Fibromyagia Medical Presentation

Fibromyagia PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Download Free Fibromyagia medical powerpoint (ppt) presentation for your medical ppt presentation

Tags : nil

Published on : Jan 08, 2019 | Views : 1906 | Downloads : 2

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Fibromyalgia
Slide 2-

Outline Definition of fibromyalgia Epidemiology of fibromyalgia Possible mechanism of fibromyalgia Signs and symptoms of fibromyalgia Diagnosis of fibromyalgia Management of fibromyalgia
Slide 3-

Case 38 yrs old female presented to the clinic with the complaint of left sided neck, chest, upper back, elbow, lower back, hip pain and accompanying stiffness for about three months. also she complains of tiredness, difficulty in concentration, waking up tired. These symptoms were there for the last 6 months she awakens 3-4 times at night and has difficulty back to sleep recently. ın the last week she also describes frequent urination, dyspnea, dry mouth. she has chronic constipation for years
Slide 4-

Case 38 yrs old female presented to the clinic with the complaint of left sided neck, chest, upper back, elbow, lower back, hip pain and accompanying stiffness for about three months. also she complains of tiredness, difficulty in concentration, waking up tired. These symptoms were there for the last 6 months she awakens 3-4 times at night and has difficulty back to sleep recently. ın the last week she also describes frequent urination, dyspnea, dry mouth. she has chronic constipation for years
Slide 5-

2010 Diagnostric Criteria. The preliminary ACR 2010 criteria for the diagnosis of FMS do not require physical examination but the requirement for the presence of widespread pain for at least three months and that the patient does not have a disorder that would otherwise explain the pain are retained. However, tender point count has been replaced by a symptom checklist which includes Widespread Pain Index (WPI) In the WPI, patients are asked to indicate the regions (maximum 19 regions) of the body in which pain has been experienced during the past week. Each positive region is given a score of 1 (WPI ranges 0 to 19). and Symptom Severity Scale (SSS).
Slide 6-

SSS is the sum of the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. Each of the 3 symptoms: severity of fatigue, waking unrefreshed and cognitive symptom, is scored between 0-3 (0 = no problem, 1 = slight or mild problems, generally mild or intermittent, 2 = moderate, considerable problems, often present and/or at a moderate level, 3 = severe: pervasive, continuous, life-disturbing problems over the last week). The extent of somatic symptoms is also scored between 0-3 (0 = no symptoms, 1 = few symptoms, 2 = a moderate number of symptoms and 3 = a great deal of symptoms).
Slide 7-

Removing the reliance on tender point count is the major advantage of the survey base criteria for FMS. In addition the SSS includes characteristic features of FMS and may be used to monitor disease activity. These criteria are not intended to replace the ACR 1990 classification criteria, but to represent an alternative method of diagnosis.
Slide 8-

Fibromyalgia chronic (>3 mo), widespread (axial, left- and right-sided, upper and lower segment), non- articular + non-inflammatory + idiopathic pain with characteristic tender points ıt is a multisystem disease characterized by sleep disturbance, fatigue, headache, morning stiffness, paresthesias, and anxiety. Female-2% male-0.5% primarily ages 25-45
Slide 9-

Pathogenesis. There is persuasive evidence that FM pain results from abnormal sensory as central sensitization and results from an amplification of peripheral sensory stimuli and a deficit of descending inhibitory control from the midbrain. The magnification of peripheral sensory input is readily visualized as increased activity in somatosensory areas of the brain on magnetic resonance imaging in FM subjects versus healthy controls.processing within the central nervous system.
Slide 10-

Possible mechanism
Slide 11-

Symptomatology widespread aching, stiffness • easy fatigability • sleep disturbance • symptoms aggravated by physical activity, poor sleep, emotional stress • patient feels that joints are diffusely swollen although joint examination is normal • neurologic symptoms of hyperalgesia, paresthesias • associated with irritable bowel or bladder syndrome, migraines, tension headaches, restless legs syndrome, obesity, depression, and anxiety
Slide 12-

ppt slide no 12 content not found
Slide 13-

Diagnosis
Slide 14-

WPI Neck jaw chest abdomen Upper arm Lower arm upper leg Lower leg Shoulder girdle Upper back lower back Hips 19
Slide 15-

