Pain, stiffness, & exhaustion

What are the general clinical manifestations of fibromyalgia?

General aches & pains; articular pains with possible joint tenderness; subjective feeling of swelling (worse in the morning); stiffness lasting 1 hour in morning; muscle weakness w/out atrophy

What are the rheumatic symptoms associated with fibromyalgia?

Neurasthenia; anxiety; depression; sleep disturbances; IBS; premenstrual syndrome; numbness; nocturia/fluid retention; palpitations; mottled skin/flushing; temperature instability

What are the non-rheumatic symptoms associated with fibromyalgia Extra resources?

Skin fold tenderness; reactive hyperemia; widespread local tenderness; jump sign; fibrositic nodules; ↓ grip strength w/out atrophy

What are the physical findings exhibited by fibromyalgia?

Reactive hyperemia

Redness after stroking skin lightly.

Jump sign

A trigger point elicits such a pronounced response that the patient jumps.

Fibrositic nodules

Feels like a palpable nodule to the patient but is rarely felt by the examiner.

Subjective aching ≥3 months; subjective stiffness ≥3 months; local point tenderness in >11 of 18 sites

What are the major criteria in the diagnosis of fibromyalgia?

Radiating pain

What is the only type of pain that should be produced by a tender point upon palpation?

Allodynia & hyperalgesia

What are the two key features of fibromyalgia?

Allodynia

Pain response to a non-noxious stimulus.

Hyperalgesia

Exaggerated response to painful stimulus.

Trigger point

Tender point that, either spontaneously or following direct pressure, causes radiating pain, paresthesias, & autonomic symptoms.

Trauma; stress; preceding infection

Aside from genetics, what are the triggers (inciting events) for fibromyalgia?

Routine chemistries, CBC, ESR, TSH, Vitamin D (25-OH) levels, muscle enzyme levels, ANAs

What are the typical laboratories that are ordered in trying to rule out other conditions that might mimic fibromyalgia?

CT diseases (RA, SLE, etc); hypothyroidism; psychogenic rheumatism; Paget's disease; cervical/lumbar syndromes; occult/overt neoplasm; DM w/neuropathies

What are some common mimics of fibromyalgia?

30%

What percentage of patients with fibromyalgia have (+) ANAs?

No

Do fibromyalgia patients with (+) ANAs progress to develop other CT disorders?

Explanation of disease, job modification (to avoid repetitive activities), physical therapy (weight loss, abdominal support exercises, posture training), heat therapy (ultrasound, hot packs), exercise

What does the 1st phase of treating fibromyalgia involve?

NSAIDs & muscle relaxants; lidocaine injection into tender points +/- steroids

What type of medications are used in the first phase of treatment?

Sleep induction; morning energy boost; pain modulation; ↑ cerebral blood flow

What does the second phase of treating fibromyalgia involve?

TCAs or benzodiazepines

What drugs are used to induce sleep in the treatment of fibromyalgia?

SSRIs

What drugs are used as a morning energy boost in the treatment of fibromyalgia?

SNRIs & anticonvulsants

What drugs are used for pain modulation in the treatment of fibromyalgia?

Stimulants like modafinil

What drugs are used to ↑ cerebral blood flow in the treatment of fibromyalgia?

Other analgesics, acupuncture, biofeedback

What does the third phase of treating fibromyalgia involve?

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