The topics that we're going to talk about today that people
tend to confuse is Fibromyalgia, with my senior gravis people.
Look at these two terms and they're like, what?
They're just kind of like Jaw drop eyes wide open and they're
like, I don't know which one is, which I don't know what the
signs and symptoms are. I don't know what to expect on
the boards for these, so let's get into them.
So, the first one is fibro myalgia, what did I say earlier,
I go. None of us had medical
terminology as our first language.
So, when you, when you start to study and you're learning
content, you have to understand, you have to learn to break down
words from the prefix to the body, to the suffix.
You have to know how to break words down because on test day
as many students have said they're going to give you
something you don't know, but they expect you to break it down
and try to figure it out and even if you kind of get a hint
of what it is, you're giving like all right.
Cool. I kind of know they're going in
this direction. So let me see what's available
in the answer. Choices, that may be applicable.
So what is fibromyalgia? Well, let's break it down.
Fibro meaning fibrous tissue, my 0, meaning muscle, An algebra
meaning pain. PN with a line over.
It is pain. So fibromyalgia.
So we've got Muscle pain, especially of the fibrous tissue
of the muscle. So what about this do we need to
know? Well, I don't really think
causes are super high yield in general in this situation.
I do think that there are something more than causes.
I think they're actually risk factors that could potentially
lead to fibromyalgia. It's a very random diagnosis.
A very random, Adam pathology. But things that could be a risk
factor. Well, first and foremost
genetics. Genetics can be a risk factor
for fibromyalgia. But you could also get some sort
of an infection that can lead to it.
Okay. Well, what type of infection
viral bacterial? Doesn't matter.
Your body's muscle is causing pain.
So, wherever that infection infiltrates in the fibrous
tissue, which can lead to fibromyalgia.
PTSD is another one PTSD, anxiety and depression.
Are all mental health issues that can lead to fibromyalgia.
So, just our own mental state is capable of causing muscle pain.
And if you think about it, think about when we talk about mental
health, when we talk about Mental Health, think about Siggy
caps, right? When we talk about Siggy caps,
you go all the way down to p p is what P stands for psychomotor
retardation. I don't like the latter part of
the word, but that is a medical diagnosis or that is a term that
they use. So, psychomotor retardation
means that because I'm depressed, I can't physically do
things that, I know, I normally can just because my mental state
is depressed. Meaning all that five-pound
weight. It is I can't lift it.
It's too heavy because mentally I'm so depressed that my body is
now reacting in the same way. So you're looking at this
five-pound weight, you're like oh it's just too much even
getting out of bed for that matter, is tough for people and
that it requires energy. Now, you take PTSD, anxiety,
depression, put in their mental health State into PTSD, anxiety,
or depression, and they can develop Miosha abuse.
Well, abuse would kind of fall in the same thing, right?
Physical abuse, mental abuse, verbal, abuse, whatever type of
abuse. It can still lead to that mental
depression, that mental state that can lead to fibromyalgia.
So, what are some signs and symptoms?
So, the cause is, again, let's recap that risk.
Factors are going to be genetics and faction, PTSD, anxiety,
depression abuse. Now we've got fibromyalgia.
Now we got this widespread, muscle pain but there are some
specific areas that it actually targets and we'll get into those
in those are called trigger points.
But in fibromyalgia, what are the signs and symptoms?
What type of a question is signs and symptoms people, get.
So they go, they get so fixated on this next gen next, to a next
gen, right? Everyone wants to know about the
next gen, but in reality, how much is next gen of r.
Entire exam, maybe 10 to 12 percent.
Let's just let's say 15 percent on the high end on the high end,
15 percent. That means 85% to 90% of your
test is still going to be old school.
It's going to be the old type of questions.
So signs and symptoms are what select all that apply right.
Select all that. Apply so with fibromyalgia, the
first thing that we're going to talk about is muscle pain.
This muscle pain is going to be in specific areas and that's
called trigger points, trigger points.
And we'll talk about those areas here when I draw a little stick
figure diagram. So, you know, my drawings you're
not the best. You also could have bone pain,
General fatigue. You're going to get headaches,
dry eyes, the depression and anxiety can result, or cause I
can go both ways. So if I've got this constant
pain, And I'm just I can't get rid of it for whatever reason
that I have it, genetics infection, whatever it is.
Do you think it's possible that my ping can lead to depression
and anxiety? Absolutely any chronic pain can
lead to somebody becoming depressed and anxious.
