These points don’t represent muscle inflammation or structural damage
Can affect men but women out number them 8:1
Misconception is that it is a disease of muscle inflammation or biochemical defects. Studies have concluded that the ligaments, tendons, and joints in FM are normal.
regulation of food intake, reproductive behavior, mood, and anxiety which importantly helps explain the involvement of depression and anxiety commonly found in FM patients
Normal fx axis CRH ACTH cortisol Explain experiments
known that in human depression there is a functional disconnection of the hypothalamus with impairment of the inhibitory glucocorticoid feedback pathway to the hypothalamus that results in the typical elevated cortisol levels and impaired dexamethasone suppression test results. It is postulated that a similar situation prevails with regards to the thyroid axis and that the increased T4 in depression, as well as the blunted TSH response to exogenous TRH, reflects glucocorticoid activation of the TRH neuron leading to increased TRH secretion (Neeck 2002).
These both help with coexisting depression and anxiety and seem to help with pain taken before bedtime appears to improve sleep and pain in FM patients, although side effects, i.e. drug hangover, are common. They found research that supports low doses of cyclobenzaprine could maintain patients pain and sleep efficacy while reducing side effects.
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Fibromyalgia: Is it real? Melissa Tucker Gilbert Boissonneault March 24, 2006
Outline of objectives <ul><li>What is Fibromyalgia? </li></ul><ul><li>Speculated mechanisms of actions </li></ul><ul><li>Current treatment </li></ul><ul><li>How does it effect us as practionars </li></ul>
What is Fibromyalgia? <ul><li>A syndrome characterized by: </li></ul><ul><ul><li>Chronic, widespread musculoskeletal pain </li></ul></ul><ul><ul><li>Pain on palpation in 11 of the 18 tender points </li></ul></ul><ul><ul><li>Pain must last longer than 3 months </li></ul></ul><ul><ul><li>Not associated with arthritis, inflammation, or degenerative disorders </li></ul></ul>
What is Fibromyalgia? <ul><li>Commonly associated symptoms include sleep disturbances, anxiety, depression, headaches, and IBS. </li></ul><ul><li>Onset usually following an injury, infection, stress, or emotional trauma </li></ul><ul><li>Affects women between 30-60 years of age. </li></ul>
How does FM effect the body? <ul><li>Pain isn’t releated to actual tissue damage </li></ul><ul><li>Beyond this there are no known causes </li></ul><ul><li>Studies concentrate on </li></ul><ul><ul><li>Serotonin dysfunctions </li></ul></ul><ul><ul><li>Hypothalamic-pituitary-adrenal axis </li></ul></ul><ul><ul><li>Hypothalamic-pituitary-thyroid axis </li></ul></ul><ul><ul><li>Growth hormone </li></ul></ul><ul><ul><li>Neuromediators </li></ul></ul>
Serotonin’s Role <ul><li>5-HT is speculated to have lower levels in the serum in FM patients </li></ul><ul><li>Inhibits the pathways that control sensations and excite the pathways that are involved in muscle control </li></ul>
Hypothalamic-pituitary-adrenal Axis <ul><li>Help explain the fatigue, sleep disturbances and pain components </li></ul><ul><li>Buskila’s (2001) idea is that there is an exaggerated adrenocoricotropin hormone response to corticotropin releasing hormone . </li></ul><ul><li>HPA axis to CRH found in the FM patients closely resembles that seen in psychiatric disorders especially those with anxious depression. </li></ul>
Hypothalamus-pituitary-thryoid axis <ul><li>Coincidence of FM with Hashimoto thyroiditis similarities, sensitivity to cold, low blood pressure and constipation </li></ul><ul><li>Research found basal TSH and thyroid hormone levels, with the exception of free thyroxine, were all in the low-normal range, and the secretion of free T4 in response to TRH was poor </li></ul><ul><li>thyroid hormone dysfunctions can also contribute to depression in FM </li></ul>
Growth Hormone <ul><li>Controlled by GH-releasing hormone and somatostain </li></ul><ul><li>A significantly lower secretion of GH in FM patients was found </li></ul><ul><li>Pulsatile secretion of GH is closely releated to stage 4 sleep in which almost 80% of its daily production is secreted </li></ul>
