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Fibromyalgia

Fibromyalgia. Rajesh Kataria, D.O. Southern Ohio Rheumatology. Objectives. Be able to diagnose patients with fibromyalgia Be able to formulate a differential diagnosis for fibromyalgia Be able to discuss treatment options available for fibromyalgia. Patient Case Study: Presentation (cont’d).

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Fibromyalgia

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  1. Fibromyalgia Rajesh Kataria, D.O. Southern Ohio Rheumatology

  2. Objectives • Be able to diagnose patients with fibromyalgia • Be able to formulate a differential diagnosis for fibromyalgia • Be able to discuss treatment options available for fibromyalgia

  3. Patient Case Study: Presentation (cont’d) • Numerous past evaluations indicated “arthritis” in his back • Not severe enough to warrant surgery • Additional complaints include: fatigue, insomnia, paresthesias (nondermatomal), and aching pains in the right shoulder, neck muscles, and both legs • Pain worsens with prolonged inactivity

  4. Blurred vision Bright lights bother eyes Double vision Loss of peripheral vision Dizziness Poor balance Ringing in ears Ear pressure Decreased hearing Vertigo Noises or talking that hurts ears Difficulty swallowing Sleep apnea Tremors Palpitations/shortness of breath/high blood pressure Poor coordination/clumsiness Constant throat pain or sore throat Lightheadedness Numbness/tingling/burning Weakness in arms or legs Loss of muscle mass Incontinence of urine Neurologic Symptoms in Fibromyalgia

  5. Cranial nerve IX,X Gag reflex abnormal Hoarseness Sensory Analgesia or anesthesia Dissociated sensory loss Impaired proprioception Impaired vibratory sensation Impaired temperature sensation Impaired pinprick sensation Motor Weakness Impaired fine motor control Increased tone Atrophy Gait Tandem abnormal Ataxia Neurologic Signs in Fibromyalgia

  6. Mechanical overuse Drugs Statins and fibrates Antimalarials Endocrinopathies Hypothyroidism Hyperparathyroidism Cushing’s syndrome Diabetes mellitus Neurological Multiple sclerosis Myasthenia gravis Malignancy Infections Hepatitis C HIV Lyme disease Differential diagnosis

  7. Rheumatologic Rheumatoid arthritis Systemic lupus erythematosus Sjogren’s syndrome Ankylosing spondylitis Polymyalgia rheumatica Inflammatory myopathies Metabolic myopathy Osteomalacia Tapering of steroids Regional pain syndrome Differential diagnosis (cont’d)

  8. Non-Pharmacologic Management • Patient education • Aerobic exercise • Cognitive behavioral therapy • Acupuncture • Myofascial release • Chiropractic manipulation

  9. Summary • Fibromyalgia is a chronic pain disorder • Do not label patients prematurely with this diagnosis • Emphasize non-pharmacologic treatment first • Combination pharmacologic treatment is often necessary • Opioids are not effective!!

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