Treatment for fibromyalgia

[Avisek Kar]

AGE : 16
SEX : F

complains of pain in the nape of the neck to the si joint ;pain in dull yet very acute sometimes; postural positions altering altering(inc.)pain

sitting
prone lying
supported sitting
supine

tender points present on

medial traps
levator scapule
infraspinatus
rhomboids
l.dorsi
g.medius

no relieving factors as such
sleep undisturbed

Investgations:
crp -ve
rh -ve
tsh -ve
hlab 27 -ve

xray shows no profound changes facet joints normal with slight reduction in spaces...

on medicinal therapy

aceclofenac + rabeprazole (to control pain)
and topical ointments compunded with heat fermentation...

Phsycal treatement

U/s at 0.8-1 ma/cm2 for 12 mins over in the interscapular region....

multidirectional isometrics of neck and shoulder girdle taught ....


THE PROBLEM IS PATIENT IS NOT GETTING MUCH HELP

AND AM RUNNING OUT OF IDEAS

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[bhalla.ravneet]

Hi Bro
How Are You ?

Try this
ask her to get an Mri done screening of spine,
meanwhile give pulsed tens 4 channels
also check for any history of falls, accidents, thyroid levels

lastly tpr for trigger points and cervical mobilization if spinous processes are painful..


also i learnt if trigger poimts are there in sole aka plantar fascia her posture gets compromised, try checking for points on bilateral sole

[roycar]

id look at biomechanics in general (from the feet up!), posture, get some kind of appropriate aerobic exercise programme going within painful limits, have a look at individual joints - any hypermobility?, very poor proprioception? etc. id also look at individual muscles and synergistic muscle groups for weakness, tightness etc.

[gcoe]

Hi Avisek Kar

there is a lot of research looking at physio for fibromyalgia. However on the whole the evidence points to some overall management strategies rather than specific symptomatic treatment. I think this is because fibromyalgia is a chronic pain syndrome, which is accompanied by central nervous system changes including abnormal pain modulation, depression and often high levels of general fatigue

The two major strategies with the most evidence is an aerobic fitness programme and strengthening - mainly progressive resistance training rather than isometric strengthening. These strategies not only help the pain but can improve mood, fatigue and quality of life.

Below is a link to the to the Ottawa panel guidelines in Physical Therapy that talk about aerobic training and strengthening. Look at the summary of the studies to find out what has been trialled.

PTJ -- Table of Contents (July 1 2008, 88 [7])

Just scroll down the page until you get to the two articles under the heading Special Issues. You can download the full text PDFs

Just one tip: patients need to slowly acclimatise themselves to aerobic exercise and PRT. If you work them too hard at first you can push them into a relapse. So better to take it slowly at first and slowly work up to the optimal level of training. Having a cognitive behavioural treatment programme going at the same time can help patients accept and adhere to exercise better. Exercise can be a very challenging thing for them.

Also is a list of other guidelines and review that you might consider reading - The first one is a good read on the overall management.

PEDro - Search Results

Are you working with a team with this patient? Appropriate medication - usuallly from a pain specialist, occupational therapy and cognitive behavioural therapy are key therapies that can help in fibromyalgia.