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PDC Test - Fibromyalgia Syndrome

You can earn 0.25 PDC by passing the exam following this article, which has been approved for publication by NCRA's Council of the Academy of Professional Reporters.

The questions are based on the material in the article but some may require additional research. Send your answer sheet to NCRA's Continuing Education Office, 8224 Old Courthouse Road, Vienna, VA 22182, and enclose a check for $40 (member) or $50 (non-member) to cover the processing fee.

Fibromyalgia Syndrome

Up until 1987, fibromyalgia syndrome had no name. In fact, the signs and symptoms puzzled the medical community. For years, doctors told patients they could find nothing wrong, and for years, many patients were told that their problems existed only in their heads and not in their bodies.

Today, however, is another story. Fibromyalgia syndrome, or FMS, is now recognized by the American Medical Association, the World Health Organization, and the National Institutes of Health as a defined, diagnosable, and treatable illness that affects, conservatively, more than 4 million Americans alone.

What Exactly Is Fibromyalgia Syndrome?

The term “fibromyalgia” is derived from the Latin “fibro,” meaning connective tissue of tendons and ligaments, the Greek “myo,” meaning muscle, and the Greek “algia,” meaning pain. Not only do people with fibromyalgia experience widespread pain throughout their bodies, but also they exhibit amplified sensitivity to pain.

Although fibromyalgia is sometimes referred to as a musculoskeletal disorder because of associated pain in the muscles, tendons, and ligaments, research has shown it to be more of a dysfunction of the central nervous system. In other words, muscle fibers are not actually causing the problem; instead, a biochemical problem affects the entire body.

According to the American College of Rheumatology, which first released its diagnosis criteria for fibromyalgia in 1990, patients with the syndrome are likely to exhibit the following: “(1) A history of widespread pain on both sides of the body, above and below the waist, present for at least three months; and (2) pain in at least 11 of 18 tender-point sites and in all four quadrants of the body.”

The tender-point sites, also known as trigger points, are specific places on the body that elicit a pain response when mild but firm pressure is applied. Research shows that the tender points almost always come in pairs bilaterally.

For someone to understand what fibromyalgia is, it is often helpful to understand what it is not. Although FMS is a chronic pain syndrome, which means the pain lasts over a long period of time, FMS is not a progressive illness. In many cases, although treated by specialists in the field of rheumatology, fibromyalgia is not an inflammatory disorder.

Signs and Symptoms

Fibromyalgia affects different people to differing degrees, but there are several common signs and symptoms.

Widespread pain is the most prominent and common symptom of FMS. How that pain manifests itself and with what intensity reveals its differences. For some, the pain is a tingling feeling; for others, it is a burning sensation or a knife-like sharpness.

People with FMS also experience abnormal sleep patterns, which, in turn, exacerbate the widespread pain and lead to a chain of other problems, such as severe fatigue, depression, anxiety, and cognitive difficulties, also known as “fibro fog.”

Other signs and symptoms can include irritable bowel syndrome, headaches, facial pain, and hypersensitivity to stimuli such as odors, light, and noise.

What Causes Fibromyalgia Syndrome and Who Gets It?

Although the majority of those who suffer from fibromyalgia are adult women, it is also found in men and, more recently, children under the age of 18. According to <I>Muscle Pain: Understanding Its Nature, Diagnosis, and Treatment<I>, women experience more pain with specific stimuli than men; hence, the higher numbers of women with FMS.

Since the development of its diagnosing criteria, medical researchers have continued to study fibromyalgia. But so far, no specific cause has been definitively identified -- only theories rendered.

Research, however, points to a direct link between hormone and neurotransmitter levels in one’s body and FMS. <I>The Fibromyalgia Advocate<I> describes fibromyalgia as the result of many neurotransmitter cascades. Fribromyalgia and Chronic Myofascial Pain states:

A neurotransmitter cascade is like a waterfall that starts at the top and bounces off rocks and ridges on the way down, wearing down rock, moving gravel, and changing the river as it goes. The neurotransmitter cascade can cause changes throughout your body, and many of these changes may start cascades of their own. Once they get going, a combination of peripheral and central factors join in to make the changes chronic, and the result is what we call fibromyalgia.

For instance, persons with FMS can have as much as three times higher the amount of substance P in the spinal cord compared to the average person. The neural hormone substance P, in simplified terms, sends loud pain messages to the brain. More substance P translates into more pain messages with a higher volume.

