Notes

MY NOTES ON FIBROMYALGIA FROM TEGRITY
Fibromyalgia (slides 137-147)
chronic disorder characterized by widespread nonarticular (not in the joints) musculoskeletal pain, fatigue, and multiple tender points. People with this also experience nonrestorative (not feeling rested) sleep, morning stiffness, irritable bowel syndrome, and anxiety. Commonly diagnosed.
A lot of people have this. It is a major cause of disability. 75-90% of those diagnosed are women. Identifying the underlying causes is heavily researched. No one really knows what causes it, but they generally agree that it involves neuroendocrine and neurotransmitter dysregulation.
It is characterized by pain amplification. A small injury causes severe pain. They think this is due to abnormal sensory processing in the central nervous system.

There are multiple physiological abnormalities.
-There is increased level of substance P in the spinal fluid (a small peptide that transmits pain signals),
-low levels of blood flow to the thalamus,
-dysfunction of hypothalamic-pituitary-adrenal (HPA) axis. This has to do with mental health, so they will have mental health issues,
-low levels of serotonin (regulation of mood) and tryptophan (helps make a person sleepy). These low levels make you likely to suffer from depression and sleep disorders.
-abnormalities in cytokine function.

There are believe genetic factors because it seems to run in families. Can be triggered by recent illness or trauma in susceptible people.

Clinical Manifestations and Complications
-widespread burning pain
-worsens and improves throughout the day for no reason
-difficult to discriminate if pain is in muscles, joints, or soft tissues (hard to tell where pain is) they get stiff and painful neck and shoulder muscles and that sometimes causes head and facial pain.
-They also have TMJ dysfunction. (temperomandibular joint)
-Cognitive effects (memory lapses or overwhelmed feeling with a small number of tasks)
-Migraine headaches
-Depression and anxiety (treated with drugs)
-anti depressants and antianxiety
-stiffness and nonrefreshing sleep
-fatigue
-numbness or tingling in the hands or feet (paresthesia)
-Restless leg syndrome (common) they just have an irresistible urge to move their legs when they're at rest
-Irritable bowel syndrome (constipation and/or diarrhea, abd pain and/or bloating)
-Difficulty swallowing
-Increased frequency of urination and urgency without having a UTI
-Women with fibromyalgia often have a more difficult menustration and the disease is worsened during menustration

Diagnostic Studies
Fibromyalgia is really hard to diagnose because there are no tests that specifically diagnose someone. Instead, labs are used to rule out other suspected disorders. If we know what it isn't, it makes us more sure of what it is.
Sometimes there is a low ANA titer.
A muscle biopsy may show a moth eaten appearance or fiber atrophy. But even that isn't diagnostic.
The way they diagnose depends on two criteria:
-a person has pain in 11 of the 18 tender spots after being touched
-a history of widespread pain (no specific spot) of at least three months
Also, they take into consideration the history of fatigue and cognitive symptoms in establishing the diagnosis.

Treatment
symptomatic. We treat symptoms.
Teach the patient about their medications, R&R because it can help pain aching and tenderness

Drug Therapy
Chronic pain: pregabalin (lyrica), dulaxetine (cymbalta), milnacipin (savella)
low dose antidepressants: valium, elevil, dezeril, zoloft.
muscle relaxants: flexeril
they avoid long acting opioids because it is a chronic disorder. they will become immune to the opioids over time, so they try tylenol and motrin as long as they can.
sometimes they prescribe ambien for sleep

Nursing Management
Because it is chronic, the pt will have many healtcare team members, supportive care is important.
Who would their healthcare members be?
nurse, hcp, pharmicist, mental health person, counselor, physical therapist

Non-drug therapy
social issues, may not be able to work, suppot them with this
may need ways to help preserve their energy and enable them to get proper rest. teach them relaxation methods
Sometimes massage is combines with ultrasound
sometimes alternation heat and cold packs
-soothes muscles and helps blood circulation
gentle muscle stretching
-relieves tension
yoga/tai chi
-promotes stretching and relaxation
low impact aerobic exercise like walking is encouraged.
-not jogging
They should limit sugar, caffeine, and alcohol because they are known muscle irritants.
They sometimes are prescribed vitamin and mineral supplements, especially those that support the immune system
the pain can cause significant stress and because of the cognitive disorders that can go along with it, they may not be able to deal with that stress well, so we teach them relaxation techniques and sometimes counseling helps.


