Fibromyalgia
: Fibromyalgia is a medical condition characterized by chronic widespread pain and a heightened and painful response to pressure in multiple areas of the body.
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Fibromyalgia Melinda A. Aquino, Cindy K. Hernandez, and Karina Gritsenko
Overview Definition: Fibromyalgia is a medical condition characterized by chronic widespread pain and a heightened and painful response to pressure in multiple areas of the body. –– Fibromyalgia is more widespread and generalized than myofascial pain syndrome. It involves soft tissue and muscles more commonly than joints. In addition to diffuse generalized pain, other clinical features include sleep disturbances, memory loss, migraines,
ICD-9 code: 729.1 M.A. Aquino, MD Department of Anesthesiology and Pain Management, Montefiore Medical Center, 111-East 210th street, Bronx, NY 10467, USA e-mail: [email protected] C.K. Hernandez, MD Department of Anesthesiology, Montefiore Medical Center, 111 East 210th street, Bronx, NY 10467, USA e-mail: [email protected] K. Gritsenko, MD (*) Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, 3400 Bainbridge Ave, LL400, Bronx, NY 10128, USA e-mail: [email protected]
morning stiffness, and GI irritation. There can be debilitating fatigue. Some patients report difficulty in swallowing, bowel and bladder dysfunction, widespread numbness and tingling in the digits, and cognitive dysfunction. Depression is an associated symptom. Headaches of the tension-type are frequent. –– Fibromyalgia is much more prevalent in females than men and occurs within ages 20–60 years old. –– Many causes have been theorized and research has shown the following to be possible causes: decreases in serotonin, physical or emotional trauma, aberrant muscle blood flow, and heightened perceptions of pain. –– Genetics appears to be involved. Fibromyalgia tends to run in families, and it is theorized that certain genetic mutations make patients more susceptible to developing the disorder.
Evaluation –– Generalized pain in three or more sites for 3 or more months. Pain is widespread, bilateral, above and below the waist, and in the axial skeleton (the skull, spine, ribs, arms, and legs). –– No other preexisting medical conditions that can cause similar symptoms. –– Tenderness in 11/18 of the following sites (Fig. 125.1).
© Springer International Publishing Switzerland 2017 R.J. Yong et al. (eds.), Pain Medicine, DOI 10.1007/978-3-319-43133-8_125
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Fig. 125.1 Tender points of fibromyalgia. © Alila Medical Media—www.AlilaMedicalMedia.com
When trigger points are palpated you may feel: –– Ropy muscle band with possible twitching. –– “Jump Sign”-when the patient moves away from pressure. –– Note: referred pain does not follow dermatomes or nerve root distributions.
Treatment Multidisciplinary: Best success is achieved when a Multi-Disciplinary approach is utilized— including Physical Therapy, Medications, Psychological Therapy, and Pain Management Service Input.
–– Physical Therapy should include heat, exercise, stretching, movement therapy –– Trigger Point Injections with local anesthetics (with or without steroids) –– Transcutaneous electrical nerv
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