FIBROMYALGIA SYNDROME by. Gari Glaser

1. FIBROMYALGIA SYNDROMEby. Gari Glaser

2. 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

3. 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.

4. What are the symptoms? • Defining symptom is pain in the connective tissues of the body such as: • muscles • tendons • ligaments

5. 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.

6. Symptoms. • Generalized achiness most often in axial locations, accompanied by stiffness that tends to be worse in the morning.

7. More Symptoms. • Patients with FMS may at times interpret touch, light or even sound as pain. • Some patients may experience a strong sensitivity to: • odors • sounds • lights • vibration that others don’t even notice

8. 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

9. 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

10. 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.

11. 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

12. 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.

13. 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!)

14. Medical Management. • Patient must be 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 2-3 hours before bedtime. • 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.

15. 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.

16. 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)

17. 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.

18. 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.