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The topics that we're going to 
talk about today that people 

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tend to confuse is Fibromyalgia,
with my senior gravis people. 

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Look at these two terms and 
they're like, what? 

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They're just kind of like Jaw 
drop eyes wide open and they're 

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like, I don't know which one is,
which I don't know what the 

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signs and symptoms are. 
I don't know what to expect on 

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the boards for these, so let's 
get into them. 

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So, the first one is fibro 
myalgia, what did I say earlier,

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I go. 
None of us had medical 

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terminology as our first 
language. 

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So, when you, when you start to 
study and you're learning 

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content, you have to understand,
you have to learn to break down 

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words from the prefix to the 
body, to the suffix. 

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You have to know how to break 
words down because on test day 

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as many students have said 
they're going to give you 

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something you don't know, but 
they expect you to break it down

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and try to figure it out and 
even if you kind of get a hint 

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of what it is, you're giving 
like all right. 

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Cool. 
I kind of know they're going in 

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this direction. 
So let me see what's available 

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in the answer. 
Choices, that may be applicable.

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So what is fibromyalgia? 
Well, let's break it down. 

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Fibro meaning fibrous tissue, my
0, meaning muscle, An algebra 

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meaning pain. 
PN with a line over. 

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It is pain. 
So fibromyalgia. 

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So we've got Muscle pain, 
especially of the fibrous tissue

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of the muscle. 
So what about this do we need to

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know? 
Well, I don't really think 

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causes are super high yield in 
general in this situation. 

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I do think that there are 
something more than causes. 

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I think they're actually risk 
factors that could potentially 

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lead to fibromyalgia. 
It's a very random diagnosis. 

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A very random, Adam pathology. 
But things that could be a risk 

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factor. 
Well, first and foremost 

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genetics. 
Genetics can be a risk factor 

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for fibromyalgia. 
But you could also get some sort

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of an infection that can lead to
it. 

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Okay. 
Well, what type of infection 

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viral bacterial? 
Doesn't matter. 

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Your body's muscle is causing 
pain. 

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So, wherever that infection 
infiltrates in the fibrous 

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tissue, which can lead to 
fibromyalgia. 

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PTSD is another one PTSD, 
anxiety and depression. 

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Are all mental health issues 
that can lead to fibromyalgia. 

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So, just our own mental state is
capable of causing muscle pain. 

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And if you think about it, think
about when we talk about mental 

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health, when we talk about 
Mental Health, think about Siggy

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caps, right? 
When we talk about Siggy caps, 

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you go all the way down to p p 
is what P stands for psychomotor

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retardation. 
I don't like the latter part of 

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the word, but that is a medical 
diagnosis or that is a term that

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they use. 
So, psychomotor retardation 

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means that because I'm 
depressed, I can't physically do

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things that, I know, I normally 
can just because my mental state

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is depressed. 
Meaning all that five-pound 

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weight. 
It is I can't lift it. 

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It's too heavy because mentally 
I'm so depressed that my body is

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now reacting in the same way. 
So you're looking at this 

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five-pound weight, you're like 
oh it's just too much even 

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getting out of bed for that 
matter, is tough for people and 

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that it requires energy. 
Now, you take PTSD, anxiety, 

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depression, put in their mental 
health State into PTSD, anxiety,

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or depression, and they can 
develop Miosha abuse. 

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Well, abuse would kind of fall 
in the same thing, right? 

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Physical abuse, mental abuse, 
verbal, abuse, whatever type of 

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abuse. 
It can still lead to that mental

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depression, that mental state 
that can lead to fibromyalgia. 

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So, what are some signs and 
symptoms? 

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So, the cause is, again, let's 
recap that risk. 

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Factors are going to be genetics
and faction, PTSD, anxiety, 

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depression abuse. 
Now we've got fibromyalgia. 

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Now we got this widespread, 
muscle pain but there are some 

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specific areas that it actually 
targets and we'll get into those

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in those are called trigger 
points. 

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But in fibromyalgia, what are 
the signs and symptoms? 

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What type of a question is signs
and symptoms people, get. 

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So they go, they get so fixated 
on this next gen next, to a next

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gen, right? 
Everyone wants to know about the

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next gen, but in reality, how 
much is next gen of r. 

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Entire exam, maybe 10 to 12 
percent. 

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Let's just let's say 15 percent 
on the high end on the high end,

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15 percent. 
That means 85% to 90% of your 

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test is still going to be old 
school. 

