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 1.2 National Fibromyalgia Association Website. About Fibromyalgia. Available at: http://www.fmaware.org/site/PageServer?pagename=fibromyalgia_affected. Accessed 3/1/2010.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 Centers for Disease Control and Prevention Website. Fibromyalgia. Available at: http://www.cdc.gov/arthritis/basics/fibromyalgia.htm. Accessed on 3/1/2010
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 Fibromyalgia Network Website. Available at: http://www.fmnetnews.com. Accessed on 3/1/2010.
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 The American Fibromyalgia Syndrome Association, Inc. Website. What is Fibromyalgia. Available at: http://afsafund.org/fibromyalgia.html. Accessed on: 3/1/2010.
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 Fibrocenter.com Website. Available at: http://fibrocenter.com. Accessed on: 3/1/2010.
