NUR 211
Lesley Chaffin, MSN, RN
Fibromyalgia
 Chronic central pain syndrome
 Widespread, nonarticular
musculoskeletal pain and fatigue
 Multiple tender points
 May also have
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Nonrestorative sleep
Morning stiffness
Irritable bowel syndrome
Anxiety
Fibromyalgia
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Commonly diagnosed
Major cause of disability
Affects 2% of the U.S. population
4-10 times more common in women
Fibromyalgia
Etiology and Pathophysiology
 Disorder involving abnormal central
processing nociceptive pain input
 Abnormal sensory processing in CNS
Fibromyalgia
Etiology and Pathophysiology
 Multiple physiologic abnormalities
 ↑ Levels of substance P in spinal fluid
 Low blood flow to thalamus
 Dysfunction of hypothalamic-pituitaryadrenal (HPA) axis
 Low levels of serotonin and tryptophan
 Abnormalities in cytokine function
 Genetics
 Recent illness or trauma
Fibromyalgia
Clinical Manifestations and Complications
 Point tenderness
 Widespread burning pain
 Worsens and improves throughout day
 Trouble determining if pain is in muscles,
joints, or soft tissues
 Head or facial pain
 Can accompany TMJ dysfunction
Case Study 1
(©Purestock/Thinkstock)
• A.S., a 45-year-old female, comes to
the clinic complaining of widespread
burning pain that worsens and
improves throughout the day.
• She also complains of being very tired.
• Her medical history is negative except
for irritable bowel syndrome.
Case Study
• What factor(s) in A.S.’s initial
presentation suggest(s) she may be
suffering from fibromyalgia instead of
myofascial pain syndrome?
(©Purestock/Thinkstock)
Case Study
(©Purestock/Thinkstock)
• What specific areas will you palpate for
point tenderness in A.S.?
Tender Points in Fibromyalgia
Case Study
(©Purestock/Thinkstock)
• What other clinical manifestations will
you ask A.S. about?
Fibromyalgia
Clinical Manifestations and Complications
 Cognitive effects
 Difficulty concentrating/memory lapses
 Feelings of being overwhelmed when
dealing with multiple tasks
 Migraine headaches
Fibromyalgia
Clinical Manifestations and Complications
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Depression and anxiety
Stiffness
Nonrefreshing sleep
Fatigue
Paresthesia
Restless legs syndrome
Fibromyalgia
Clinical Manifestations and Complications
 Irritable bowel syndrome
 Difficulty swallowing
 ↑ Frequency of urination and urinary
urgency
 For women, difficult menstruation
Case Study
• What diagnostic studies would you
anticipate the health care provider to
order?
(©Purestock/Thinkstock)
Fibromyalgia
Diagnostic Studies
 Difficult to establish a definitive
diagnosis
 Laboratory results rule out other
suspected disorders
 Low ANA titer, but not diagnostic
 Muscle biopsy
 Nonspecific moth-eaten appearance
 Fiber atrophy
Case Study
(©Purestock/Thinkstock)
• A.S.’s lab work results are all within
normal limits.
• The health care provider diagnoses her
with fibromyalgia.
• What criteria would the health care
provider use to support the diagnosis
of fibromyalgia?
Fibromyalgia
Diagnostic Studies
 Fibromyalgia if two criteria are met:
 Pain is experienced in 11 of 18 tender
points on palpation
 History of widespread pain is noted for
at least 3 months
 Fatigue, cognitive symptoms, somatic
symptoms help establish diagnosis
Fibromyalgia
Diagnostic Studies
 Subsequent classification by ACR
 Nontender point diagnostic criteria
 Symptom severity scale
 Widespread pain index
Fibromyalgia
Interprofessional Care
 Symptomatic treatment
 Requires high level of patient
motivation
 Patient teaching
 Rest
Case Study
(©Purestock/Thinkstock)
• A.S. tells you she is glad that she finally
knows what is wrong with her.
• She is anxious to begin her medications
to help her feel better.
• What drug treatments might you
anticipate the health care provider
ordering for A.S.?
Fibromyalgia
Interprofessional Care
 Drug therapy for chronic widespread pain
 Pregabalin (Lyrica)
 Duloxetine (Cymbalta)
 Milnacipin (Savella)
 Low-dose tricyclic antidepressants (TCAs),
SSRIs, or benzodiazepines
 Muscle relaxants
 Nonopioid analgesics
 Zolpidem (Ambien)
Case Study
• What other treatments and/or
interventions would you teach A.S.
about?
(©Purestock/Thinkstock)
Fibromyalgia
Nursing Management
 Supportive care
 Massage combined with ultrasound
 Application of alternating heat and
cold packs
 PT (gentle stretching)
 Yoga/Tai Chi
 Low impact aerobic exercise
Fibromyalgia
Nursing Management
 Limit intake of sugar, caffeine, alcohol
 May be muscle irritants
 Vitamin and mineral supplements
 Relaxation strategies
 Biofeedback, imagery, meditation,
cognitive behavioral therapy
 Psychologic counseling