Fibromyalgia and acupuncture
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Review of pathophisiology of Fibromyalgia and its therapy with acupuncture

Review of pathophisiology of Fibromyalgia and its therapy with acupuncture

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Fibromyalgia and acupuncture Presentation Transcript

  • 1. FIBROMYALGIA DR. OSCAR MENDIZABAL POLANCO MÉDICO CIRUJANO UNAM ESPECIALISTA EN ACUPUNTURA HUMANA IPN
  • 2. WHAT IS IT?  Clinical syndrome defined by: • WIDESPREAD PAIN • Fatigue • Sleep disturbances • Variable somatic complaints • Cognitive dysfunction • Mood disturbances Clauw DJ, Arnold LM, McCarberg BH. The Science of Fibromyalgia. Mayo Clin Proc. 2011; 86(9): 907-9011
  • 3. EPIDEMIOLOGY  2-5% of general population  2ª cause of rheumatologic consultations (EUA)  6 times more frequent in women  > prevalence between ages 20-50 Clauw DJ, Arnold LM, McCarberg BH. The Science of Fibromyalgia. Mayo Clin Proc. 2011; 86(9): 907-9011.
  • 4. ETHIOLOGY Genetic factors Neuroendocrine factors Environmental factors Close relationship Russell IJ, Larson AA. Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheum Dis Clin North Am. 2009;35(2):421-435.
  • 5. GENETIC FACTORS Positive family history Monoamine related genes: • HTR2A • HTTLPR • D4R • COMT Central pain processing abnormalities Staud R. Abnormal pain modulation in patients with spatially distributed chronic pain: Fibromyalgia. Rheum Dis Clin North Am. 2009;35(2):263-274.
  • 6. NEUROENDOCRINE FACTORS  P substance  Hypothalamic-Pituitary-Adrenal axis activity reduction  Diminished release of CRH and GH  Hypothalamic-Pituitary-Adrenal axis hyperactivity  Augmented serum cortisol Staud R. Abnormal pain modulation in patients with spatially distributed chronic pain: Fibromyalgia. Rheum Dis Clin North Am. 2009;35(2):263-274.
  • 7. ENVIRONMENTAL FACTORS Child abuse history Physical violence in adulthood Emotional stress situations Arnold LM. The pathophysiology, diagnosis, and treatment of fibromyalgia. Psychiatr Clin North Am. 2010;33(2):375-408
  • 8. SIMPTOMS  Allodynia  Sleep disturbances (+/-)  Fatigue  Weakness  Cognitive dysfunction  Headache (tensional or migraine)  Depression  IBS  Paresthesia Arnold LM. The pathophysiology, diagnosis, and treatment of fibromyalgia. Psychiatr Clin North Am. 2010;33(2):375-408
  • 9. Allodynia Abnormal pain processing Clauw DJ, Arnold LM, McCarberg BH. The Science of Fibromyalgia. Mayo Clin Proc. 2011; 86(9): 907-9011
  • 10. DIAGNOSIS 1990 ACR criteria: • Widespread pain for 3 or more months • Pain in 11 of 18 points Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classiication of fibromyalgia: report of a multi-center criteria committee. Arthtiis Rheum. 1990;33(2):160-172.
  • 11. DIAGNOSIS  At least 4 of the following: • Fatigue • Sleep disturbances • Neuropsychiatric symptoms • Headache • Paresthesia • IBS • Not caused by other condition Arnold LM. The pathophysiology, diagnosis, and treatment of fibromyalgia. Psychiatr Clin North Am. 2010;33(2):375-408.
  • 12. OTHER SYMPTOMS  Articular stiffness  Cold sensation  Raynaud’s fenomena  Cystitis  Temporo – mandibular dysfunction  Chronic pelvic pain  Multiple chemical sensitivity Arnold LM. The pathophysiology, diagnosis, and treatment of fibromyalgia. Psychiatr Clin North Am. 2010;33(2):375-408.
  • 13. DIAGNOSIS  ACR 2010 preliminary criteria: • Widespread index (WPI) of > 7 and • Symptom severity scale (SS) > 5 • Or WPI 3-6 y SS > 9 • 3 months or more • Not caused by other conditions Wolfe F, Clauw DJ, Fitzcharles M, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB. The American College of Rheumatology preliminary diagnostic driteria for dibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62:600–610.
  • 14. LAB WORKUP  CBC  ESR  PCR  Blood Chem.  TSH Longo DL, Fauci AS, et al. Harrison’s Principles of Internal Medicine. 2012. 18 ed. Ch. 335. Mc Graw Hill.
  • 15. DIFERENTIAL  RA  Polymyalgia rheumatica  SLE  HIV  HCV  Lyme  Hypothyroidism  Etc. Clauw DJ, Arnold LM, McCarberg BH. The Science of Fibromyalgia. Mayo Clin Proc. 2011; 86(9): 907-9011.
  • 16. TREATMENT
  • 17. PHARMACOLOGIC TREATMENT  Aimed to symptom control • Paint management • Sleep improvement  Antidepressants (tricyclic, SSRI)  Anticonvulsants  Central acting analgesics Arnold LM. The pathophysiology, diagnosis, and treatment of fibromyalgia. Psychiatr Clin North Am. 2010;33(2):375-408.
  • 18. NON PHARMACOLOGIC TREATMENT  Symptom control and improvement of life quality • Exercise (yoga, tai-chi) • Group therapy • Cognitive-conductual therapy • Acupuncture Rakel D. Integrative Medicine. 2012. 3rd ed. Saunders. Ch. 46, pp 438-455.
  • 19. ACUPUNCTURE AND FIBROMYALGIA
  • 20. WHAT IS ACUPUNCTURE?  TCM discipline • Yin/Yang theory • Jing-luo theory • Zang fu theory • Wu xing theory Maciocia G. The Foundations of Chinese Medicine. 2 ed. Elsevier. 2005. Ch 1-4, pp 1- 92.
  • 21. WHAT IS ACUPUNCTURE?  Needle insertion at specific sites (acupoint)  Point selection according to TCM diagnosis  Reestablish Qi/Xue circulation Maciocia G. The Foundations of Chinese Medicine. 2 ed. Elsevier. 2005. Ch 1-4, pp 1-92.
  • 22. HOW DOES IT WORK?  Multiple action mechanisms  Mostly mediated by endorphin release  Regulates ANS Stux G; Hammerschlag R. Clinical Acupuncture: Scientific Basis. 2001. Springer. Ch. 1-3, pp 1-68.
  • 23. IN FIBROMYALGIA…  Inhibits ascending pathways (endorphins)  Stimulates descending pathways (serotonin)  Regulates cortisol production  Increases GH production  Improves sleep quality Han JS. Acupuncture and Endorphins. Neurosci Lett. 2004. May 6;361 (1-3): 258-261 Lin JG, Chen WL. Acupuncture analgesia: A review of its mechanisms of action. 2008. Am J Chin Med. 2008;36(4):635-45. Zhao ZQ. Neural Mechanisms underlying acupuncture. Prog Neurobilol. 2008 Aug;85(4):355-75.