NSG 555 Quiz 3 UPDATED ACTUAL Questions and CORRECT
Answers
Fibromyalgia -most frequent in women aged 20-50
-chronic, widespread musculoskeletal pain syndrome with multiple tender points
-fatigue, HA, numbness common
-objective signs of inflammation absent; lab studies normal
Fibromyalgia pathophysiology -cause unknown
-NOT caused by specific disease or disorder
Suspect:
-aberrant perception of painful stimuli
-sleep disorders
-depression
-viral infx
Fibromyalgia diagnostic criteria Pain must be present in at least 4 of 5 regions:
1- left upper
2- right upper
3- left lower
4- right lower
5-axial
Symptoms must be present at a similar level for 3 months or greater
Fibromyalgia scoring requirements WPI 7 or greater and SSS 5 or greater
OR
WPI 4-6 and SSS 9 or greater
Widespread pain index 0-19 (counts number of painful body regions)
Symptom severity scale 0-12 (rates fatigue, unrefreshed sleep, cognitive
symptoms "fibro fog", additional somatic sx)
Fibromyalgia diagnosis Symptoms must not be better explained by another medical or psychiatric
disorder
-Diagnosis remains valid even in the presence of other illnesses
, Fibromyalgia s/s -chronic aching pain and stiffness for 3 months or greater
--involves entire body
--more around neck, shoulders, low back, hips
-fatigue
-nonrestorative sleep
-cognitive dysfunction "fibro fog"
-mood disturbances (anxiety, depression)
-subjective numbness with paresthesias
-chronic HA
-IBS
-even minor exertion aggravates pain and increases fatigue
-TMJ
-Interstitial cystitis
-Subjective swelling
-PE IS NORMAL
--except for "trigger points" of pain produced by palpation of various areas such
as the trapezius, medial fat pad of knee, lateral epicondyle of the elbow
-no biomarkers
-lab studies are normal
Fibromyalgia tx non-pharm -reassure pts they have a diagnosable illness that is not progressive-tx are
imperfect
-CBT with mindful meditation is helpful
-exercise programs are beneficial
--tai chi, yoga, resistance exercise
Fibromyalgia tx pharm First line:
pregabalin
-initial 75mg PO BID, increase to 150mg BID
duloxetine
-initial 30mg PO daily, increase to 60mg PO daily
milnaciprin
-initial 12.5mg PO daily, increase to 50mg PO BID
Additional:
amitriptyline
tramadol
fluoxetine
cyclobenzaprine
gabapentin
low-dose naltrexone
cannabinoids
NSAIDs are ineffective
Do not use (and ineffective) opioids and corticosteroids
Treat depression and anxiety (frequently co-occur)
Low back pain imaging If no red flag sx, DO NOT need x-rays for 6 weeks
Answers
Fibromyalgia -most frequent in women aged 20-50
-chronic, widespread musculoskeletal pain syndrome with multiple tender points
-fatigue, HA, numbness common
-objective signs of inflammation absent; lab studies normal
Fibromyalgia pathophysiology -cause unknown
-NOT caused by specific disease or disorder
Suspect:
-aberrant perception of painful stimuli
-sleep disorders
-depression
-viral infx
Fibromyalgia diagnostic criteria Pain must be present in at least 4 of 5 regions:
1- left upper
2- right upper
3- left lower
4- right lower
5-axial
Symptoms must be present at a similar level for 3 months or greater
Fibromyalgia scoring requirements WPI 7 or greater and SSS 5 or greater
OR
WPI 4-6 and SSS 9 or greater
Widespread pain index 0-19 (counts number of painful body regions)
Symptom severity scale 0-12 (rates fatigue, unrefreshed sleep, cognitive
symptoms "fibro fog", additional somatic sx)
Fibromyalgia diagnosis Symptoms must not be better explained by another medical or psychiatric
disorder
-Diagnosis remains valid even in the presence of other illnesses
, Fibromyalgia s/s -chronic aching pain and stiffness for 3 months or greater
--involves entire body
--more around neck, shoulders, low back, hips
-fatigue
-nonrestorative sleep
-cognitive dysfunction "fibro fog"
-mood disturbances (anxiety, depression)
-subjective numbness with paresthesias
-chronic HA
-IBS
-even minor exertion aggravates pain and increases fatigue
-TMJ
-Interstitial cystitis
-Subjective swelling
-PE IS NORMAL
--except for "trigger points" of pain produced by palpation of various areas such
as the trapezius, medial fat pad of knee, lateral epicondyle of the elbow
-no biomarkers
-lab studies are normal
Fibromyalgia tx non-pharm -reassure pts they have a diagnosable illness that is not progressive-tx are
imperfect
-CBT with mindful meditation is helpful
-exercise programs are beneficial
--tai chi, yoga, resistance exercise
Fibromyalgia tx pharm First line:
pregabalin
-initial 75mg PO BID, increase to 150mg BID
duloxetine
-initial 30mg PO daily, increase to 60mg PO daily
milnaciprin
-initial 12.5mg PO daily, increase to 50mg PO BID
Additional:
amitriptyline
tramadol
fluoxetine
cyclobenzaprine
gabapentin
low-dose naltrexone
cannabinoids
NSAIDs are ineffective
Do not use (and ineffective) opioids and corticosteroids
Treat depression and anxiety (frequently co-occur)
Low back pain imaging If no red flag sx, DO NOT need x-rays for 6 weeks
