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FIBROMYALGIA

FIBROMYALGIA. Rosamund Vallings MB BS. FIBROMYALGIA. Is it a symptom or a disease? CENTRAL SENSITISATION SYNDROME. Tired and achy all the time. Fatigue/Pain The commonest symptoms seen in general practice. FATIGUE. Common symptom in GP consultation Normal fatigue

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FIBROMYALGIA

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  1. FIBROMYALGIA Rosamund Vallings MB BS

  2. FIBROMYALGIA Is it a symptom or a disease? CENTRAL SENSITISATION SYNDROME

  3. Tired and achy all the time

  4. Fatigue/PainThe commonest symptoms seen in general practice

  5. FATIGUE • Common symptom in GP consultation • Normal fatigue • Disease related fatigue: acute or chronic • Fatigue in CFS/FM: • Unrelieved by rest • Worsened by exercise • Delayed recovery

  6. What is CFS?

  7. CFS/FM • Most people with CFS have FM • Most people with FM have chronic fatigue • Common features: • Myalgia • Headaches • Generalised pain • Sleep disorder • Cognitive difficulties

  8. PREDISPOSING FACTORS • GENETIC • VIRAL • STRESS: Physical/Mental • SLEEP DEFICIT • SEX • PERSONALITY • OVEREXERCISE/INJURY

  9. Who gets CFS/FM

  10. IMMUNOLOGICAL CHANGES • INCREASED CYTOKINES (Klimas) • DECREASED NK CELLS (Klimas) • ABNORMAL R-NaseL (Suhadolnik) • Raised NPY (Fletcher) etc

  11. Associated Conditions • Irritable bowel syndrome • Irritable bladder • Migraine • Endometriosis • Orthostatic intolerance • Hypersensitivity/allergies • ?Autoimmune

  12. ORTHOSTATIC INTOLERANCE • LOW BLOOD VOLUME (Bell) • LOW BP (Rowe) • POOR BRAIN PERFUSION (Mena, Kuratsune) • PALPITATIONS • Symptoms: postural dizziness brain fog cold extremities bloatedness

  13. DIAGNOSIS OF FM • EXCLUSION OF OTHER DISORDERS • ASSOCIATION WITH OTHER ILLNESS (egIBS,CFS,PPS,SLE,LYME etc) • STAND ALONE CONDITION • CHRONIC PAIN SYNDROME • VALIDITY OF PRESSURE POINTS

  14. PAIN History(M Fitzgerald) • Genetic predisposition • Pain is a CNS problem (microglia) • Background of trauma • Neonates • Bad experiences associated with pain • Conditioning (original site reactivation)

  15. Diagnostic Criteria FM • A. Widespread pain in all four quadrants of the body, for a minimum of three months • B. At least 11 of the 18 specified tender points

  16. Laboratory Findings in CFS/FM • Typically normal except for… • Immune abnormalities • Atypical lymphs • Autoantibodies • Anti-nuclear (ANA) • Thyroid Komaroff et alia, Arch IM, 155, Jan 1995

  17. MANAGEMENT • CORRECT DIAGNOSIS • ACKNOWLEDGEMENT/SUPPORT • EDUCATION • LIFESTYLE

  18. GENERAL MEASURES • Stress management • Gentle exercise (breathing, sunshine) • Diet (salt, frequency, balance) • Supplements (B12, Mg, CoQ10, omega 3) • Hormones • Sleep management • Pain management

  19. CBT/Psychotherapy • Useful for stress management • Understanding of sleep disorder • Change in negative thinking • A focus on what is possible

  20. Relaxation strategies • Music • Physical relaxation/deep breathing • Creative visualisation • Meditation • Prayer • Self hypnosis

  21. EXERCISE • NONE LEADS TO POOR OUTCOME • TOO MUCH LEADS TO RELAPSE • NEEDS TO BE REGULAR/OUTSIDE • START AT LOW LEVEL (?lie down) • LITTLE and OFTEN • PREPARATION and REST • BUILD SLOWLY • AVOID CRASH and BURN

  22. NUTRITION • BALANCED DIET/VARIETY • SMALL REGULAR MEALS • MINIMISE ALCOHOL, CAFFEINE • AVOID RICH FATTY FOODS • PLENTIFUL FLUIDS (not excess) • SALT/potassium • SUNSHINE

  23. SUPPLEMENTS • BETTER ABSORBED VIA FOOD • DEFICIENCIES IN BLOOD • DEFICIENCIES IN DIET • TREATMENT OF CONDITION POSSIBILITIES: • OMEGA 3/OMEGA 6 OILS • B VITAMINS (B12 INJECTIONS) • MAGNESIUM (MALIC ACID) • COENZYME Q-10 • D-RIBOSE • AVOID VIT C EXCESS

  24. Sleep • Sleep is our natural restorative phase • Sleep restores, replenishes and heals • Stress, pain etc lead to disturbed sleep • FM, CFS lead to loss of sleep quality • Until sleep is corrected nothing will come right

  25. Levels of Sleep • Deep level 4 sleep needed for restoration of body, healing, hormone release etc • REM sleep required for restoration of brain, memory, etc - associated with dreams. • Body functions continue and use energy

  26. Causes of abnormal sleep • Illness – acute/chronic • Anxiety/depression • Environmental • Body clock disturbances • Hormonal • Drugs/caffeine/alcohol • Sleep disorders • Bad habit • PAIN

  27. Management of Sleep • Lifestyle • Sleep hygiene • Treatment of underlying disorders • Relaxation strategies • Sleep deprivation • CBT/psychotherapy • Herbal preparations • Medication

  28. Herbal Preparations • Tend to be mild in effect • Maybe useful for physical symptom control • Valerian • Kava • 5HTP • Lavender • Herbal may not mean “natural” • Watch costs/charlatans • NB Magnetic mattresses

  29. Medication • Benzodiazepines • Muscle relaxants • Tricyclics • Antihistamines • Melatonin • Gabapentin • Antipsychotics • Stimulants

  30. Restless legs/cramps • Supplements – magnesium, calcium, salt • Relaxation • ?Co enzyme Q10 • Quinine • Ropinarole

  31. Pain • Pain is exhausting • Pain creates stress • Pain disturbs sleep • Pain in FM resistant to normal treatments • Central sensitization

  32. Kids’ website http://faculty.washington.edu/chudler/pain.html

  33. Management of Fibropain • Non-pharmacologic • Aerobic exercise • Cognitive therapy (CBT) • Physical therapy • Acupuncture • Biofeedback • Balneotherapy • Hypnotherapy • Massage • Pharmacologic • Sleep • Antidepressants • Analgesics • Antiepileptics • Naltrexone • Hormones

  34. Realistic Goals • Complete pain relief is rarely achieved • Common goals include: • Pain reduction • Improvement in functional ability • Improved concentration • Improved mood • Improved sleep

  35. ONGOING ISSUES • Surveillance • Report new symptoms • Multidisciplinary team • Future research • Avoidance of relapse • Balanced lifestyle

  36. BALANCE

  37. books@calicopublishing .co.nz

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