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PT Students

on 31 May 2013

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Transcript of Fibromyalgia

FIBROMYALGIA WHAT IS IT?? * Chronic pain syndrome What are the most common Symptoms?? Immune system abnormalities * Hypersensitivity to touch * Widespread tender points * Pain must be felt for at least 3 months, and tender points must be present in 11out of 18 locations * Fatigue * Problems with sleeping * Anxiety * Depression Other Symptoms include * Tingling & Numbness in hands and feet * Digestive problems * Bowel and bladder issues * Sensitivity to touch, light and sound * Fibro Fog * Muscle Weakness and Stiffness * Chronic widespread pain * Tender points * NT's that process pain are increased substance P * NT's that inhibit pain are decreased Seratonin
Epinephrine * Stress level hormones are decreased Norepinephrine
Cortisol * Low levels of IGF-1 * Low levels of growth hormone * Brain scans show a decrease in blood flow to parts of the brain that modulate pain signals * Can be confused with Rheumatoid arthritis and Lupus Decreased phosphocreatine
Decreased ATP Overly thickened capillaries * Pain in neck, low back, knees & elbows * Waddell Signs Tenderness
Stimulation test
Distraction test
Regional disturbances
Overreaction * Symptoms for 5 mo but diagnosed recently By: Team Awesome AKA- Jonathan Amato
Carolyn Humphrey
Cindy Bagadiong
Jaime Rosero Etiology ?? * For the most part the etiology is unknown, however there are several factors that may predispose an individual to the disease Things like.. Frequency in surveyed population Demographics Race and Ethnicity Duration of Symptoms Number of children Marital Status An overview * Caucasian 91.5%
* Afro-American 2.3%
* Asian 0.4%
* Hispanic 2.6% Less than 7 months 0.6%
7-12 months 1.5%
1-2 years 3.9%
2-4 years 13.1%
>4 years 75.5% Currently married 64.2%
Never married 11.2%
Divorced 17.4%
Widowed 2.5% None 26.5%
One 16.5%
Two 30.5%
Three or more 20.9% But thats not all!!! Prevalence and Incidence * About 2% or 5 Million adults in 2005 in the US
* Much higher prevalence in women(3.4%) than men(0.5%)
* Mainly middle aged over the age of 50
* Working adults average 17 days of work missed per year due to the disease, compared to 6 days for persons without Fibromyalgia * Incidence of fibromyalgia has been poorly defined and CDC has minimal data
* However a study done by the University of Utah showed a total of 2595 incident cases of fibromyalgia between 1997 and 2002, in which;
Males: 6.88 cases per 1,000 person-years
Females: 11.28 cases per 1,000 person-years Patients with fibromyalgia were 2.14-7.05 times more likely to develop one of the following co-morbid conditions
* Depression
* Anxiety
* Headache
* Chronic fatigue syndrome
* Lupus
* Rheumatoid arthritis How does this pertain to our patient??? Our patient is:
Middle aged
Sedentary Since depression is linked to fibromyalgia patients we need to closely monitor our patient Social complications??? Neurotransmitters & Hormones What is happening in the body? What is a neurotransmitter? * Muscle abnormalities What our patient presents with.. Treatment options? * FDA approved medications A) Lyrica (pregabalin) - Approved in 2007 - Side effects: sleepiness, dizziness, weight gain, difficulty concentrating, blurry vision, swelling of hands and feet, and dry mouth. Allergic reaction is rare but possible B) Cymbalta (Duloxetine Hydrochloride) - Approved in 2008 - Side effects: nausea, dry mouth, sleepiness, constipation, decreased appetite, and increased sweating. Additionally, increased thoughts of suicide in those who are taking the Cymbalta for depression, including those with fibromyalgia who suffer from depression, occur. Other Drugs.. Tri-cyclic antidepressants
-Imipramine Serotonin and Norepinephrine Reuptake Inhibitors -Venlafaxine
-Milnacipran Selective Serotonin Reuptake Inhibitors (SSRIs) -Fluoxetine
-Paroxetine Opioids αAlpha2-Delta Ligands -Pregabalin
-Gabapentin Non- Pharmacological ?? Food Supplementation *Anthocyanidins
-Flavonoid derived from plants
-Found in:Black tea, red wine, grape seed, billberries and cranberries
-Recommended dosage is 80mg/day
-May improve pain, fatigue and sleep disturbance

*Chlorella Pyrenoidosa
-Phytonutrient derived from freshwater blue-green alga.
*Vegetarian Diet
*Vegan Diet Dietary Supplements - Super Malic
- SAMe
- St. Johns Wart
- Melatonin
- Probiotics Physical Therapy
Interventions Ultrasound Transcutaneous Electrical Nerve Stimulation (TENS) Exercise Manual Therapy Superficial heat Sound waves of more than 20,000Hz - Absorbed by tissues differently based on protein content- Possible to heat deep structures such as joints, muscles and bone-Increases blood flow, membrane permeability and capillary density in muscle tissue - Low frequency vs high frequency - Low intensity vs high intensity - High frequency,low intensity vs
low frequency, high intensity - Strength training
- Aerobic conditioning
- Stretching - Connective tissue manipulation -Hot pack
-Wool What does this mean for our patient?? How can we help? As therapists we would...... Get to know our patient and what Medications she is on Patient Education - Inform our patient about possible supplementation - Inform her on the current theories on physiological changes associated with fibromyalgia Treatment options for in clinic and at home At Home In clinic Intervention options - TENS
-Strength training
- Heat therapy - Ultrasound
- Hot pack
- Parafin wax - Flexibility training - Aerobic training Home exercise program (HEP) - Stretching
- Strengthening
- Aerobic exercise
- Use of a portable TENS unit
- Superficial heat Are there other options??? Is there anything else she can do?? Alternative medicines - Yoga
- Tai-Chi
- Qi gong
- Acupuncture
- Lymph drainage
- Balneotherapy
- Biofeedback
- Reiki
- Pilates * Genetic predisposition
* Traumatic Experiences
* Personality type
* Lifestyle choices
* Previous episodes of depression
* Viral infection
* Surgery
* Emotional or physical stress
* Exposure to drugs or chemicals * Headaches
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