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Transcript Fibromyalgia

Lisa Alamanza
Lubbock Christian University
NUR 5200
Introduction to Graduate Studies
February 26, 2014
“Fibromyalgia is a chronic musculoskeletal syndrome characterized by
widespread joint and muscle pain, fatigue, and tender points.” (Brashers,
Huether, McCance, & Rote, 2010, p. 1606).
Primarily affects 80 – 90 % of women between the ages of 30 – 50 and etiology
is unknown.
“The most common precipitating factors include the following:
Flulike viral illness
Chronic fatigue syndrome
Human immunodeficiency virus (HIV) infection
Lyme disease
Physical trauma
Emotional trauma
Medications, especially steroid withdrawal” (Brashers, Huether, McCance, &
Rote, 2010, p. 1606).
“Fibromyalgia as a chronic pain syndrome is defined by subjective symptoms
and not unique pathophysiologic characteristics.” (Brashers, Huether,
McCance, & Rote, 2010, p. 1607).
“Six probable pathological mechanisms behind the chronic, diffuse pain and
other symptoms of FM are:
(1) Central nervous system (CNS) sensation,
(2) Dysfunction of descending inhibitory pain pathways
(3) Peripheral nervous system (PNS) sensitization,
(4) Release of inflammatory mediators,
(5) Endocrine irregularity in the hypothalamic-pituitary-adrenal (HPA) axis,
(6) Neurotransmitter abnormalities” (Wierwille, L. M. C.,2012, p. 185)
Patient Presentation
Chronic aching pain and stiffness
Chronic headaches
Sleep disorders
Irritable bowel symptoms
Excess sensitivity to cold
These symptoms have a great impact on their daily living. Patients have
difficulty maintaining a social life, undertaking physical exercise, and remain
active in the workplace.
Clinical Assessments
The Fibromyalgia Impact Questionnare
Visual analogue scales
Numerical pain scales
McGill Pain Questionnaire
Beck Depression Inventory
Spielberger State-Trait Anxiety Inventory
No diagnostic tests are available
“The American College of Rheumatology (ACR) criteria for fibromyalgia are
considered the gold standard for diagnosis (Wolfe et al 1990).” (Ryan, 2013, p.
“The criteria include the presence of widespread pain of at least three months
duration and pain at 11 of 18 designated tender points when finger pressure
(enough to blanch the healthcare practitioner’s fingernails) is applied.” (Ryan,
2013, p. 38)
Pharmacologic therapy:
Muscle relaxants
CNS agents
Dopamine agonists
Non-Pharmacologic therapy:
Cognitive Behaviour Therapy
Sleep Therapy
Patient Education
Understanding of fibromyalgia
Sleep hygiene
Exercise Programs
Drug Therapy
Psychotherapeutic interventions
Ryan, S.(2013). Care of patients with fibromyalgia: assessment and
management. Nursing Standard, 37-43.
Fibromyalgia is a condition that affects the central nervous system and is
diagnosed by exclusion.
Completion of a thorough assessment and assessments of visual analogue
scales and numerical pain scales are used to diagnosis illness.
Fibromyalgia is not curable and the treatment of choice is both pharmacology
and Non-pharmacology.
Patient education is the most important factor to assist patients dealing with
Brashers, Valentina L., Huether, Sue E., McCance, K. L., & Rote, Neal S.
(2010). The Musculoskeletal System . In Huether, Sue E. & K. L.
McCance (Eds.), Pathophysiology: The biological basis for disease in
adults and children (6th ed., pp. 1606-1608). Philadelphia: Mosby
McPhee, Stephen J., & Papadakis, Maxine A. (2013). Musculoskeletal &
Immunologic Disorders. In Diedrich, Christine, Holton, Barbara, &
Lebowitz, Harriet(Eds.), Current Medical Diagnosis & Treatment (52nd
ed., pp. 822-823). Rockefeller: McGraw Hill
Ryan, S.(2013). Care of patients with fibromyalgia: assessment and
management. Nursing Standard, 37-43.
Staud R. Pharmacological treatment of fibromyalgia syndrome: new
developments. Drugs. 2010;70(1):1-14.
Wierwille, L. M. C.(2012). Fibromyalgia: Diagnosing and managing a complex
syndrome. Journal of the American Academy of Nurse Practitioners,