Rosamund Vallings MB BS FIBROMYALGIA Is it a symptom or a disease CENTRAL SENSITISATION SYNDROME Tired and achy all the time FatiguePain The commonest symptoms seen in general practice FATIGUE ID: 149219
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FIBROMYALGIA
Rosamund Vallings
MB BSSlide2
FIBROMYALGIA
Is it a symptom or a disease?
CENTRAL SENSITISATION SYNDROMESlide3
Tired and achy all the timeSlide4
Fatigue/PainThe commonest symptoms seen in general practiceSlide5
FATIGUECommon symptom in GP consultation
Normal fatigue
Disease related
fatigue: acute or chronic
Fatigue in
CFS/FM:Unrelieved by restWorsened by exercise
Delayed recoverySlide6
What is CFS?Slide7
CFS/FMMost people with CFS have FM
Most people with FM have chronic fatigue
Common features:
Myalgia
Headaches
Generalised painSleep disorder
Cognitive difficultiesSlide8
PREDISPOSING FACTORSGENETICVIRAL
STRESS: Physical/Mental
SLEEP DEFICIT
SEX
PERSONALITY
OVEREXERCISE/INJURYSlide9
Who gets CFS/FMSlide10
IMMUNOLOGICAL CHANGES
INCREASED CYTOKINES (Klimas)
DECREASED NK CELLS (Klimas)
ABNORMAL R-
NaseL
(Suhadolnik)
Raised NPY (Fletcher)
etcSlide11
Associated ConditionsIrritable bowel syndrome
Irritable bladder
Migraine
Endometriosis
Orthostatic intolerance
Hypersensitivity/allergies?AutoimmuneSlide12
ORTHOSTATIC INTOLERANCELOW BLOOD VOLUME (Bell)
LOW BP (Rowe)
POOR
BRAIN PERFUSION
(Mena, Kuratsune)
PALPITATIONSSymptoms: postural dizziness
brain fog
cold extremities
bloatednessSlide13
DIAGNOSIS OF FMEXCLUSION OF OTHER DISORDERS
ASSOCIATION WITH OTHER ILLNESS (
eg
IBS,CFS,PPS,SLE,LYME
etc)STAND ALONE CONDITIONCHRONIC PAIN SYNDROMEVALIDITY OF PRESSURE POINTSSlide14
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)Slide15
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 pointsSlide16Slide17
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 1995Slide18
MANAGEMENT
CORRECT
DIAGNOSIS
ACKNOWLEDGEMENT/SUPPORT
EDUCATION
LIFESTYLESlide19
GENERAL MEASURESStress management
Gentle exercise (breathing, sunshine)
Diet (salt, frequency, balance)
Supplements (B12, Mg, CoQ10, omega 3)
Hormones
Sleep managementPain managementSlide20
CBT/Psychotherapy
Useful for stress management
Understanding of sleep disorder
Change in negative thinking
A focus on what is possibleSlide21
Relaxation strategies
Music
Physical relaxation/deep breathing
Creative visualisation
Meditation
Prayer
Self hypnosisSlide22
EXERCISENONE 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 RESTBUILD SLOWLYAVOID CRASH and BURNSlide23
NUTRITIONBALANCED DIET/VARIETYSMALL REGULAR MEALS
MINIMISE ALCOHOL, CAFFEINE
AVOID RICH FATTY FOODS
PLENTIFUL FLUIDS (not excess)
SALT/potassium
SUNSHINESlide24
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 EXCESSSlide25
Sleep
Sleep is our natural restorative phase
Sleep restores, replenishes and heals
Stress, pain
etc
lead to disturbed sleepFM, CFS lead to loss of sleep qualityUntil sleep is corrected nothing will come rightSlide26Slide27
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 energySlide28
Causes of abnormal sleep
Illness – acute/chronic
Anxiety/depression
Environmental
Body clock disturbances
Hormonal
Drugs/caffeine/alcohol
Sleep disorders
Bad habit
PAINSlide29
Management of Sleep
Lifestyle
Sleep hygiene
Treatment of underlying disorders
Relaxation strategies
Sleep deprivation
CBT/psychotherapy
Herbal preparations
MedicationSlide30Slide31
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 mattressesSlide32
Medication
Benzodiazepines
Muscle relaxants
Tricyclics
Antihistamines
Melatonin
Gabapentin
Antipsychotics
StimulantsSlide33
Restless legs/cramps
Supplements – magnesium, calcium, salt
Relaxation
?Co enzyme Q10
Quinine
RopinaroleSlide34
PainPain is exhausting
Pain creates stress
Pain disturbs sleep
Pain in FM resistant to normal treatments
Central sensitizationSlide35
Kids’ website
http://faculty.washington.edu/chudler/pain.htmlSlide36
Management of Fibropain
Non-pharmacologic
Aerobic exercise
Cognitive therapy (CBT)
Physical therapy
AcupunctureBiofeedbackBalneotherapy
Hypnotherapy
M
assage
Pharmacologic
Sleep
Antidepressants
Analgesics
Antiepileptics
Naltrexone
HormonesSlide37
Realistic GoalsComplete pain relief is rarely achieved
Common goals include:
Pain reduction
Improvement in functional ability
Improved concentration
Improved moodImproved sleep Slide38
ONGOING ISSUESSurveillance
Report new symptoms
Multidisciplinary team
Future research
Avoidance of relapse
Balanced lifestyleSlide39
BALANCESlide40
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