I once had a patient when I was doing when I was out in Chicago,
doing Psych in neuro? When I was on the site floor, we
had a patient that came in who was so depressed.
They developed fibromyalgia, which basically exacerbated the
depression and we talk about pain.
My patient had told me, this is the severity of the pain.
And when we talk about The trigger points.
One is behind the scapula, okay, right behind the scapula.
And that's one of the trigger points.
And my patient had told me that, it felt like somebody took a
spoon, Doug it behind their scapula, and was twisting it all
day long. That's a pretty specific way to
describe pain. So you can imagine how severe
the pain can become. Yeah, it's not pleasant.
So when we say wait a minute, what's going on here?
How bad is your pain? On a scale of 1-10?
Obviously there were saying it was ten out of ten.
Hence why they were admitted? So now if I'm in pain, I've got
depression anxiety. Do you think I'm going to have
trouble focusing? Yeah.
How about trouble sleeping? Yeah.
And then, how about bladder issues?
Yeah, and if I bladder issues and I'm definitely gonna have
bowel issues all that fibrous tissue muscle tissue bladder is
muscle, right? So we've got these things that
are going to altogether, make things worse IQ.
Compound one thing on top of the other, on top of the other on
top of the other, this is not a pleasant situation to be in.
It's not a pleasant situation to be in, but now we come back to
something. That I teach over and over
again. Repetitive as I can be on a
common theme that we will see over and over and over again.
What am I going to do about a patient with fibromyalgia?
What are the first things that I can do about this patient
cognitive behavioral therapy because we are talking about
something that potentially could be a mental health issue, right?
And with that, how about the pneumonic I came up with needs
do you think nutrition can play a role in here?
Absolutely. So there are some studies and
this is not board relevant. But just for real life there are
some studies that show that vitamin D & Co Q 10.
So vitamin D, calcium & Co Q 10. Yeah, absolutely.
Do you think that they can help with depression that they can
help with the body and the muscle?
Yeah, absolutely. Now it's not something that the
board's you're going to ask but for real life, so it just shows
you nutrition plays a big part in mental health, in body, so on
and so forth. How about exercise?
But doctors either in so much pain.
They're in so much pain. Like how are they even going to
exercise? Give me something.
That wouldn't be a lot of stress on the body.
How about yoga? How about stretching walking?
Maybe swimming? Yeah, give me what you can do
but give me something. You'll be surprised how
important exercise is. Oh well, dr.
Zee, they've got a broken leg or they're in too much pain to
decide to give me what you can when does needs ever change and
ceds nutrition exercise. Etoh is what alcohol etoh is
out. Alcohol and we are going to
avoid alcohol. Do you think alcohol is going to
exacerbate? Fibromyalgia.
You better believe it? Yeah.
So are we going to say, decrease it?
No. We're going to say all together.
Cut it out. And then, what's another
substance that is full of carcinogens that will
deteriorate our body and our brain cigarettes.
So, don't smoke the DS and needs.
Don't smoke. Look, I say this over and over
again, because I talked about this in cardio.
Yes, absolutely. I talked about this in g.i.?
Yes, don't talk about this in endocrine.
Yes, respiratory. Yes, here we are
musculoskeletal. Do I talk about?
Here. Yes, when does it ever change
you use this moving forward in any?
In any question? This is your select all that.
Apply find it find nutrition. Find a type of exercise find
that you can't drink and don't smoke when you say the opposite
never. Never never never.
So that's what we start because we always start from least
invasive. To most invasive, least invasive
to most invasive. So CBT or cognitive behavioral
therapy. Get into a group with other
people that have fibromyalgia. You'll be surprised at how many
people are going to be like. Yeah, I deal with it in this
manner and like, wow, I never really thought about that.
Oh yeah. Would you like to talk about it
or when you're in pain? Hey, you know, would you like
to, you know, give me a call when you're feeling really down
or depressed, you'll be surprised.
Be surprised, cool. All right, but there are other
ways to treat it so some of the more popular drugs and I'm going
to talk about the two, the two popular drugs that I think will
show up on the boards. The two, most popular drugs, I
would that would show up on the boards.
The first one is an snri snris. What a serotonin Norepinephrine
reuptake inhibitor. And the snri that the boards are
going to like is Duloxetine do L'Occitane.
So what is an SNR? When we typically use an snri or
an SSRI, right? They're basically the same thing
except for one is a selective serotonin SSRI, this one attacks
serotonin and norepinephrine. Do you think serotonin
norepinephrine in our brain? And good levels helps fight
depression and anxiety? Absolutely.
