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Fibromyalgia - Improving the consultation PowerPoint Presentation

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Description : This medical presentation titled "Fibromyalgia - Improving the consultation" talks about fibromyalgia, a chronic centralised pain syndrome associated with sleep disturbance, chronic fatigue and mood disorders.

Tags : Fibromyalgia, chronic centralised pain syndrome, sleep disturbance, chronic fatigue, mood disorders, symptoms, Inflammatory rheumatic conditions, Early rheumatoid, arthritis, Polymyalgia rheumatic, Giant cell arteritis, Systemic vasculitis, Inflammatory spondyloarthritis, Systemic lupus erythematosus, Myositis

Published on : Apr 26, 2021 | Views : 2355 | Downloads : 4

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Slide 1-

Fibromyalgia Improving the consultation
Slide 2-

“What do you think about Fibromyalgia?”
Slide 3-

“What characteristics do patients with Fibromyalgia exhibit?”
Slide 4-

How do patients with Fibromyalgia make you feel?
Slide 5-

Fibromyalgia
Slide 6-

Fibromyalgia Fibromyalgia is a chronic centralised pain syndrome that affects 2-5% of the population It is associated with sleep disturbance, chronic fatigue and mood disorders There is a female:male incidence ratio of 2:1 There is a waxing and waning pattern to the condition There is scepticism in the medical profession as to the validity of the diagnosis
Slide 7-

What is fibromyalgia? Fibromyalgia is a diagnostic term for a chronic widespread centralised pain syndrome with attendant features. There is no diagnostic laboratory test or imaging. It is characterised by chronic widespread pain for which no physical explanation can be given. There are accompanying symptoms, which may or may not be present in an individual and will usually vary over time
Slide 8-

What are the symptoms of fibromyalgia? Pain – chronic (3 months +) widespread and unexplained (central symptom) Mood disturbance Cognitive impairment Fatigue Other associated conditions/symptoms
Slide 9-

Other associated conditions/symptoms Irritable bowel syndrome Migraine Severe menstrual pain Lower urinary tract symptoms Facial and tempromandibular joint pain Somatic symptoms Sexual dysfunction (up to 97% of sufferers)
Slide 10-

Is fibromyalgia a clinical entity? The pathogenesis of fibromyalgic pain is multifactorial. There is no practical diagnostic test and imaging is only helpful to rule out underlying pathology. However in research studies, where more invasive testing and specialised imaging is available, physiological changes have been identified in fibromyalgia.
Slide 11-

Is fibromyalgia a clinical entity? The underlying problem in fibromyalgia is an enhancement of the neurophysiologic sensory response. This is evidenced by abnormal activity in pain centres in response to touch and heat, increased neuropeptides both peripherally in the nociceptors and centrally in the cerebrospinal fluid (notably Substance P) and is manifest in the allodynia experienced by fibromyalgia sufferers.
Slide 12-

Is fibromyalgia a clinical entity? The increased concentration of neuropeptides and other substances related to the excitation of the pain pathways in the CSF may be linked to the fatigue, mood disturbance and cognitive impairment seen in fibromyalgia. Patients with fibromyalgia often have other symptoms that could be considered as "visceral allodynia" e.g. irritable bowel, pelvic pain, lower urinary tract symptoms etc. These conditions could be considered as sensory attenuation based.
Slide 13-

Is fibromyalgia a clinical entity? There is sufficient research evidence to demonstrate an abnormality in sensory perception and to explain the symptom complex seen in fibromyalgia
Slide 14-

Making a diagnosis Fibromyalgia should be suspected in patients presenting with chronic (greater than 3 months), multifocal pain that cannot be explained by an obvious pathological process – e.g. inflammation, infection, degeneration or neoplasm. Once fibromyalgia is suspected simple laboratory tests should be performed to exclude conditions that can present in the same way as fibromyalgia.
Slide 15-

Making a diagnosis Inflammatory rheumatic conditions Early rheumatoid arthritis Polymyalgia rheumatic Giant cell arteritis Systemic vasculitis Inflammatory spondyloarthritis Systemic lupus erythematosus Myositis Hypothyroidism Depression Neuropathies (tend to be more localised) Multiple sclerosis (tend to have motor and sensory defects) Vitamin d deficiency
Slide 16-

