Fibromyalgia

Created by: Paul
Created on: 07-12-12 13:25

Epidemiology - Fibromyalgia

30-65, mean age of onset 54-65, no geographical or ethnical predilect, affects woman 5 x more than men

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Aetiology - Fibromyalgia (1) - Genetic

Clusters in families, Substance P (3x higher in sufferers), HPA-a dysfunction - higher cortisol lacking diurnal fluctuation

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Aetiology - Fibromyalgia (2) - Serotonin

Polymorphism in 5-HTT transporter, lower levels, abnormal signalling linked to chronic pain and anxiety

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Aetiology - Fibromyalgia (3) - Depression

Worsens pain - vice versa, psychiatric co-morbidity

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Aetiology - Fibromyalgia (4) - Sleep

Lack of stage 4 sleep, possibly due to PLMD

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Aetiology - Fibromyalgia (5) - PTSD

Abuse emotional - physical, Physical trauma -flaws?, PTSD changes in brain

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Aetiology - Fibromyalgia (6) - Peripheral

Altered ATP +ADP metabolism in tender spots

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Aetiology - Fibromyalgia (7) - Viral

May activate CNS cytokines via viral neurotropism and subsequent glial activation may play a role

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Pathophysiology - Fibromyalgia (1) - Dysfunctional DIPP

Show abnormalities in descending efferent pathways, Show dysfunction in DNIC

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Pathophysiology - Fibromyalgia (2) - Central sensatisation

ATS - 'wind-up', NMDA receptor in post synaptic membrane - dorsal horn, normally inactive, show abnormal pain amplification at spinal level

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Pathophysiology - Fibromyalgia (3) - Glial activation

Glial cells are activated by stimuli that induce pain, Glial cells also express receptors for bacteria and viruses, They release neuroactive substances on activation (nitric acid, reactive oxygen species, excitatory amino acids)

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Pathophysiology - Fibromyalgia (4) - Glial activation

Activated glial up regulate and release substance P and other excitatory amino acids from the primary efferent neurons in the spinal cord and enhance the excitability of pain transmission neurons

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Rx - Fibromyalgia

Anti-depressants?, sleep aid - cyclobenzaprine, Multidisciplinary CBT, PT, aerobic exercise and patient education

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Other cards in this set

Card 2

Front

Aetiology - Fibromyalgia (1) - Genetic

Back

Clusters in families, Substance P (3x higher in sufferers), HPA-a dysfunction - higher cortisol lacking diurnal fluctuation

Card 3

Front

Aetiology - Fibromyalgia (2) - Serotonin

Back

Card 4

Front

Aetiology - Fibromyalgia (3) - Depression

Back

Card 5

Front

Aetiology - Fibromyalgia (4) - Sleep

Back

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Fibromyalgia