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It's going to be the old type of
questions. 

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So signs and symptoms are what 
select all that apply right. 

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Select all that. 
Apply so with fibromyalgia, the 

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first thing that we're going to 
talk about is muscle pain. 

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This muscle pain is going to be 
in specific areas and that's 

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called trigger points, trigger 
points. 

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And we'll talk about those areas
here when I draw a little stick 

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figure diagram. 
So, you know, my drawings you're

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not the best. 
You also could have bone pain, 

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General fatigue. 
You're going to get headaches, 

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dry eyes, the depression and 
anxiety can result, or cause I 

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can go both ways. 
So if I've got this constant 

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pain, And I'm just I can't get 
rid of it for whatever reason 

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that I have it, genetics 
infection, whatever it is. 

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Do you think it's possible that 
my ping can lead to depression 

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and anxiety? 
Absolutely any chronic pain can 

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lead to somebody becoming 
depressed and anxious. 

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I once had a patient when I was 
doing when I was out in Chicago,

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doing Psych in neuro? 
When I was on the site floor, we

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had a patient that came in who 
was so depressed. 

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They developed fibromyalgia, 
which basically exacerbated the 

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depression and we talk about 
pain. 

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My patient had told me, this is 
the severity of the pain. 

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And when we talk about The 
trigger points. 

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One is behind the scapula, okay,
right behind the scapula. 

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And that's one of the trigger 
points. 

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And my patient had told me that,
it felt like somebody took a 

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spoon, Doug it behind their 
scapula, and was twisting it all

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day long. 
That's a pretty specific way to 

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describe pain. 
So you can imagine how severe 

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the pain can become. 
Yeah, it's not pleasant. 

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So when we say wait a minute, 
what's going on here? 

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How bad is your pain? 
On a scale of 1-10? 

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Obviously there were saying it 
was ten out of ten. 

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Hence why they were admitted? 
So now if I'm in pain, I've got 

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depression anxiety. 
Do you think I'm going to have 

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trouble focusing? 
Yeah. 

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How about trouble sleeping? 
Yeah. 

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And then, how about bladder 
issues? 

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Yeah, and if I bladder issues 
and I'm definitely gonna have 

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bowel issues all that fibrous 
tissue muscle tissue bladder is 

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muscle, right? 
So we've got these things that 

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are going to altogether, make 
things worse IQ. 

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Compound one thing on top of the
other, on top of the other on 

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top of the other, this is not a 
pleasant situation to be in. 

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It's not a pleasant situation to
be in, but now we come back to 

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something. 
That I teach over and over 

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again. 
Repetitive as I can be on a 

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common theme that we will see 
over and over and over again. 

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What am I going to do about a 
patient with fibromyalgia? 

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What are the first things that I
can do about this patient 

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cognitive behavioral therapy 
because we are talking about 

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something that potentially could
be a mental health issue, right?

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And with that, how about the 
pneumonic I came up with needs 

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do you think nutrition can play 
a role in here? 

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Absolutely. 
So there are some studies and 

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this is not board relevant. 
But just for real life there are

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some studies that show that 
vitamin D & Co Q 10. 

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So vitamin D, calcium & Co Q 10.
Yeah, absolutely. 

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Do you think that they can help 
with depression that they can 

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help with the body and the 
muscle? 

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Yeah, absolutely. 
Now it's not something that the 

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board's you're going to ask but 
for real life, so it just shows 

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you nutrition plays a big part 
in mental health, in body, so on

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and so forth. 
How about exercise? 

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But doctors either in so much 
pain. 

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They're in so much pain. 
Like how are they even going to 

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exercise? 
Give me something. 

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That wouldn't be a lot of stress
on the body. 

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How about yoga? 
How about stretching walking? 

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Maybe swimming? 
Yeah, give me what you can do 

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but give me something. 
You'll be surprised how 

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important exercise is. 
Oh well, dr. 

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Zee, they've got a broken leg or
they're in too much pain to 

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decide to give me what you can 
when does needs ever change and 

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ceds nutrition exercise. 
Etoh is what alcohol etoh is 

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out. 
Alcohol and we are going to 

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avoid alcohol. 
Do you think alcohol is going to

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exacerbate? 
Fibromyalgia. 

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You better believe it? 
Yeah. 

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So are we going to say, decrease
it? 

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No. 
We're going to say all together.