So very important to know Duloxetine is an S and are easy
to mental health, but we can use it here because again, what are
some of the main causes mental health, mental health, right?
All right. That's the first one.
The next one is a nasty drug tricyclic antidepressants TC, a
tricyclic antidepressant. And the one that we use for
fibromyalgia is amitriptyline again, we're talking about
antidepressants notice both the drugs that I'm using are
attacking the mental health portion of it.
Have you noticed that? So you can imagine when we talk
about genetic infection cool. But when you talk about abuse
PTSD anxiety, depression, we're talk about Mental Health, So, I
know I put this in musculoskeletal because it
presentation is going to be because of that, muscle pain.
But ultimately look at this. Do you think this can overlap
into mental health? 100% 100%?
Especially when it comes to treatment and or risk factors.
So now we think about this and we're like all right, TCH TCH we
learned about some mental health.
What about tcas or amitriptyline?
Are we freaking out about? First and foremost, with any
antidepressant, both that I mentioned.
What's the first thing that we're scared of with any
antidepressant, you're always scared of that black box
warning, that this drug may cause suicidal ideation if I
gave somebody Duloxetine or I gave somebody amitriptyline,
what is a statement on the board's that's going to scare me
that I'm freaking out about that this person is potentially
suicidal. They're going to say I'm still
in pain or depressed but I've got all this energy.
Like, I've got all this energy but I still feel really, really
bad internally. Now, they've got the energy to
potentially go out and commit suicide.
Some other things, they're giving away all their
belongings. They're not making future plans.
Whoa, red flag, right? Pay attention to these.
These are things that may suddenly get into your answer
choices and you'll just kind of Overlook it.
Oh, they're getting rid of their stuff.
Maybe they didn't need it. No, no, no, no, absolutely not.
They're giving things away because they don't need it and
they don't they know they're not going to use it anymore.
That's when I'm freaking out about.
How about that patient that says, I'm not even worried about
my next birthday, who cares? I don't care about my grandkids
birthday. You know, it's coming up.
Who cares? Whatever?
Yeah, now I'm freaking out now. I'm like, well, wait a minute,
this person doesn't care about the future.
However, if they're like, yeah, I can't wait to see my grandpa.
My grandkids turned five and six.
Hmm. Now you're thinking in the
future, right? So look at that mentality.
Look at the mentality, very important.
Very important suicidal ideation with TCA, specifically TCA,
specifically, like amitriptyline, we're worried
about cardiotoxicity with cardio toxicity.
Worried about dysrhythmias. Somebody tell me what the most
deadliest dysrhythmia there is out there which of our cardio
toxicity we're talking about v-fib We're talking about v-fib.
Yeah, and when we talk about that in our EKG lectures, it's
pretty straightforward, we're freaking out about it, v-fib you
defib, right? We talk about that all the time
in our EKG lectures. Alright.
The last drug that we can give is more of a recent drug and
it's kind of interesting because it doesn't help with muscle pain
but it helps with neuropathy and that is pre Gavilan Pregabalin,
so it does affect Gaba. And what we're worried about
here is we can help with the neuropathy.
I would not be surprised if they gave pregabalin with one of the
other drugs. Like if you were to give
Gabapentin pregabalin, they're all the same class of drugs,
Gabapentin pregabalin, they all help with neuropathy.
I wouldn't be surprised if they gave them.
Together, give them a Duloxetine and give them a Gabapentin or P
Gavilan. So, you know, you got the, the
depression portion, the mental health, portion of it, and
you're helping with neuropathy number, kind of attacking two
for one at the same time. So that's that, trigger points.
Where are trigger points. So my wonderful stick figure
human being. If you're looking at the front
of a patient, you're going to look underneath the jaw, kind of
right around the neck area above the clavicle, that whole area
can be a trigger point, your forearm as well, too.
And then your calf. If you're looking at the patient
straightforward, if you turn your patient around and you look
towards your back, the lower neck, shoulders and underneath
the scapula. Lower neck, shoulders, and
underneath the scapula, go straight down your lower back
and your glutes and your glutes. These are the more common
trigger points. Are these, the only trigger
points now? Absolutely, not this can present
anywhere, but these are the ones that typically present
themselves. So, that is Fibromyalgia, super
high yield. And a topic that people tend to
like just put in the back burner and not think about it.
So I want you to know that this is a high-yield subject.
I know everything I've taught you thus far.