MPS/CFS/Other

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    Chronic Fatigue Syndrome

    Source; MKSAP 16 question

    • Defined as:
      • Medically unexplaiend fatigue that persists ≥ 6mo 

        AND (≥4)

        • Subjective memory impairment
        • Sore throat
        • Tender lymph nodes
        • Muscle/Joint pain
        • Headache
        • Unrefreshing sleep
        • Postexertional malaise lasting > 24hrs

         

    • Management:
      • Challenging!
      • Non-pharmacologic therapy:
        • Lifestyle modification
        • Sleep hygiene
        • Graded exercise program (improves symptoms in studies!!)
        • CBT (focus on breaking cycle of effort avoidance, works with graded exercise).  

     

    Fibromyalgia

    • Central Pain sensitivity syndrome.
    • Widespread pain --> central pain sensory processing is altered producing allodynia or hyperalgesia. 
    • Both biological and psychosocial factors
    • 2% of population, Female predominance
    • Symptoms:
      • Diffuse pain (myalgias, arthralgias, paresthesias)
      • Mood Disorders, Fatigue, Sleep disturbance
      • Cognitive dysfunction (but on testing normal cognition)
    • Physical Exam
      • Normal 
      • Joint exam will have painless ROM (whereas inflammatory conditions will be severely painful)
    • Laboratory Investigations
      • Normal

     

    • Diagnostic Criteria:
      • Old criteria includes tender points
      • New criteria are more global (important to rule out other conditions)
      • 2010 Diagnostic Criteria by the American Rheumatology Association

        • 3 of following are met:
          • Widespread pain index (WPI) ≥ 7 and Symptom Severity (SS) scale score ≥ 5
            OR
            WPI 3-6 and SS score ≥ 9
            • To remember:  Widespread pain, Wakes unrefreshed, Significant fatigue, and Cognitive difficulties.
          • Symptoms ≥ 3mo
          • Does not have a disorder that would explain pain
    • (WPI attached)
    • Treatment
      • Non-Pharmacologic
        • Treat Symptoms
          • Correct sleep disturbance
          • Address mood disorder
          • Avoid unnecessary referring
        • 8Reassure
          • Joints won't be damaged
          • Cannot hurt themselves by exercising
          • etc
        • Aerobic Exercise!!! -- titrate up to 30min/day most days of week.
        • CBT
      • Pharmacologic
        • SNRI (duloxetine, milnacipran) - FDA approved, and effective
          • (effective with or without depression)
        • Gabapentin & Pregabalin
          • Effective in studies
        • TCA (Amitryptiline)
          • Effective, but not tolerated due to S/E (fatigue, constipation, dry mouth, etc..)
        • Cyclobenzaprine can be effective
        • Do not use opioids (do not address underlying problem)
      • NOTES:
        • SSRI - equivocal data, unclear. 
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