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Cut it out. 
And then, what's another 

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substance that is full of 
carcinogens that will 

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deteriorate our body and our 
brain cigarettes. 

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So, don't smoke the DS and 
needs. 

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Don't smoke. 
Look, I say this over and over 

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again, because I talked about 
this in cardio. 

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Yes, absolutely. 
I talked about this in g.i.? 

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Yes, don't talk about this in 
endocrine. 

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Yes, respiratory. 
Yes, here we are 

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musculoskeletal. 
Do I talk about? 

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Here. 
Yes, when does it ever change 

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you use this moving forward in 
any? 

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In any question? 
This is your select all that. 

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Apply find it find nutrition. 
Find a type of exercise find 

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that you can't drink and don't 
smoke when you say the opposite 

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never. 
Never never never. 

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So that's what we start because 
we always start from least 

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invasive. 
To most invasive, least invasive

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to most invasive. 
So CBT or cognitive behavioral 

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therapy. 
Get into a group with other 

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people that have fibromyalgia. 
You'll be surprised at how many 

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people are going to be like. 
Yeah, I deal with it in this 

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manner and like, wow, I never 
really thought about that. 

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Oh yeah. 
Would you like to talk about it 

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or when you're in pain? 
Hey, you know, would you like 

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to, you know, give me a call 
when you're feeling really down 

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or depressed, you'll be 
surprised. 

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Be surprised, cool. 
All right, but there are other 

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ways to treat it so some of the 
more popular drugs and I'm going

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to talk about the two, the two 
popular drugs that I think will 

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show up on the boards. 
The two, most popular drugs, I 

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would that would show up on the 
boards. 

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The first one is an snri snris. 
What a serotonin Norepinephrine 

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reuptake inhibitor. 
And the snri that the boards are

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going to like is Duloxetine do 
L'Occitane. 

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So what is an SNR? 
When we typically use an snri or

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an SSRI, right? 
They're basically the same thing

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except for one is a selective 
serotonin SSRI, this one attacks

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serotonin and norepinephrine. 
Do you think serotonin 

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norepinephrine in our brain? 
And good levels helps fight 

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depression and anxiety? 
Absolutely. 

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So very important to know 
Duloxetine is an S and are easy 

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00:12:46,500 --> 00:12:49,400
to mental health, but we can use
it here because again, what are 

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some of the main causes mental 
health, mental health, right? 

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All right. 
That's the first one. 

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The next one is a nasty drug 
tricyclic antidepressants TC, a 

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tricyclic antidepressant. 
And the one that we use for 

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fibromyalgia is amitriptyline 
again, we're talking about 

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antidepressants notice both the 
drugs that I'm using are 

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attacking the mental health 
portion of it. 

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Have you noticed that? 
So you can imagine when we talk 

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about genetic infection cool. 
But when you talk about abuse 

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PTSD anxiety, depression, we're 
talk about Mental Health, So, I 

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know I put this in 
musculoskeletal because it 

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presentation is going to be 
because of that, muscle pain. 

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But ultimately look at this. 
Do you think this can overlap 

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into mental health? 
100% 100%? 

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00:13:50,700 --> 00:13:54,000
Especially when it comes to 
treatment and or risk factors. 

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So now we think about this and 
we're like all right, TCH TCH we

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learned about some mental 
health. 

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What about tcas or 
amitriptyline? 

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Are we freaking out about? 
First and foremost, with any 

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antidepressant, both that I 
mentioned. 

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What's the first thing that 
we're scared of with any 

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antidepressant, you're always 
scared of that black box 

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warning, that this drug may 
cause suicidal ideation if I 

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gave somebody Duloxetine or I 
gave somebody amitriptyline, 

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what is a statement on the 
board's that's going to scare me

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that I'm freaking out about that
this person is potentially 

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suicidal. 
They're going to say I'm still 

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in pain or depressed but I've 
got all this energy. 

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Like, I've got all this energy 
but I still feel really, really 

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bad internally. 
Now, they've got the energy to 

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potentially go out and commit 
suicide. 

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Some other things, they're 
giving away all their 

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belongings. 
They're not making future plans.

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Whoa, red flag, right? 
Pay attention to these. 

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These are things that may 
suddenly get into your answer 

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choices and you'll just kind of 
Overlook it. 

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Oh, they're getting rid of their
stuff. 

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Maybe they didn't need it. 
No, no, no, no, absolutely not. 

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They're giving things away 
because they don't need it and 

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they don't they know they're not
going to use it anymore. 

