Name
FIBROMYALGIA
DESCRIPTION
DETAIL
CAUSES β’ Loss of non-REM stage IV sleep β’ Stress β’ Trauma -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Hypothyroidism β’ Psychogenic rheumatism β’ Muscle strain/sprain β’ Muscle disease (e.g., polymyositis) β’ Polymyalgia rheumatica β’ Temporal arteritisβ’ Normal Westergren erythrocyte sedimentation rate β’ Normal creatine phosphokinase and aldolase β’ Normal TSH, T3 resin uptake and T4 β’ Normal complete blood count, renal and liver function SPECIAL TESTS β’ Sleep study; rarely indicated, but consider if obstructive sleep apnea a consideration or patient fails initial sleep hygiene measures β’ Thermography of trigger point areas DIAGNOSTIC PROCEDURES The clinical history and physical examination
TYPENOTES
RISK FACTORS: Sleep disturbance (e.g., sleep apnea), Trauma, Depression, Weather changesGENERAL MEASURES: β’ Electroprobe. A direct current technique utilizing 500-1000 mA in 30 second intervals repeated over 15 minutes, 4 times per week for several weeks to break the cycle of pain. β’ Electrical stimulation pads. Used as an adjunctive therapy to the electroprobe for fi bromyalgia. They provide inferential stimulation (alternating current) at 80-150 Hz in 15 second sweeps for 15 minutes. β’ Ultrasound, hot packs, conditioning, increasing social interactions and general conditioning exercises (the last is supplemental only) β’ Stress management β’ TENS and the variant called MENS has not proven effective in treating fibromyalgia DRUG(S) OF CHOICE : . Sleep restorative without interfering with stage IV sleep: . Zolpidem (Ambien) 5-10 mg hs prn . Temazepam (Restoril) 15-30 mg hs prn . Local injection of trigger points . Lidocaine 1% injectable 1/2 cc ALTERNATIVE DRUGS β’ Trazodone (Desyrel) 50 mg po hs prn β’ Flurazepam (Dalmane) 15-30 mg hs prn (note: Significant hangover potential secondary to long half-life) β’ Triazolam (Halcion) 0.125 mg po hs prn increased gradually to 0.5 mg (use is controversial) β’ Cyclobenzaprine (Flexeril) 10 mg tid prn (of lesser efficacy) β’ Amitriptyline (Elavil) 20-50 mg hs prn (of lesser efficacy) β’ NSAIDs may provide non-narcotic symptomatic pain relief (of lesser efficacy) PATIENT MONITORING : β’ For efficacy at 2-4 weeks β’ For medication side effects every 3-6 months PREVENTION/AVOIDANCE : β’ Adequate sleep β’ General conditioning exercises POSSIBLE COMPLICATIONS : β’ Chronic pain, chronic loss of work β’ Fibromyalgia is allegedly a greater source of work loss and dysfunction than rheumatoid arthritis EXPECTED COURSE/PROGNOSIS : β’ With resolution of sleep disturbance, may resolve totally β’ Aggressive physical therapy is critical in those who do not respond β’ Approximately 5% do not respond to any form of therapeutic intervention. Hypnosis may be attempted in that group.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
CPK ( MALE ), COMPLETE BLOOD COUNT, THYROID PROFILE
FIBROMYALGIA - AROMA
[FIBROMYALGIA]