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Fibromyalgia: Review from the 3 rd Annual Southern Academic Pain Symposium

Fibromyalgia: Review from the 3 rd Annual Southern Academic Pain Symposium. Betsy Patterson RN MSN ACNP AOCN. Agenda. Neurobiology of Persistent Pain and its Clinical Implications Genetic Factor in Fibromyalgia Brain Imaging Studies Neuroendocrine Dysfunction in Fibro

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Fibromyalgia: Review from the 3 rd Annual Southern Academic Pain Symposium

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  1. Fibromyalgia: Review from the 3rd Annual Southern Academic Pain Symposium Betsy Patterson RN MSN ACNP AOCN

  2. Agenda • Neurobiology of Persistent Pain and its Clinical Implications • Genetic Factor in Fibromyalgia • Brain Imaging Studies • Neuroendocrine Dysfunction in Fibro • Stress and Resilience in Fibro • Exercise Based Treatment in the Management of Fibro • Pharmacologic Intervention in Fibro • Fibromyalgia in Children

  3. Neurobiology of Persistent Pain and its Clinical Implications • Speaker Ronald Dubner DDS, PhD • University of Maryland Dental School • Relationship between stimulus intensity and pain sensation without preexisting injury and after injury. • Clear changes in the excitability of neurons after tissue damage or nerve injury. Peripheral sensitization Central sensitization

  4. Chemical Mediators • Involved in central sensitization Ca++ influx Kainate Metabotropic glutamate Neurotrophins 5HT = serotonin Opioids = brain endorphins

  5. Genetic Factors in Fibro • Martin Offenbaecher MD • University Hospital, Munich Germany • 58 off spring of mothers with FM 16 had FM (28%) • Environmental-familial component in FM • Suggested link to depression and narcolepsy • ? Gene for FM that is linked to HLA region • Functions of the Serotonin (5HT) and its transport and receptors sites in humans. (Neurotransmitter defect) • Altered tryptophan metabolism pathway

  6. Abnormal Pain Perception • Laurence A Bradley, PhD • University of Alabama • The prevalence of FM is 2-5% across western cultures • 90% of FM sufferers are women • High level of psychiatric morbidity, especially depression, and other affective disorders. • Association with migraine and anxiety disorders • Thermal sensitively altered: Increased substance P Increased nerve growth factor Increased nitrogen oxide levels

  7. Neuroendocrine Dysfunction in Fibro • Leslie J. Crofford MD • Division of Rheumatology, Univ. of Michigan • Cognitive complaints are short term memory, vocabulary, and working memory • FM process memory speed normally • Depression, sleep, and anxiety do not correlate • “Stress is life and life is stress” Symptoms onset and exacerbation during periods of stress Fibro have low level of IGF (Insulin growth factors) Altered Cortisol levels and fattened circadian variation

  8. Stress and Resilience in Fibro • Alex Zautra, PhD • Arizona State University • Vulnerability to stress Among women in Chronic Pain with Fibro • Women with FM had poorer emotional and physical health, lower positive affect, a poorer quality social function, and more frequent use of avoidant coping strategies with pain.

  9. Exercise Based Treatment • Glenn McCain MD, Charlotte, NC • Includes coping and life style management • Specific exercise with a unique program of aerobic exercise is devised • Patient continues to commitment at home and for life time. • Patients are expected to perform no matter at what gravity of their pain or fatigue.

  10. Fibro in Children • Laura E Schanberg MD, Duke Medical Center • JPFS is a common of unknown etiology characterized by widespread persistent pain, fatigue, sleep disturbance and presence of multiple discrete tender points. • Treatment: psychotherapy exercise medication stress and coping management maintain regular age related activities

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