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A primary care provider referred a 45-year-old female to physical therapy with the diagnosis of back pain. The patient reports that she experiences pain in her back, but she also feels pain "all over her body." In addition to pain, she experiences fatigue, difficulty sleeping, poor memory, and frequent headaches. Her pain "never seems to get better" and "it gets worse with prolonged activity." Her symptoms started approximately 4 years ago after she fell down a flight of stairs. Repeated x-rays of the thoracic and lumbar spine were negative for fractures or bony abnormalities that could contribute to her symptoms. Previous physical therapy interventions (moist heat, massage, ultrasound, stretching) have not improved her symptoms. Her medical history is significant for irritable bowel syndrome and abdominal pain (both started 2 years ago). She works as a court reporter and describes her lifestyle as rather sedentary. Based on the patient's history, you suspect she may have fibromyalgia syndrome (FMS).

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Based on the patient's symptoms and medical history, what are the most appropriate examination tests to help confirm the diagnosis of FMS?

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What are the most appropriate physical therapy interventions?

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What are possible complications that may limit the effectiveness of physical therapy?

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ALLODYNIA: Pain in response to a stimulus that would not normally cause pain

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FIBROMYALGIA SYNDROME (FMS): Chronic widespread pain condition of unknown etiology marked by increased sensitivity to stimuli (e.g., hyperalgesia, allodynia) and symptoms that may significantly impact functional capacity and quality of life

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SICCA: Dryness of the mouth and eyes

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TENDER POINT: Localized region on the body that is tender to digital pressure; FMS has been historically associated with 18 tender point locations (9 spots on each side of the body)

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  1. Describe fibromyalgia syndrome and identify potential comorbidities associated with this diagnosis.

  2. Describe American College of Rheumatology diagnostic criteria for FMS.

  3. Prescribe a therapeutic exercise program designed to improve function and decrease pain in this population.

  4. Understand common adverse drug reactions (ADRs) for medications used in the treatment of FMS that may affect physical therapy examination and/or interventions.

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PT considerations during management of the individual with a diagnosis of fibromyalgia syndrome:

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  • General physical therapy plan of care/goals: Decrease pain; increase muscular flexibility; increase muscular endurance and strength; improve aerobic fitness capacity
  • Physical therapy interventions: Patient education regarding potential pathogenesis of condition; massage/soft tissue mobilization techniques to decrease pain; muscular flexibility exercises; resistance exercises to increase muscular endurance capacity and functional strength; aerobic exercise program
  • Precautions during physical therapy: Monitor vital signs; address precautions or contraindications for exercise based on patient's pre-existing condition(s)
  • Complications interfering with physical therapy: Excessive fatigue, symptoms interfering with exercise tolerance, depression

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Fibromyalgia syndrome (FMS; also frequently referred to as fibromyalgia) is a chronic widespread pain condition ...

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