Pain FM-related pain is usually perceived as arising from muscle; however, many patients also report joint pain but have no objective evidence of arthritis.
Slide 16-

Symptoms severity score 0 = no problem 1 = slight or mild problems 2 = moderate, considerable problems 3 = severe: life-disturbing problems
Slide 17-

Fatique Easy fatigability from physical exertion, mental exertion, and psychological stressors is typical of FM. Patients with CFS and FM share many similarities; about 75% of patients meeting the diagnostic criteria for CFS also meet the criteria for FM.
Slide 18-

SLEEP FM patients have nonrestorative sleep. difficulty falling asleep, and frequent wakening Even if they sleep continuously for 8 to 10 hours, they awake feeling tired. Many exhibit an alpha-delta electroencephalographic pattern that explains their failure to achieve restorative stages 3 and 4 of non–rapid eye movement sleep. A poor night’s sleep is often followed by a worsening of FM symptoms the next day. Restless leg syndrome and the associated periodic limb movement disorder occur in up to 60% of FM patients.
Slide 19-

COGNITIVE DYSFUNTION Cognitive dysfunction is a prominent complaint of many FM patients. They commonly describe difficulties with working memory, semantic memory, concentration, logical analysis, and motivation.
Slide 20-

Clinical features. ■ Morning stiffness ■ Subjective swelling ■ Raynaud-like symptoms ■ Sleep disturbance ■ Headache ■ Dry mouth ■ Paresthesias ■ Irritable bowel
Slide 21-

Most patients with fibromyalgia syndrome are not depressed. There are some depressive symptoms, but it does not usually reach the level of clinical depression. One way of screening/testing for depression and anxiety is to use the Hospital Anxiety and Depression Score, a validated self-completed screening questionnaire for depression and anxiety. It is simple to complete and can quickly assess the Having a chronic, painful disorder for which there is no generally accepted cure often produces an existential crisis.mood of the patient.
Slide 22-

Patients with high tender point count, low pressure pain threshold and mild/no mood disturbance often do well because their coping strategy is often more effective. In 30% of patients has significant depression,anxiety. It is useful to ask sadness,feeling of worthness,or emptiness,lack of pleasure in activities which were previously enjoyable. Poor appetite, and succidal thought.
Slide 23-

ppt slide no 23 content not found
Slide 24-

EXERCISE. exercise program (walking, aquatic exercises), physical therapy (good posture, stretching, muscle strengthening, massage)
Slide 25-

STRESS REDUCTION stress reduction, CBT
Slide 26-

NO evidence no evidence for alternative medicine such as biofeedback, meditation, acupuncture
Slide 27-

RED FLAG 1-Weight loss, Fever, joint swelling, muscle weakness, abnormal gait, Skin rash, delayed reflexes, lympadenopathy.
Slide 28-

Fibromyalgia It is a diagnosis of exclusion It is a must to rule out other disorders by history and physical exam
Slide 29-

D/D • diagnosis of exclusion • rule out other disorders by history and physical exam (RA, SLE, PMR, myositis, hypothyroidism, hyperparathyroidism, neuropathies)
Slide 30-

Investigations to be considered serology: do not order ANA or RF unless there is clinical suspicion for a connective tissue disease
Slide 31-

Goal of treatment. Decrease pain ■ Decrease distress ■ Increase energy level ■ Improve function ■ Treat associated symptoms, including anxiety and depression
Slide 32-

Management
Slide 33-

Excercise It is important to encourage the patient to stay active and to start graded Classical analgesics (paracetamol) may be helpful before exercises and activity.exercise.
Slide 34-

Warm bath Warm water baths are often helpful
Slide 35-

ppt slide no 35 content not found
Slide 36-

PREGABLIN,GABAPENTIN Anticonvulsant medications such as gabapentin, pregabalin, and topiramate are increasingly being used in FM and other chronic pain states; they inhibit the presynaptic release of glutamate and thus modulate the Pregabalin has FDA approval for use in FM..activation of NMDA receptors
Slide 37-

Analgesics analgesics may be beneficial for pain that interferes with sleep (NSAIDs, not narcotics)
Slide 38-

PITFALLS in THERAPY. Psychosocial issues not addressed Benefit of exercise undervalued ■ Exercise program too rigorous or advanced too quickly ■ Tricyclic therapy discontinued prematurely ■ Unrealistic expectations for improvement