Adding to the equation, researchers have also found that serotonin, the neurotransmitter that regulates the brain’s ability to control pain and mood, tends to be at lower levels and is processed poorly in people with fibromyalgia. Serotonin also assists the body in reaching deep, restorative sleep -- something people with FMS have trouble achieving. These sleep disturbances also lead to fatigue, pain, and mood swings.

More studies indicate that people with fibromyalgia secrete less adrenaline than people without the syndrome, revealing a different response to physical and emotional stress.

As one can see, those findings are so intertwined that it is hard to establish which is the cause and which is the effect.

Some studies suggest that there may be a genetic predisposition to fibromyalgia, while other studies believe a common environment causes members of the same family to get fibromyalgia. No single cause exists for FMS. For some, its onset comes from physical or emotional trauma. For others, the onset cannot be tied to a particular event, but, rather, it develops over time with a slow cascade of responses, which sets off another chain of responses.

Is There Treatment for Fibromyalgia?

Although there is no known cure for FMS, treatment options do exist and can provide relief from symptoms.

Current studies show that low dosages of tricyclic antidepressants (such as amitriptyline, doxepin, and nortriptyline) can be effective. Tricyclic antidepressants assist in restoring deep sleep, which, in turn, increases the amount of serotonin and growth hormone produced, which is known to help with muscle repair. The newer class of antidepressants, known as serotonin and norepinephrine reuptake inhibitors, or SNRIs, show positive results in treating FMS. Oftentimes, a combination of a tricyclic antidepressant with an SNRI fine-tunes the body’s balancing act and helps bring symptoms under control. SNRIs include medications such as Effexor and Cymbalta. Although studies are not complete, pregabilin, an antiseizure medication, has recently been shown to also reduce the signs and symptoms of FMS. In a few cases, analgesics such as acetaminophen or nonsteroidal anti-inflammatory drugs (for example, ibuprofen) help relieve pain symptoms.

However, muscle relaxants, prescription sleeping pills, and benzodiazepines may help muscles relax and promote sleep. But they do not provide long-term benefits for FMS sufferers. In fact, additional long-term problems, such as addiction, may be a consequence for the short-term benefits.

Alternative and complementary therapies, such as massage, acupuncture, biofeedback, chiropractic care, and yoga, have also been successful in relieving symptoms.

Learning to Live with Fibromyalgia Syndrome

The key to living with FMS lies within each patient. With education, a few lifestyle changes, and the right medical team, a person can lead an active and productive life. It is a matter of self-discipline when it comes to diet and exercise, self-awareness of personal limitations, and self-motivation to take control of this chronic condition.

Stretching and exercise play a vital role in the treatment of fibromyalgia. Although exercise may seem counterintuitive for someone with chronic pain and fatigue, it actually combats the widespread pain by building stronger muscles and by keeping bone and cartilage tissue strong. It also prompts the release of endorphins, which are the body’s natural pain relievers; boosts energy levels; helps with sleep; decreases depression and anxiety; and provides an outlet for stress -- all of which are problematic for people with FMS. A lack of exercise, however, leads to deconditioning, stiffness, and muscle tension, which then lead to increased pain.

Maintaining a healthy diet, avoiding unnecessary stressors, and learning to pace oneself and to rest when needed also assist one in gaining control of fibromyalgia. In addition, fibromyalgia support groups now exist in cities around the country and offer online help with daily struggles.

Resources on Fibromyalgia

Advances have been made in treating FMS in the past two decades, and research continues to search for answers and solutions. More information on FMS can be found at the Mayo Clinic Web site at <web>www.MayoClinic.com<web> and at the American College of Rheumatology Web site at <web>www.rheumatology.org<web>, as well as in numerous books, such as Good Living with Fibromyalgia and Fibromyalgia and Chronic Myofascial Pain: A Survival Manual.


Resources

  • American College of Rheumatology. “Fibromyalgia” www.rheumatology.org.
  • Arthritis Foundation. Good Living with Fibromyalgia. Atlanta, Ga.:
     Arthritis Foundation, 2006.
  • Mayo Clinic, “Fibromyalgia,” <web> www.MayoClinic.com/health/fibromyalgia/DS00079/DSECTION=2<web>.
  • Mense, Siegfried, David G. Simons, I. Jon Russell. Muscle Pain: Understanding Its Nature, Diagnosis, and Treatment Baltimore, Md.: Lippincott Williams & Wilkins, 2000.
  • Starlanyl, Devin J. The Fibromyalgia Advocate. Oakland, Calif.: New Harbinger Publications, 1999.
  • Starlanyl, Devin J. and Mary Ellen Copeland Fibromyalgia and Chronic Myofascial Pain, A Survival Manual<I>, 2nd edition. Atlanta, Ga.: New
    Harbinger Publications, Inc., 2001.

