Fibromyalgia

1. Fibromyalgia Lisa Alamanza Lubbock Christian University NUR 5200 Introduction to Graduate Studies February 26, 2014

2. Introduction “Fibromyalgia is a chronic musculoskeletal syndrome characterized by widespread joint and muscle pain, fatigue, and tender points.” (Brashers, Huether, McCance, & Rote, 2010, p. 1606). Primarily affects 80 – 90 % of women between the ages of 30 – 50 and etiology is unknown. “The most common precipitating factors include the following: Flulike viral illness Chronic fatigue syndrome Human immunodeficiency virus (HIV) infection Lyme disease Physical trauma Emotional trauma Medications, especially steroid withdrawal” (Brashers, Huether, McCance, & Rote, 2010, p. 1606).

3. Pathophysiology “Fibromyalgia as a chronic pain syndrome is defined by subjective symptoms and not unique pathophysiologic characteristics.” (Brashers, Huether, McCance, & Rote, 2010, p. 1607). “Six probable pathological mechanisms behind the chronic, diffuse pain and other symptoms of FM are: • Central nervous system (CNS) sensation, • Dysfunction of descending inhibitory pain pathways • Peripheral nervous system (PNS) sensitization, • Release of inflammatory mediators, • Endocrine irregularity in the hypothalamic-pituitary-adrenal (HPA) axis, and • Neurotransmitter abnormalities” (Wierwille, L. M. C.,2012, p. 185)

4. Patient Presentation Chronic aching pain and stiffness Numbness Chronic headaches Sleep disorders Irritable bowel symptoms Excess sensitivity to cold Anxiety These symptoms have a great impact on their daily living. Patients have difficulty maintaining a social life, undertaking physical exercise, and remain active in the workplace.

5. Clinical Assessments The Fibromyalgia Impact Questionnare Visual analogue scales Numerical pain scales McGill Pain Questionnaire Beck Depression Inventory Spielberger State-Trait Anxiety Inventory No diagnostic tests are available

6. Diagnosis “The American College of Rheumatology (ACR) criteria for fibromyalgia are considered the gold standard for diagnosis(Wolfe et al 1990).” (Ryan, 2013, p. 38) “The criteria include the presence of widespread pain of at least three months duration and pain at 11 of 18 designated tender points when finger pressure (enough to blanch the healthcare practitioner’s fingernails) is applied.” (Ryan, 2013, p. 38)

7. Intervention Pharmacologic therapy: Antidepressants Muscle relaxants CNS agents Dopamine agonists Analgesics Non-Pharmacologic therapy: Exercise Cognitive Behaviour Therapy Meditation Sleep Therapy

8. Patient Education Understanding of fibromyalgia Sleep hygiene Exercise Programs Drug Therapy Psychotherapeutic interventions Ryan, S.(2013). Care of patients with fibromyalgia: assessment and management. Nursing Standard, 37-43.

9. Conclusion Fibromyalgia is a condition that affects the central nervous system and is diagnosed by exclusion. Completion of a thorough assessment and assessments of visual analogue scales and numerical pain scales are used to diagnosis illness. Fibromyalgia is not curable and the treatment of choice is both pharmacology and Non-pharmacology. Patient education is the most important factor to assist patients dealing with Fibromyalgia.

10. References Brashers, Valentina L., Huether, Sue E., McCance, K. L., & Rote, Neal S. (2010). The Musculoskeletal System . In Huether, Sue E. & K. L. McCance(Eds.), Pathophysiology: The biological basis for disease in adults and children(6th ed., pp. 1606-1608). Philadelphia: Mosby Inc. McPhee, Stephen J., & Papadakis, Maxine A. (2013). Musculoskeletal & Immunologic Disorders. In Diedrich, Christine, Holton, Barbara, & Lebowitz, Harriet(Eds.), Current Medical Diagnosis & Treatment (52nd ed., pp. 822-823). Rockefeller: McGraw Hill Ryan, S.(2013). Care of patients with fibromyalgia: assessment and management. Nursing Standard, 37-43. StaudR. Pharmacological treatment of fibromyalgia syndrome: new developments. Drugs. 2010;70(1):1-14. Wierwille, L. M. C.(2012). Fibromyalgia: Diagnosing and managing a complex syndrome. Journal of the American Academy of Nurse Practitioners, 184-192.