Endorphins, Enkephalins and Neuromodulators <ul><li>Act as receptor sites for opiate drugs, which play an important role in regulating pain </li></ul><ul><li>Hyperalgesia of FM patients could be explained by lowered endorphin levels </li></ul><ul><li>Descending pathways selectively inhibit the transmission of information originating in nociceptors and release certain endogenous opioids. </li></ul><ul><li>These endogenous opiates respond to a variety of stressful situations </li></ul>
Cytokines <ul><li>In the immune system cells release a substantial amount of protein messengers that regulate host cell division and function of the immune defenses </li></ul><ul><li>In response to trauma, inflammation, or infection immune cells release proinflammatory cytokines </li></ul><ul><li>proinflammatory cytokines provide signals to the central nervous system thereby creating exaggerated pain as well as a number of physiologic, behavioral, and hormonal changes </li></ul><ul><li>Cytokine signaling could correspond to a vital means of interlinking the chronic pain of FM to the relevance of stressors </li></ul>
Pharmacologic <ul><li>First approach is with an anitdepressent, commonly amitriptyline or fluoxetine. </li></ul><ul><li>Muscle relaxants show some assistance in the management of FM, cyclobenzaprine </li></ul><ul><li>Other classes of drugs used are NSAIDs and analgesics </li></ul>
Nonpharmacologic Therapies <ul><li>Physical therapy include stretching, deep tissue massage, transcutaneous electrical nerve stimulation </li></ul><ul><li>Acupuncture showed short term benefit </li></ul><ul><li>Low impact exercise such as Yoga </li></ul><ul><li>Chiropractic manipulation </li></ul>
References <ul><li>Anderberg, U., Lui Z., Bergland L., Nyberg F. Elevated plasma levels of the Neuropeptide Y in female fibromyalgia patients. Europe Journal Of Pain. 1999; 3: 19-30 </li></ul><ul><li>Bauer A., Elkin P., Loehrer L., Mandrekar J., Oh T., Thompson J., Vinent A., and Wahner-Roedler D. Use of Complementary and Alternative Medical </li></ul><ul><li>Therapies by Patients Referred to a Fibromyalgia Treatment Program At a Tertiary Care Center. Mayo Clinical Procedures. 2005; 80: 55-60. </li></ul><ul><li>Bayazit Y., Gursoy S., Karakurum G., Madenci E., and Ozer E. Neurotologic Manifestations of the fibromyalgia syndrome. Journal of the Neurological </li></ul><ul><li>Sciences. 2002; 196: 77-80. </li></ul><ul><li>Bennett R., and Rao S. Pharmacolgoical therapies in fibromyalgia. Best practice And Research Clinial Rheumatology. 2003; 17: 611-627. </li></ul><ul><li>Bradley L., and McKendree-Smith N. Central nervous system mechanisms of pain In fibromyalgia and other musculoskeletal disorders: behavioral and </li></ul><ul><li>Psychological treatment approaches. Current Opinion in Rheumatology. 2002; 14: 45-51. </li></ul><ul><li> Buesing A. A conservative, cost effectie approach to fibromyalgia. JAAPA. 2005; 18: 32-37. </li></ul><ul><li>Buskila D. and Press J. Neuroendocrine mechanisms in fibromyalgia-chronic Fatigue. Best Practice and Research Clinical Rheumatology. 2001; 15: 747-758. </li></ul><ul><li>Dinan, T.G. Serotonin and the regulation of hypothalamic-pituitary-axis Function. Life Science. 1996; 58: 1683-1694. </li></ul>
References <ul><li>Hamaty D. Valentine J.L., Howard J., et. al. The plasma endorphin, prostaglandin And catecholamine profile of patients with birositis treated with cyclobenzaprine and placebo:a 5-month study. Journal of Rheumatology. 1989; 16: 164-168. </li></ul><ul><li>Landis, C.A., Lentz, M.J., Rothermel, J., Riffle, S.C., Chapman, D., Buchwald, D., Shaver, J.L. Decrease nocturnal levels of prolactin and growth Hormone in women with fibromyalgia. Journal Clinical Endocrinol Metab. 2001; 86: 1672-1678. </li></ul><ul><li>Neeck G. Pathogenic mechanisms of fibromyalgia. Department of Rheumatology. 2001; 1: 243-255. </li></ul><ul><li>Neeck, G., Riedel, W. Thyroid function in patients with fibromyalgia syndrome. Journal of Rheumatology. 1992; 19: 1120-1122. </li></ul><ul><li>Pongratz D. and Sievers M. Fibromyalgia- symptom or diagnosis: A definition of The position. Scand J Rheumatol. 2000; 29: 3-7. </li></ul><ul><li>Staud R. Fibromyalgia pain: do we know the source? Current Opinion in Rheumatology. 2004; 16: 157-163. </li></ul>
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