 

Fibromyalgia Syndrome Test

1. Fibromyalgia is:
A. An inflammatory disease
B. A chronic pain syndrome
C. A progressive condition
D. A contagious infection

2. With FMS, pain will most likely be felt on one side of the body and not the other:
A. True
B. False

3. The most common, prominent symptom of fibromyalgia is:
A. Headaches
B. Cramping
C. Widespread pain
D. Irritable bowel syndrome

4. Which of the following is not associated with FMS:
A. Cognitive difficulty/memory problems
B. Fatigue
C. Hypersensitivity to odors, light, and noise
D. Heart problems

5. The majority of those who suffer from fibromyalgia are:
A. Men
B. Women
C. Children
D. Infants

6. Persons with FMS have been found to have lower levels of substance P in the spinal cord.
A. True
B. False

7. So far, medical research on the topic has found:
A. A definitive cause for fibromyalgia syndrome
B. A treatment that completely cures FMS
C. FMS symptoms are all imaginary
D. A link between hormone and neurotransmitter levels and FMS

8. Substance P, a neural hormone in the body, provides what function:
A. Sends loud pain messages to the brain
B. Sends messages of hunger to the brain
C. Helps blood clot
D. Aids in digestion

9. Serotonin is a neurotransmitter which:
A. Regulates the beating of the heart
B. Creates trigger points
C. Regulates the brain’s ability to control pain and mood
D. All of the above
E. None of the above

10. Part of the problem for people with fibromyalgia syndrome is that they get too much deep sleep.
A. True
B. False

11. Which pharmacological treatment is found to be least effective in treating FMS long-term:
A. Tricyclic antidepressants
B. SSRI antidepressants
C. Anti-seizure medication
D. Sleeping pills

12. For the person with fibromyalgia syndrome, the trigger points:
A. Turn red and swell
B. Usually get infected
C. Refer pain to other parts of the body when touched
D. Elicit a pain response to pressure

13. The onset of fibromyalgia or flare-ups may be caused by:
A. Emotional and physical stress
B. Sleep disturbances
C. Injury
D. All of the above
E. None of the above

14. One vital component in the self-management of FMS is:
A. A sedentary lifestyle
B. Exercise
C. Eating foods with high quantities of salt and sugar
D. To keep up one’s activities no matter what

15. The signs and symptoms of FMS may wax and wane, but there is no cure.
A. True
B. False

16. Aggravating factors for FMS are:
A. Changes in weather
B. Infections
C. Allergies
D. All of the above
E. None of the above

17. People with fibromyalgia should not exercise because it will injure their muscles further.
A. True
B. False

18. If a person has a rheumatic disease, such as rheumatoid arthritis or lupus, he/she may be more likely to have fibromyalgia.
A. True
B. False

19. Which of the following is the criteria established by the American College of Rheumatology for the diagnosis of fibromyalgia:
A. Depression for at least three months
B. Pain in at least 11 of 18 trigger points on the body
C. Stiffness in the head and neck
D. Persistent migraines

20. Research has shown that FMS patients experience a somewhat increased cerebral blood flow to the brain compared to healthy individuals.
A. True
B. False

21. Studies show people with fibromyalgia syndrome may have a different response to physical and emotional stress because they secrete less:
A. Sweat
B. Dopamine
C. Adrenaline
D. All of the above
E. None of the above

22. SNRIs are what kind of medication:
A. Anti-seizure medication
B. Analgesics
C. Antidepressants
D. Narcotics

23. Other therapies which may be helpful to the FMS patient include:
A. Massage
B. Acupuncture
C. Biofeedback
D. All of the above
E. None of the above

24. Physicians can perform a specific diagnostic blood test to determine if a person has fibromyalgia:
A. True
B. False

25. Fibromyalgia affects, conservatively, 4 million Americans:
A. True
B. False

 


 

You can earn 0.25 PDC by passing the exam following this article, which has been approved for publication by NCRA's Council of the Academy of Professional Reporters.