Term
|
Definition
Abnormal response to stimuli and decrease in sleep
- excessive Sub P and glutamate, low serotonin and NE |
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Term
| What are symptoms of FMS? |
|
Definition
- Widespread pain and tender points
- Fatigue
- Unrefreshing sleep
- HA, anxiety, depression
- Symptoms last at least 3 months, symmetrical. No inflammation |
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|
Term
|
Definition
Females > males
Onset 20-50
Increased prevalence of SLE and RA |
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|
Term
| What can FMS be confused with? |
|
Definition
- Hypothyroidism
- Statin-induced myopathy
- Vit D insufficiency
- Myofascial pain syndrome
- Paget's - bone syndrome |
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Term
| What are non-pharmacologic Tx for FMS? |
|
Definition
Strong evidence:
- Education/support groups
- Cognitive therapy
- Aerobic exercise
Moderate evidence:
- Strength training
- Acupuncture
- Tai-chi/Yoga |
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Term
| Which medications are APPROVED for the Tx of FMS? |
|
Definition
- Lyrica/Pregabalin - analgesic and anxiolytic. Dose: 75 mg BID --> 150 BID, MAX 225 mg BID
- Cymbalta/Duloxetine - SNRI and mild DA inhibitor. Start with 30 mg QD, increase to 60 mg QD. Causes Nausea, do not combine with MAOIs
- Savella/Milnacipran - SNRI. 50-100 mg BID. Do not take w/ glaucoma |
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|
Term
| What other agents are used to treat FMS? |
|
Definition
- TCAs - 2nd line- low dose amitryptiline
- SSRIs - fluoxetine, Citalopram, sertraline. Can use Amitryp + SSRI
- Apap/tramadol
- BZDs not recommended
- Ambien has no effect on sleep quality and morning fatigue
- Lidocaine as trigger point injections or as a patch
- Capsaicin cream
- Flexeril - good for 6 months, then tolerance
- Neurontin - 1200 - 2400 mg/day |
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