Download FIBROMYALGIA SYNDROME

FIBROMYALGIA SYNDROME
by. Gari Glaser
What is Fibromyalgia?
 It is defined as a widespread
musculoskeletal pain and fatigue disorder
for which the cause is still unknown.
 FIBROMYALGIA is derived from the latin
roots –
“fibros” = fibrous tissue
“myo” = muscle
“al”
= pain
“gia” = condition of
A few things to ponder.
 FMS is most common in people between the ages
of 20 and 50.
 This disorder affects more women than men.
 Up to 5% of the population is affected.
 Nearly everyone with FMS exhibits reduced
coordination skills and decreased endurance
abilities.
 You may also hear it called: fibrositis, fibromyositis,
myofascial pain syndrome or psychogenic
rheumatism.
 It is NOT considered life threatening and does NOT
cause permanent damage.
What are the symptoms?
 Defining symptom is
pain in the connective
tissues of the body
such as:
 muscles
 tendons
 ligaments
Where is the pain felt?
 Patients complain of
pain in the:





Neck
Back
Shoulders
Pelvic girdle
Hands
 Note:
• Fibromyalgia symptoms are different from rheumatoid
arthritis and osteoarthritis because they do NOT involve
the joints.
Symptoms.
 Generalized
achiness most often
in axial locations,
accompanied by
stiffness that tends to
be worse in the
morning.
More Symptoms.
 Some patients may
experience a strong
sensitivity to:




odors
sounds
lights
vibration that others
don’t even notice
 Patients with FMS may at times interpret touch, light or
even sound as pain.
Aggravating Factors.
 The condition may be
aggravated or brought
on by things such as:
 cold or humid weather
 physical or mental
fatigue
 excessive physical
activity
 anxiety or stress
Additional problems.
Patients can experience additional
problems associated with FMS, including:
 irritable bowel syndrome
 tension headaches, beginning with neck
discomfort
 parasthesia (sensation of numbness or
tingling) of upper extremities with normal nerve
conduction studies
 sensation of edematous hands with no visible
edema
 sleep disturbances
How is it diagnosed?
Currently there are no lab tests available
for diagnosing this condition.
Diagnosis depends on self-reported
symptoms, a physical exam and an
accurate manual tender point exam.
Diagnosing a patient.
 It can only be diagnosed
after other diseases with
similar symptoms are
ruled out and the
individual experiences:
 widespread pain in all 4
quadrants of the body for
a minimum of 3 months
 tenderness or pain in at
least 11 of the 18
specified tender points
when pressure is applied
Something interesting.
A physician may perform a blood
chemistry screening, a complete blood
count or an erythrocyte sedimentation
rate, and they will all be NORMAL in
patients with FMS.
A sleep study may also be ordered, but
are typically found normal as well.
Let’s try to relate.
 Think back to the last time you had a bad
flu . .
 every muscle in your body shouted out in pain.
 you felt devoid of energy – like someone had
unplugged your power supply.
 Do you remember that
feeling?
 The severity of symptoms fluctuate
from person to person with FMS, but
they very much resemble a post-viral state
(like having the flu!)
Medical Management.
 Patient must be
 Primary treatment
approach is patient
education and
reassurance.
 Patient must fully
understand disease
process.
 Patient must be
informed that this is not a
psychiatric disturbance
and that the symptoms
they are experiencing
are NOT uncommon in
the general population.
 Exercise regularly
each day.
taught about
importance of sleep
habits.
• Maintain regular
sleep patterns by
going to bed and
awaking at the same
time each day.
• Avoid long naps.
• Recognize the
effects of drugs on
sleep such as
nicotine, alcohol and
caffeine.
• Avoid large meals 23 hours before
bedtime.
Medications.
 There is no SINGLE treatment for FMS, but it is shown
that combining certain meds can be helpful.
 Meds that boost your body’s level of seratonin and
norepinephrine (nuerostransmitters that control sleep,
pain and immune system function) are commonly
prescribed in low doses:
 Amitriptyline (Elavil)
 Cyclobenzaprine (Flexeril)
Why?

These meds are TCA’s (Tricyclic Anti-depressants) and can
diminish local pain and stiffness, improve sleep patterns & can
decrease the number of tender points.
Medications.
 Along with TCA’s patients
may be prescribed:
 Sedatives or Hypnotics
to help with sleep:
 Zolpidem tartrate
(Ambien)
 Eszopiclone (Lunesta)
 Muscle relaxants to help decrease symptoms of leg
movements – especially during the night:
 Clonazepam (Klonopin)
Nursing Interventions.

Focus on functional goals that empower the
patient as they may feel powerless to the
condition.
 Encourage exercise to maintain function and
provide relaxation techniques for comfort.
 exercise should include low-impact
such as swimming, or stationary
cycling.
 stretching can be helpful to relieve
tight muscles.
 relax by taking a warm bath or
getting in the spa which also can
relieve tight muscles.
Prognosis.
 This condition is chronic, but the symptoms may
come and go.
 The impact of FMS on daily living activities
differs among patients, but has proven to be as
equally disabling as rheumatoid arthritis.
 Books say prognosis is excellent - but if you ask
someone with the condition – there’s nothing
excellent about it.