MS. MILLS' END OF LECTURE NOTES REVIEW ON FIBROMYALGIA
What do you see with fibromyalgia? how to diagnose
tender points (18)
-any 11 is diagnostic
-widespread, burning pain of three months or more

other things we see with this?
-nonrestorative sleep
-morning stiffness
-irritable bowel syndrome
-anxiety
-abnormal processing of pain response in CNS
-fatigue

How do we treat it?
treat the symptoms with NSAIDs, ambien, antidepressants, lyrica, muscle relaxers
Pain control with heat and cold applications
cold application uses? swelling, inflammation, and pain
heat application uses? soreness and stiffness (warm towel, warm shower/tub, teach pt saftey. do not burn yourself with heating pad or water that is too hot)

QUESTIONS ON FIBROMYALGIA
1.)What is fibromyalgia?
chronic disorder characterized by widespread nonarticular (not in the joints) musculoskeletal pain, fatigue, and multiple tender points.

2.) Who does this disorder affect?
75-90% of those diagnosed are women.

3.) What causes fibromyalgia?
Identifying the underlying causes is heavily researched. No one really knows what causes it, but they generally agree that it involves neuroendocrine and neurotransmitter dysregulation. Also thought to be genetic because it does run in families.

4.) Major disease characterization?
pain amplification. A small injury causes severe pain. They think this is due to abnormal sensory processing in the central nervous system.

5.) What are the physiological abnormalities?
-There is increased level of substance P in the spinal fluid (a small peptide that transmits pain signals),
-low levels of blood flow to the thalamus,
-dysfunction of hypothalamic-pituitary-adrenal (HPA) axis. This has to do with mental health, so they may have mental health issues,
-low levels of serotonin (regulation of mood) and tryptophan (helps make a person sleepy). These low levels make you likely to suffer from depression and sleep disorders.
-abnormalities in cytokine function. (she did not elaborate on this, so idk what it means) (sorry niggas)

6.) What are the clinical manifestations and complications
-widespread burning pain
-worsens and improves throughout the day for no reason
-difficult to discriminate if pain is in muscles, joints, or soft tissues (hard to tell where pain is) they get stiff and painful neck and shoulder muscles and that sometimes causes head and facial pain.
-They also have TMJ dysfunction. (temperomandibular joint)
-Cognitive effects (memory lapses or overwhelmed feeling with a small number of tasks)
-Migraine headaches
-Depression and anxiety
-stiffness and nonrefreshing sleep
-fatigue
-numbness or tingling in the hands or feet (paresthesia)
-Restless leg syndrome (common) they just have an irresistible urge to move their legs when they're at rest
-Irritable bowel syndrome (constipation and/or diarrhea, abd pain and/or bloating)
-Difficulty swallowing
-Increased frequency of urination and urgency without having a UTI
-Women with fibromyalgia often have a more difficult menustration and the disease is worsened during menustration

7.)What are the diagnostic studies?
Fibromyalgia is really hard to diagnose because there are no tests that specifically diagnose someone. Instead, labs are used to rule out other suspected disorders. If we know what it isn't, it makes us more sure of what it is.
Sometimes there is a low ANA titer.
A muscle biopsy may show a moth eaten appearance or fiber atrophy. But even that isn't diagnostic.
The way they diagnose depends on two criteria:
-a person has pain in 11 of the 18 tender spots after being touched
-a history of widespread pain (no specific spot) of at least three months
Also, they take into consideration the history of fatigue and cognitive symptoms in establishing the diagnosis.

8.) What is the drug therapy for fibromyalgia?
Chronic pain: pregabalin (lyrica), dulaxetine (cymbalta), milnacipin (savella)
low dose antidepressants: valium, elevil, dezeril, zoloft.
muscle relaxants: flexeril
they avoid long acting opioids because it is a chronic disorder. they will become immune to the opioids over time, so they try tylenol and motrin as long as they can.
sometimes they prescribe ambien for sleep

9.) Who does "Collaborative Care" consist of?
Because it is chronic, the pt will have many healtcare team members, supportive care is important.
Who would their healthcare members be?
nurse, hcp, pharmicist, mental health person, counselor, physical therapists

10.) What are the non-drug treatments and patient teaching?
social issues, may not be able to work, suppot them with this
may need ways to help preserve their energy and enable them to get proper rest. teach them relaxation methods
Sometimes massage is combines with ultrasound
sometimes alternation heat and cold packs
-soothes muscles and helps blood circulation
gentle muscle stretching
-relieves tension
yoga/tai chi
-promotes stretching and relaxation
low impact aerobic exercise like walking is encouraged.
-not jogging
They should limit sugar, caffeine, and alcohol because they are known muscle irritants.
They sometimes are prescribed vitamin and mineral supplements, especially those that support the immune system
the pain can cause significant stress and because of the cognitive disorders that can go along with it, they may not be able to deal with that stress well, so we teach them relaxation techniques and sometimes counseling helps.