MPS/CFS/Other

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.