Fibromyalgia Past Paper PDF 2021

My eyelashes and tips of my hair are the only parts of me that don't hurt.” Who gets FM? Women > 50 y and low SES Those with autoimmune disease are at...

My eyelashes and tips of my hair are the only parts of me that don't hurt.” Who gets FM? Women > 50 y and low SES Those with autoimmune disease are at higher risk Durstine Ch: 23 Busch et al. (2011) Curr Pain Headache Rep 15: 358 - 367  Pathology of FM PATHOPHYSIOLOGY OF FM Pathophysiology of FM Loading… No diagnosis tests - official American College of Rheumatology criteria for fibromyalgia  POSSIBLE CAUSES OF FM Genetic susceptibility to: · Microtrauma of musculature Neurohormonal dysfunction Genetic susceptibility to: Microtrauma of musculature Polymorphisms of monoamines (NT for Neurohormonal dysfunction Polymorphisms of monoamines (NT for sensory processing & responding to stress) sensory processing & responding to stress) Peripheral mechanisms Abnormalities w/i skeletal muscle Immunological Peripheral mechanisms Infections (EBV, Lyme disease) Issues with CNS structures (thalamus, caudate nucleus) – low pain thresholds Abnormalities w/i skeletal muscle Immunological Infections (EBV, Lyme disease) Issues with CNS structures (thalamus, caudate nucleus) – low pain thresholds  POSSIBLE CAUSES OF FM Central mechanisms Electroencephalographic Central mechanisms Electroencephalographic (EEG) abnormalities (EEG) abnormalities Hypothyroidism HPA axis Physical trauma Neuroendocrine abnormalities Loading… Accidents, certain catastrophic events (war) Psychological trauma Hypothyroidism HPA Central axis mechanisms Electroencephalographic (EEG) abnormalities Physical trauma Neuroendocrine abnormalities Hypothyroidism HPA axis Accidents, Physical traumacertain catastrophic Accidents, certain catastrophic events (war) events (war) Psychological trauma Psychological trauma  Secondary Fibromylagia SECONDARY FIBROMYALGIA Physical injury Physical Injury Ankylosing spondylitis Ankylosing Surgery spondylitis · Lyme disease Surgery Hepatitis C Lyme Disease Hepatitis C  DIAGNOSIS Diagnosis for FM FOR FM American American College college of of Rheumatology Rheumatology (ACR) (ACR) published criteria published criteria (19902, 2010, 2011, 2016) Widespread Widespread Pain Index Pain Index(WPI) (WPI)- 19 areas Symptom Severity Scale (SS) – 12 areas Symptom Severity Scale (SS) – 12 areas Fatigue, sleep disturbances, cognition, and somatic complaints need 7 points on this scale Need 5 on this scale to qualify as FM  DIAGNOSIS FOR FM 1. 7/19 WPI and of 5/12 SS OR 3–6/19 WPI and 9/12 SS American College of Rheumatology (ACR) published criteria (19902, 2010, 2011, 2016) Widespread Pain Index (WPI)- 19 areas Symptom Severity Scale (SS) – 12 areas 2. Presence of generalized pain (defined as pain in at least 4 of 5 regions) AND 3. Experiencing for least 3 mo AND 4. Absence of another disorder that could explain the pain. # DIAGNOSIS FOR FM * FYI 2016 Revisions Loading…  MEDICAL MANAGEMENT OF Medical Management of FM FM Pain reduction, promote sleep, depression (mood) Pain reduction, promote sleep, depression (mood) Medications Medications No evidence if NSAIDs work, but acetaminophen’s (Tylenol) Chronic pain meds (anticonvulsants) Prevailing (Lyrica) - first drug approved by FDA (anti-epileptic), gabapentin No evidence if NSAIDs work but acetaminophens (Tylenol) Antidepressants Chronic pain meds (anticonvulsants) Pregabalin (Lyrica) – 1st drug approved by FDA (anti-epileptic), Pain reduction, promote sleep, depression (mood) gabapentin Medications No evidence if NSAIDs work but acetaminophens (Tylenol) Antidepressants Chronic pain meds (anticonvulsants) Pregabalin (Lyrica) – 1st drug approved by FDA (anti-epileptic), gabapentin Antidepressants Tricyclic Tricyclic antidepressants (amitryptiline) antidepressants (amitryptiline) Cymbalta, Savella- FDA approved Serotonin-norepinephrine reuptake inhibitors (duloxetine) Cymbalta, Savella- FDA approved brain NTs – serotonin & norepinephrine Serotonin-norepinephrine reuptake inhibitors (duloxetine) brain NTs – serotonin & norepinephrine  THE EFFECT OF FIBROMYALGIA The effect of FM on Exercise ON EXERCISE Less active bc of pain - what does this lead due Less active b/c of pain – what does this lead due? Decrease in neuromuscular, cardiorespiratory, muscular strength/endurance & flexibility (Less ROM)  THE EFFECT OF EXERCISE ON FIBROMYALGIA (TABLE 3 BUSCH) Improvement in flexibility, neuromuscular, CV, function IMprovement in flexibility, neuromuscular, CV function