dear parents: please complete this form in english and submit together with the application materials. student name family name, first name, middle name date of Birth day/month/year grade applying for student health history Please indicate if your child has or has had any of the medical conditions listed below. Medical Condition Medical Condition If you have answered yes to
Fibromyalgia (much of this is lifted from the current fact sheetFibromyalgia
Fibromyalgia syndrome (FM) is defined as a common rheumatological syndrome characterized by chronic, diffuse musculoskeletal pain and tenderness with a number of associated symptoms, among which sleep disturbances, fatigue, and affective dysfunction Epidemiology and Economics
Affects 2–10% of the general population, in all ages, ethnic groups, and cultures.
Its gender distribution is up to seven times more common in females than males.
FM’s impact on an individual’s quality of life and physical function is substantial.
In the United States, about 15% of patients receive disability funding because of their Pathophysiology
The pathophysiology of FM is not completely clarified, but a number of neuroendocrine, neurotransmitter-related, and neurosensory disturbances, as well as genetic predisposition, have been implicated in its generation.
Neuroendocrine: Dysfunction of the hypothalamic-pituitary-adrenal axis, including blunted cortisol responses; abnormal growth hormone regulation Neurotransmitter: Decreased serotonin in the central nervous system; elevated levels of substance P and nerve growth factor in the spinal fluid Neurosensory: Central amplification of pain and/or reduced antinociception (central sensitization, abnormalities of descending inhibitory pain pathways) Genetic: Strong familial aggregation for FM; evidence for a role of polymorphisms of genes in the serotoninergic, dopaminergic, and catecholaminergic systems in the Clinical Features
FM has either a gradual or a post-traumatic onset The pain is described as a persistent, diffuse, deep, aching, throbbing, sensation in Clinical symptoms associated with FM are affective dysfunction, cognitive deficits, short-term memory loss, headache, nonrestorative sleep, and daytime tiredness A number of clinical conditions occur more frequently in FM than in the general fatigue, including chronic fatigue syndrome dysmenorrhea, interstitial cystitis, other rheumatic conditions, and FM patients have abnormal reactivity to painful stimuli: hypersensitivity to painful stimuli applied to somatic structures, not only in painful sites but also in normal control areas lower pain thresholds to thermal, mechanical, electrical and chemical enhanced temporal summation (pain on repeated stimulation is greater) after infusion of hypertonic saline, muscle pain with a longer duration and referred pain that spreads to a larger area than in controls Abnormal responses to pain seen on functional brain neuroimaging: Diagnostic Criteria
The present criteria for FM diagnosis are those established by the American College of 1) A history of widespread pain (involving all 4 limbs and the trunk) of at least 3 2) Tenderness to digital palpation (with a pressure of 4 kg) in at least 11 of 18 (9 symmetrical) predetermined body districts called tender points (TePs) (a tender point is defined as a site of exquisite tenderness in soft tissues, in contrast to the trigger points of myofascial pain syndrome).
Diagnosis and Treatment
FM does not threaten the patient’s life but can cause severe disability and thus substantially compromise quality of life. Complete resolution of symptoms is almost never achieved, but significant improvement can be obtained with adequate therapy.
Management of FM is typically multimodal: education for affected individuals, family, and society encouragement for the patient to take an active role in self-care physical therapy, primarily with an exercise program (aerobic, strengthening), with the addition of physical modalities, such as massage moderate doses of medications proven to be effective: i. low-dose tricyclic antidepressants (amitriptyline) ii. dual serotonin-norepinephrine reuptake inhibitors iii. selective serotonin reuptake inhibitors iv. antiepileptics (gabapentin, pregabalin) References
Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA 2004;292:2388–95.
Russell IJ, Bieber CS. Myofascial pain and fibromyalgia syndrome. In: McMahon SB, Koltzenburg M, editors.
Melzack and Wall’s textbook of pain, 5th ed. Edinburgh: Churchill Livingstone; 2005. p. 669–81.
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