Making a diagnosis Laboratory tests should be tailored to the patient’s symptoms, however if a diagnosis of fibromyalgia is suspected the following would be considered a baseline set of investigations:- Full blood count Erythrocyte sedimentation rate C-reactive protein Thyroid function Creatine kinase
Slide 17-

Making a diagnosis 1990 ACR criteria were never intended to be used as diagnostic criteria Relied on tender point examination Superseded by 2010 criteria May use self reported scale
Slide 18-

2010 criteria
Slide 19-

2010 criteria
Slide 20-

2010 criteria A patient satisfies diagnostic criteria for fibromyalgia if all the following 3 conditions are met: 1) Widespread pain index (WPI) 7 and symptom severity (SS) scale score 5 or WPI 3–6 and SS scale score 9. 2) Symptoms have been present at a similar level for at least 3 months. 3) The patient does not have a disorder that would otherwise explain the pain.
Slide 21-

Management The management of fibromyalgia has 4 main components:- Patient education Physical therapy Psychological therapy/support Drug treatment
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Slide 23-

Patient education Clear diagnosis Education about their condition Patient information leaflets Adjuvant to face-to-face explanation Chronic nature of the condition Interventions, at best, provide partial symptomatic relief A condition that waxes and wanes They are part of the treatment Adherence to treatment regimes
Slide 24-

Physical therapy Stress reduction Sleep hygiene Weight reduction (if overweight) Remain in work if possible Graduated exercise regime Little or no evidence for massage or physiotherapy Adherence to exercise regimes is poor Directed or group exercise has greater adherence
Slide 25-

Psychological therapy/support CBT Try to stay positive Not to focus on the pain Catastrophising and stopping moving are poor prognostic indicators
Slide 26-

Drug treatment Drug treatment should be tailored to the patient and the choice of medication should take in to account the additional symptoms affecting the patient
Slide 27-

Drug treatment A meta analysis published in 2011 estimated treatment differences vs. placebo, separately, for duloxetine, fluoxetine, gabapentin, milnacipran, pramipexole, pregabalin, either of two tricyclic antidepressants, and tramadol plus paracetamol The analysis examined pain response and did not report on other symptoms. The response was measured as a 30% reduction and a 50% reduction in reported pain from baseline
Slide 28-

Drug treatment when compared with placebo, statistically significant pain responses (improvement of 30% and 50%) were observed for patients treated with duloxetine, milnacipran 200 mg/day, pregabalin 300 or 450 mg/day, and tramadol plus paracetamol. Treatment with fluoxetine, gabapentin, or milnacipran 100 mg/day resulted in significant findings for the 30% improvement in pain response
Slide 29-

Drug treatment All eight active treatments displayed evidence suggesting improvement over placebo in the treatment of pain in patients suffering from fibromyalgia. Indirect comparison of active treatments found no strong differences Seven of the eight regimens had increased discontinuation due to side effects when compared to placebo (the exception being fluoxetine)
Slide 30-

Drug treatment Severe adverse effects were statically significant for milnacipran (a serotonin–norepinephrine reuptake inhibitor (SNRI) licensed specifically for fibromyalgia but currently only available in the US and Russia) and pregabalin
Slide 31-

Summary Fibromyalgia is a chronic centralised pain syndrome that affects 2-5% of the population It is associated with sleep disturbance, chronic fatigue and mood disorders There is a female:male incidence ratio of 2:1 Use the 2010 ARC diagnostic criteria A stepwise approach to treatment is advised Patient education is the first step and the patient needs to be an active participant
Slide 32-

Summary The aim is to reduce symptoms and increase patient function There is a waxing and waning pattern to the condition There is scepticism in the medical profession as to the validity of the diagnosis There are measurable (research) biochemical changes in fibromyalgia There is an evidence base to treatment which must be tailored to the patient’s symptoms
Slide 33-

Summary The management of fibromyalgia has 4 main components:- Patient education Physical therapy Psychological therapy/support Drug treatment Do not (or with caution) use long term opiates
Slide 34-

And finally Patients with fibromyalgia will need a long term relationship with their primary care physician – and this is best built on trust, mutual respect and an understanding of the condition