Improvement in pain & disease symptoms · Improvement in flexibility, neuromuscular, CV, function Improvement in pain & disease symptoms Effects Effects ofonexercise of exercise on “fibrofog” “fibrofog” (cognitive function)? (cognitive function)? Some show no improvement in memory, attention (light resistance exercise) Some show no improvement in memory, attention (light resistance Used in conjunction with medical management Both aerobic and strength training alleviates pain, fatigue, depression, & QoL exercise) Resistance training improves pain, tenderness, depression and overall well being Mixed (aerobic, strength & flexibility): Improvements in pain and function Used in conjunction with medical management Both aerobic and strength training alleviates pain, fatigue, depression, & QoL Resistance training improves pain, tenderness, depression and overall well being Mixed (aerobic, strength & flexibility): Improvements in pain and function EFFECT OF EX ON FM: BUSCH Effect of Ex on FM: Busch most effective X  Ex EXERCISE TESTING & FM AND FM Testing Before Before Test Test Determine best time of day when to administer the test & if test needs to be split up Administer Fibromyalgia Impact Questionnaire (FIQ- Revised) Determine cognition level Educate: Difference between normal fluctuations in pain and fatigue w/ exercise (muscle soreness) vs fibromyalgia symptoms. FIBROMYALGIA IMPACT Notfested Fibromyalgia Impact Questionnaire on this QUESTIONNAIRE  EXERCISE TESTING ASTRAND (OR MODIFIED) CYCLE SUBMAX ERGOMETER TEST P. 80-82 GETP 6 min 6 min 50rpm 50rpm Workload Workload is dependent isdependentsex& fitness level on HRupon goalsex : and fitness level 125-170 bom HR goal: 125-170bpm HR measured HR is measured during the 6th minute during 5th & 6th Average min. of 2 HRs & estimate VO2max Average of 2 HRs & estimate VO2max from nomogram Then, VO2max is adjusted for age by multiplying VO2max w/ correction factor.  Astrand Nomogram ASTRAND NOMOGRAM at linkon website Ov = 1. 9 * look Woman exercising at 450 kpm/min; canvas avg HR = 164 bpm Ex at 450Kyre/min exercising : Woman augHtR /Byr= Correction factor is needed & depends on age (p. 82be GETP) and nomogram able to read line - Multiply the VO2max by correction factor fortest factor dependent https://www.youtube.com/watch? Correction orage v=0tz25ogjBuQ Extesting EXERCISE&TESTING FM AND FM Modified Astrand or modified astrand and lear body , and.based Astrand mass Leanstrand a body. Mass- , based Astrand or other submax cycle ergometer tests  LeanBodymass Astrand LEAN BODY MASS-BASED ASTRAND Cycle Cycleat. Sw/kg of COM 0 W/kg LBM at 0.5 at a constant rate of 60 at yeaDoOymass) rpm.a constant out of GORP After After2 2mins min ↑↑ Workload workloadtoto 1 1.5. S W/kgLOM /Ky LBM. If the If the HRHR isis-100pm < 120 bpm, ↑ ↑Workload workload byby Sw/kg 0.5 W/kg comLBM every 2every mirs 2 min. , OrceHRiS Once HR > 120 bpm, cycle for 6 min atFixed fixed workload til steady XzoDym , Cycleforminat state phase (HR did not vary more than ±5 bpm) duringthathe final 2 Workload til The meanphase sirady min of exercise. Statu (HR does not HR during the final 2vary more I Sypm) min of exercise during was the final 2 min of exercise calculated. glot Plot EXERCISE TESTING AND FM Astrand or modified Astrand or other submax cycle ergometer tests 5’, 6’, or 10’ walk tests Shuttle walk test Be careful of weight bearing exercises (TM) Depression?; high levels of motivation is needed. How? Dolorimeter Monitor pain and fatigue continuously Strength and flexibility tests BORG CR 10 SCALE  Exercise Testing and FM Visual Numeric Pain Scale FIGURE 11.1. Visual numeric pain scale. (Reprinted with permission from.) 205. Ritter PL, Gonzalez VM, Laurent DD, Lorig KR. Measurement of pain using the visual numeric scale. J Rheumatol. 2006;33(3):574–80.  EX RX FOR FIBROMYALGIA Ex RX for Fibromyalgia  NEW INTERVENTIONS FOR EX & FM NEw intervention for ex & FM TaiTai chi,chi, gonggong, yoga, Nordic walking, vibration Twice weekly Increase in SF-36 (physical & mental health survey) Pilates Possibly  CONSIDERATIONS Considerations of Ex and FM OF EX AND FM Adverse effects of exercise Adverse effects of exercise Increased symptoms (pain, stiffness, fatigue) symptoms (pain, stiffness, fatigue) Increased musculoskeletal problems (plantar fasciitis, impingement syndrome) musculoskeletal problems (plantar fasciitis, impingement syndrome) Associated low compliance Associated low compliance Knowing this – how would you design your program so as to have high compliance?