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That's when I'm freaking out 
about. 

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How about that patient that 
says, I'm not even worried about

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my next birthday, who cares? 
I don't care about my grandkids 

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birthday. 
You know, it's coming up. 

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Who cares? 
Whatever? 

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Yeah, now I'm freaking out now. 
I'm like, well, wait a minute, 

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this person doesn't care about 
the future. 

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However, if they're like, yeah, 
I can't wait to see my grandpa. 

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My grandkids turned five and 
six. 

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Hmm. 
Now you're thinking in the 

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future, right? 
So look at that mentality. 

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Look at the mentality, very 
important. 

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Very important suicidal ideation
with TCA, specifically TCA, 

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specifically, like 
amitriptyline, we're worried 

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about cardiotoxicity with cardio
toxicity. 

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Worried about dysrhythmias. 
Somebody tell me what the most 

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deadliest dysrhythmia there is 
out there which of our cardio 

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toxicity we're talking about 
v-fib We're talking about v-fib.

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Yeah, and when we talk about 
that in our EKG lectures, it's 

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pretty straightforward, we're 
freaking out about it, v-fib you

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defib, right? 
We talk about that all the time 

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in our EKG lectures. 
Alright. 

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The last drug that we can give 
is more of a recent drug and 

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it's kind of interesting because
it doesn't help with muscle pain

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but it helps with neuropathy and
that is pre Gavilan Pregabalin, 

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so it does affect Gaba. 
And what we're worried about 

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00:16:47,500 --> 00:16:50,100
here is we can help with the 
neuropathy. 

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00:16:50,400 --> 00:16:55,400
I would not be surprised if they
gave pregabalin with one of the 

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other drugs. 
Like if you were to give 

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Gabapentin pregabalin, they're 
all the same class of drugs, 

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Gabapentin pregabalin, they all 
help with neuropathy. 

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I wouldn't be surprised if they 
gave them. 

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00:17:07,800 --> 00:17:11,500
Together, give them a Duloxetine
and give them a Gabapentin or P 

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00:17:11,500 --> 00:17:13,800
Gavilan. 
So, you know, you got the, the 

283
00:17:13,800 --> 00:17:15,900
depression portion, the mental 
health, portion of it, and 

284
00:17:15,900 --> 00:17:18,099
you're helping with neuropathy 
number, kind of attacking two 

285
00:17:18,099 --> 00:17:21,800
for one at the same time. 
So that's that, trigger points. 

286
00:17:23,400 --> 00:17:29,400
Where are trigger points. 
So my wonderful stick figure 

287
00:17:29,400 --> 00:17:31,500
human being. 
If you're looking at the front 

288
00:17:31,500 --> 00:17:34,800
of a patient, you're going to 
look underneath the jaw, kind of

289
00:17:34,808 --> 00:17:38,000
right around the neck area above
the clavicle, that whole area 

290
00:17:38,200 --> 00:17:43,000
can be a trigger point, your 
forearm as well, too. 

291
00:17:44,200 --> 00:17:46,700
And then your calf. 
If you're looking at the patient

292
00:17:46,700 --> 00:17:50,100
straightforward, if you turn 
your patient around and you look

293
00:17:50,100 --> 00:17:55,800
towards your back, the lower 
neck, shoulders and underneath 

294
00:17:55,800 --> 00:18:00,400
the scapula. 
Lower neck, shoulders, and 

295
00:18:00,400 --> 00:18:04,900
underneath the scapula, go 
straight down your lower back 

296
00:18:05,500 --> 00:18:10,100
and your glutes and your glutes.
These are the more common 

297
00:18:10,100 --> 00:18:11,600
trigger points. 
Are these, the only trigger 

298
00:18:11,600 --> 00:18:14,400
points now? 
Absolutely, not this can present

299
00:18:14,400 --> 00:18:17,300
anywhere, but these are the ones
that typically present 

300
00:18:17,300 --> 00:18:21,900
themselves. 
So, that is Fibromyalgia, super 

301
00:18:21,900 --> 00:18:25,600
high yield. 
And a topic that people tend to 

302
00:18:25,600 --> 00:18:28,800
like just put in the back burner
and not think about it. 

303
00:18:29,200 --> 00:18:33,100
So I want you to know that this 
is a high-yield subject. 

304
00:18:33,100 --> 00:18:35,500
I know everything I've taught 
you thus far.