- FIBROMYALGIA:
- Symptoms: Widespread pain
- Associated Symptoms: Fatigue, Unrefreshing Sleep, Cognitive Symptoms - fibrofog
- Diagnosis: All 3 diagnostic criteria required (2011 Modification of ACR prelim criteria; JAMA 2014)
- 1. Widespread Pain Index (WPI) ≥7 with Symptom Severity Score (SSS) of ≥ 5 OR WPI 3 -6 with SSS ≥ 9 (≥13 on Patient Self-Report Survey is suggestive of Fibromyalgia)
- 25% of patient with Fibromyalgia do not have 11 tender points
- 2. of > 3 month duration
- 3. with no alternative diagnosis
- Labs: CBC, CMP, ESR, CRP, TSH, Vitamin D, (RF and ANA only if clinically indicated - 13.3 % of US adults have positive ANA of 1:80) (JAMA 2014)
- Accompanying Comorbid Conditions: Poor Sleep, Fatigue, Depression,
- Treatment:
- Non-Pharmacological:
- Stress Reduction: FIBROGUIDE.com
- Sleep
- Exercise
- Pharmacological
- Reduce activity of facilitatory neurotransmitters. Gabapentinoids reduce glutamate
- Increase activity of inhibitory neurotransmitters such as Serotonin and Nor-epinephrine. SNRI, γ-aminobutyric acid (e.g., γ-hydroxyglutamate)
- TCA (Amitriptyline 10 - 70 mg, Cyclobenzaprine 5 - 20 mg)
- Treatment strategy
- First: Low therapeutic trial of low-dose tricyclic compounds
- Next: Depression or Fatigue: SNRI
- Next: Anxiety or sleep issues: Gabapentinoid
- Note: Opiods are ineffective due to hyperactive endogenous opoiod system. Hence, Low dose Naloxone may work.
Fibromyalgia
Fibromyalgia additional readings
|
|