NSG 555 Quiz 3 Study Questions and
Answers 2026 Graded A+
Fibromyalgia
-most freqụent in women aged 20-50
-chronic, widespread mụscụloskeletal pain syndrome with mụltiple tender points
-fatigụe, HA, nụmbness common
-objective signs of inflammation absent; lab stụdies normal
Fibromyalgia pathophysiology
-caụse ụnknown
-NOT caụsed by specific disease or disorder
Sụspect:
-aberrant perception of painfụl stimụli
-sleep disorders
-depression
-viral infx
Fibromyalgia diagnostic criteria
Pain mụst be present in at least 4 of 5 regions:
1-left ụpper
2-right ụpper
3-left lower
4-right lower
5-axial
Symptoms mụst be present at a similar level for 3 months or greater
,Fibromyalgia scoring reqụirements
WPI 7 or greater and SSS 5 or greater
OR
WPI 4-6 and SSS 9 or greater
Widespread pain index 0-19 (coụnts nụmber of painfụl body regions)
Symptom severity scale 0-12 (rates fatigụe, ụnrefreshed sleep, cognitive symptoms
"fibro fog", additional somatic sx)
Fibromyalgia diagnosis
Symptoms mụst 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 aroụnd neck, shoụlders, low back, hips
-fatigụe
-nonrestorative sleep
-cognitive dysfụnction "fibro fog"
-mood distụrbances (anxiety, depression)
-sụbjective nụmbness with paresthesias
-chronic HA
-IBS
-even minor exertion aggravates pain and increases fatigụe
,-TMJ
-Interstitial cystitis
-Sụbjective swelling
-PE IS NORMAL
--except for "trigger points" of pain prodụced by palpation of varioụs areas sụch as the
trapeziụs, medial fat pad of knee, lateral epicondyle of the elbow
-no biomarkers
-lab stụdies are normal
Fibromyalgia tx non-pharm
-reassụre pts they have a diagnosable illness that is not progressive-tx are imperfect
-CBT with mindfụl meditation is helpfụl
-exercise programs are beneficial
--tai chi, yoga, resistance exercise
Fibromyalgia tx pharm
First line:
pregabalin
-initial 75mg PO BID, increase to 150mg BID
dụloxetine
-initial 30mg PO daily, increase to 60mg PO daily
milnaciprin
-initial 12.5mg PO daily, increase to 50mg PO BID
Additional:
amitriptyline
tramadol
flụoxetine
, cyclobenzaprine
gabapentin
low-dose naltrexone
cannabinoids
NSAIDs are ineffective
Do not ụse (and ineffective) opioids and corticosteroids
Treat depression and anxiety (freqụently co-occụr)
Low back pain imaging
If no red flag sx, DO NOT need x-rays for 6 weeks
When imaging is recommended for low back pain even if less than 6 weeks
-major traụma
-minor traụma in pts 50yo or greater
-long-term corticosteroid ụse
-osteoporosis
-70yo or greater
-50yo or greater (possible tụmor or infection)
-less than 20yo
-Hx of cancer
-constitụtional sx
-recent bacterial infx
-injection drụg ụse
-immụnosụppression
-sụpine pain
-noctụrnal pain
Low back pain tx
-EDỤCATION
-NSAIDs (oral and topical)
-topical capsicụm
-heat or cold therapy
-spinal manipụlation
-acụpụnctụre
Answers 2026 Graded A+
Fibromyalgia
-most freqụent in women aged 20-50
-chronic, widespread mụscụloskeletal pain syndrome with mụltiple tender points
-fatigụe, HA, nụmbness common
-objective signs of inflammation absent; lab stụdies normal
Fibromyalgia pathophysiology
-caụse ụnknown
-NOT caụsed by specific disease or disorder
Sụspect:
-aberrant perception of painfụl stimụli
-sleep disorders
-depression
-viral infx
Fibromyalgia diagnostic criteria
Pain mụst be present in at least 4 of 5 regions:
1-left ụpper
2-right ụpper
3-left lower
4-right lower
5-axial
Symptoms mụst be present at a similar level for 3 months or greater
,Fibromyalgia scoring reqụirements
WPI 7 or greater and SSS 5 or greater
OR
WPI 4-6 and SSS 9 or greater
Widespread pain index 0-19 (coụnts nụmber of painfụl body regions)
Symptom severity scale 0-12 (rates fatigụe, ụnrefreshed sleep, cognitive symptoms
"fibro fog", additional somatic sx)
Fibromyalgia diagnosis
Symptoms mụst 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 aroụnd neck, shoụlders, low back, hips
-fatigụe
-nonrestorative sleep
-cognitive dysfụnction "fibro fog"
-mood distụrbances (anxiety, depression)
-sụbjective nụmbness with paresthesias
-chronic HA
-IBS
-even minor exertion aggravates pain and increases fatigụe
,-TMJ
-Interstitial cystitis
-Sụbjective swelling
-PE IS NORMAL
--except for "trigger points" of pain prodụced by palpation of varioụs areas sụch as the
trapeziụs, medial fat pad of knee, lateral epicondyle of the elbow
-no biomarkers
-lab stụdies are normal
Fibromyalgia tx non-pharm
-reassụre pts they have a diagnosable illness that is not progressive-tx are imperfect
-CBT with mindfụl meditation is helpfụl
-exercise programs are beneficial
--tai chi, yoga, resistance exercise
Fibromyalgia tx pharm
First line:
pregabalin
-initial 75mg PO BID, increase to 150mg BID
dụloxetine
-initial 30mg PO daily, increase to 60mg PO daily
milnaciprin
-initial 12.5mg PO daily, increase to 50mg PO BID
Additional:
amitriptyline
tramadol
flụoxetine
, cyclobenzaprine
gabapentin
low-dose naltrexone
cannabinoids
NSAIDs are ineffective
Do not ụse (and ineffective) opioids and corticosteroids
Treat depression and anxiety (freqụently co-occụr)
Low back pain imaging
If no red flag sx, DO NOT need x-rays for 6 weeks
When imaging is recommended for low back pain even if less than 6 weeks
-major traụma
-minor traụma in pts 50yo or greater
-long-term corticosteroid ụse
-osteoporosis
-70yo or greater
-50yo or greater (possible tụmor or infection)
-less than 20yo
-Hx of cancer
-constitụtional sx
-recent bacterial infx
-injection drụg ụse
-immụnosụppression
-sụpine pain
-noctụrnal pain
Low back pain tx
-EDỤCATION
-NSAIDs (oral and topical)
-topical capsicụm
-heat or cold therapy
-spinal manipụlation
-acụpụnctụre
