Fibromyalgia Fibromyalgia is characterized as a musculoskeletal disorder with widespread pain accompanied by fatigue, as well as memory, sleep, and emotional and mental distress (Centers for Disease Control and Prevention, 2018). The prevalence of fibromyalgia in the general population is approximately 0.2% to 6.6% worldwide, including 6.4% of the U.S. population (Marques, Santo, Berssaneti, Matsutani, & Yuan, 2017). This updated literature review found the prevalence in women to be between 2.4% and 6.8%, between 0.7% and 11.4% for those living in urban areas and 0.01% and 5.2% for those living in rural areas (Marques et al., 2017). The American College of Rheumatology has updated established criteria for the diagnosis of fibromyalgia (Wolfe et al., 2010). In the Widespread Pain Index (WPI), clients indicate the number of painful body regions. In the Symptom Severity (SS) scale, the person rates symptom severity on a scale of 0 to 3 (with a higher number indicating more severe symptoms) for fatigue, waking unrefreshed, cognitive symptoms, and somatic (physical) symptoms (such as muscle pain, irritable bowel syndrome, muscle weakness, headache, pain/cramps in the abdomen) (Wolfe et al., 2010). Patients are deemed to have met the diagnostic criteria for fibromyalgia if their scores on the WPI and SS are higher than 7 and 5, respectively, or if their scores on the WPI are lower (3 to 6) but their scores on the SS are higher than 9; their symptoms have presented consistently for a minimum of 3 months at a similar level of intensity; and they have no other disorder that would account for the pain they are experiencing (Wolfe et al., 2010). Individuals with fibromyalgia often experience additional symptoms of sleep disorders, paresthesia, tenderness, stiffness, mood disturbances, and anxiety (Sommer, 2010; Wolfe et al., 2010). Recovery is unusual for those with fibromyalgia so, the focus on treatment tends to be management of the symptoms (Kwiatek, Considerations for pain across the life span Pediatric chronic pain has become an increasingly recognized clinical problem (Linhares et al., 2012; Liossi & Howard, 2016). Although the prevalence of pediatric pain is relatively high, ranging between 20% and 46% worldwide, it continues to be under recognized and undertreated (King et al., 2011; Stanford, Chambers, Biesanz, & Chen, 2008; Walther-Larsen et al., 2017). Reyes and Brown (2016) completed a study looking at what Canadian occupational therapy practitioners know about pain and found that there was a limited understanding of how children experience pain. The ability to report pain improves for most children as they develop the ability to communicate. However, for those who experience cognitive or communication limitations or are otherwise restricted in the ability to express themselves, reporting pain becomes unreliable (Sekhon, Fashler, Versloot, Lee, & Craig, 2017). When reviewing the evidence for children’s experiences of postoperative pain management, Sng et al. (2017) found that children are able to communicate to their parents that they were in pain and provide accurate information on the intensity of the pain. Children did need the parent to advocate for pain management, as the child is less likely to share this information with nursing or other staff. The causes for the pain can be due to a chronic condition, injury, surgery, and can occur without a definitive cause or explanation. Depending on the condition, there are indicators for some interventions. Nerve blocks are often used with children who experience cancer pain, phantom limb pain, and CRPS. Pain caused by spasticity may be treated with baclofen and juvenile idiopathic arthritis with intra-articular steroids (Shah, Cappiello, & Suresh, 2016). Nonpharmacological treatment and interventions for pediatric clients who experience pain include those that they are able to complete on their own and those provided by others. Strategies that the child could complete independently include cognitive behavioral (distraction, imagery, thought stopping)
2017). Unfortunately, responsiveness to fibromyalgia therapies varies, with only 30% to 50% of individuals experiencing clinically significant improvements of their symptoms (Staud, 2010). Treatment approaches include self-management skills training, exercise, and pharmaceutical approaches. Self- management involves education, coping skills training. and use of cognitive behavioral approaches to address changes in thinking and behavior (Kwiatek, 2017). Helpful exercise activities include aerobic exercise, muscle strength training, stretching, and aerobic exercise (Sosa-Reina et al., 2017). In addition, exercise-based complementary and alternative medicine (CAM) interventions including tai chi, qigong, and yoga have been found to help patients with fibromyalgia (Lauche, Cramer, Häuser, Dobos, & Langhorst, 2015). In addition the use of mind/ body CAM interventions such as meditation, mindfulness-based stress reduction, and guided imagery all have a positive effect on the symptoms of fibromyalgia (Lauche et al., 2015). The use of CAM in pain management will be discussed in a later section. Currently, there are three types of FDA-approved drugs for fibromyalgia, and medical management is found to be only partially successful (Macfarlane et al., 2016). These include an antiepileptic drug (pregabalin) and two serotonin-norepinephrine reuptake inhibitors (SNRIs) (Forte et al., 2015). Antidepressants, analgesics, opioid analgesics, anti-inflammatories, and muscle relaxants are used off-label for the treatment of fibromyalgia in the United States (Forte et al., 2015). According to Stutts et al. (2009), one factor underlying the varied responses to treatment using pharmaceutical and nonpharmaceutical approaches may be the client’s high expectations of efficacy of treatment. The authors advise healthcare professionals to incorporate those expectations into treatment plans, provide education, and set realistic goals with clients. reinforcement, breathing, distraction), physical (massage, positioning), assistance with activities of daily living (Sng et al., 2017). Exercise, strengthening, sensory desensitization can be used with success when combined with other psychological and pharmacological interventions (Rodriguez-Lopez, Fernandez- Baena, Barroso, & Yáñez-Santos, 2015). Although emotional support and personal belongings did not reduce pain for children, both were found to improve a child’s ability to manage the pain (Sng et al., 2017). An older adult with pain often experiences more severe disability and impaired quality of life than does a younger person and physical (sleeping, positioning, rubbing) techniques (Sng et al., 2017). Caregivers may provide cognitive behavioral (positive (Fitzcharles, Lussier, & Shir, 2010). The older adult frequently has comorbid diseases, a slower rate of tissue healing, more rapid muscle deconditioning, and reduced mobility (Ferrell et al., 2009; Fitzcharles et al., 2010). Older adults may also have certain beliefs and challenges that affect pain assessment and management. They have had longer to develop their beliefs about pain and how to cope with it. An older adult may believe that “pain is something to be endured, strong analgesics lead to addiction, complaining about pain is a sign of personal weakness, and pain is an inevitable part of aging” (Catananti & Gambassi, 2010, p. 140). An older adult may also have short-term memory loss, necessitating repetition to reinforce teaching and the use of written aids to be studied at his or her leisure. Older adults excrete drugs more slowly and are more likely to have increased sensitivity to drugs and their side effects (Fitzcharles et al., 2010). Comorbid disease and polypharmacy are common and can put an older client at risk for “drug– disease” and “drug–drug” interactions (Fitzcharles et al., 2010). Older adults can have difficulty keeping track of medication times and dosages.
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