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A 35-year-old female computer operator presents with a prescription from her rheumatologists that reads: “Physical therapy -- primary fibromyalgia syndrome”.

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What is the difference between primary fibromyalgia (FM) syndrome and secondary fibromyalgia syndrome?

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Primary (idiopathic) FM is a common form of nonneuropathic chronic neuromuscular pain of unknown etiology. The etiology of secondary FM can be determined as it is often triggered by conditions such as rheumatoid arthritis, lupus, hypothyroidism, HIV, and cancer.

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What are the most common sites of tenderness with primary fibromyalgia syndrome?

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The most common sites of tenderness with primary FM include:

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a. the upper scapular area, particularly the midpoint of the upper trapezius

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b. the middle or lower part of the sternocleidomastoid muscle

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c. the lateral portion of the pectoralis major muscle, or the second costochondral junction

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d. the midsubstance of the supraspinatus muscle located in the suprascapular fossa

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e. the middle to upper and outer quadrant of the buttock at the iliac crest

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f. just distal to the medial or lateral epicondyles of elbow

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g. the medial fat pad at the knee

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h. just posterior to the hip trochanters

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Describe the differences between myofascial pain syndrome and primary fibromyalgia syndrome.

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Although similar in many respects (muscle pain, muscle tenderness on palpation, and the fact that both are very common maladies), primary FM and myofascial pain syndrome (MPS) are distinct entities. The pain associated with MPS may be acute or chronic; there is a referred pain patent specific to each involve muscle; nonmusculoskeletal symptoms are unusual; myofascial trigger points are found only in muscle, and radiate pain remotely; muscles containing trigger points frequently contain taut bands; and the psychological status of the patient is usually not a factor.1 Conversely, primary PM is associated with chronic pain; there is diffuse pain involving many muscles, ligaments, or bones; nonmusculoskeletal symptoms are common; fibromyalgic tender points are found in muscle and other sites such as tendon insertions, fat pads, and bony prominences; and psychological factors are important in about 25% of patients.1

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What therapeutic intervention is appropriate for primary FM?

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A multifaceted physical therapy approach involving a focus on cardiovascular fitness training, strength and endurance training, massage, postural education, and electrotherapeutic and physical modalities, including microstimulation and spray and stretch, may help to reduce some of the disease consequences.2

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What medications are typically prescribed for patients with fibromyalgia syndrome?

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The medical intervention for FM includes the prescription of drugs that influence chemicals in the ascending and descending ...

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