Soft tissue pain disorder

defining characteristics

Widespread and migratory pain/tenderness; waxes & wanes, other nonspecifc MSK sx (IBS, headaches), fatigue, weight change, night sweats, weakness, SLEEP PROBLEMS, trouble concentrating, TMJ, ENT sx, nondermatomal parasthesias
Chronic widespread pain involving ALL 4 quadrants and axial skeleton; Presence of 11/18 tender points

disease development

No inflammation or tissue pathology!
Abnl neurochemistry affects pain perception; mood & sleep disturbance along w/ changes in HPA axis causes decreased blood flow to thalamus (pain perception center), resulting in decreased pain thresholds

potential causes

Pain perception thresholds decreased (abnl neurochem)
Physical/emotional triggers can precede or aggravate sx (virus, trauma, dep/anx)

epidemiology

Prev? 4% of population F>>M (10:1)
Peak onset 30-55y.o.

risk factors

First degree relatives w/ FM (8x higher risk!)
Mutations in serotonin gene

labimaging

Clinical? Should not see weakness! Dramatic pain/tenderness at pressure points
No anemia
Nl CPK, aldolase Nl ESR/CRP
Nl thyroid studies Negative ANA, RF

conventional treatment

Pt education
Anti-inflammatory/ analgesic meds (not better than placebo)
AVOID NARCOTICS
tricyclics (muscle relaxant, antidep)
Serotonin reuptake inh
Lyrica (decrease perception of pain) FITNESS TRAINING! (low impact aerobics and muscle strength)

complications

prevention

protocols