2. Understanding Fibro
Definitions of Fibromyalgia, ME/CFS
Symptoms
Pain cycle
The 3 Ps
How do you get it?
Breaking the pain cycle
Multidisciplinary approach
Where do I start?
Therapeutic Interventions
Latest Research
Conclusion
3. Traditional Definition
This definition describes Fibromyalgia as fibre
muscle pain that is widespread and chronic.
- Fibro (fibres)
- my (muscles)
- algia (pain)
4. Why the long face?
Headache
Muscle pain/stiffness
Sensitivity to cold
Immune dysfunction
IBS
Fatigue
Bladder issues
Poor sleep
Restless legs
5. Am I off my trolley?
Cognitive dysfunction called fibro fog
• Poor concentration
• Difficulty in understanding speech
• Difficulty in speaking
• Reading dysfunction
• Memory problems
• Bumping into things
• Dropping things
• Diminished comprehension
• Anxiety/Depression
• Panic attacks
6. Newer Definition
Research is now pointing to the CNS. Fibro is a
neurological hypersensitivity syndrome resulting
in over activity of the sensory and autonomic
nervous pathways.
In layman's terms Fibro is a change in the way
the brain and spinal cord 'listen' to the body.
7. Diagnosis
Doctors used criteria set in 2010 by the American College of
Rheumatology (ACR) to diagnose the syndrome. According to these rules,
you have fibromyalgia if both of the following are true:
You experience constant pain in all four quadrants of the body (left and
right sides, above and below the waist) for at least three consecutive
months
You have tenderness in at least 11 of the 18 tender points associated
with fibromyalgia
Criteria updated to include Widespread Pain Index (WPI) that involves a
checklist of 19 areas of the body.
Symptom Severity score (SS) uses categories unrelated to pain (including
fatigue, cognitive problems, etc.)
WPI score greater than 7 and SS score greater than 5
WPI score between 3 and 6 and SS score greater than 9
8. Differential Diagnosis
If diagnosed….get a second opinion!
Fibromyalgia symptoms are nonspecific. This
means that many of the symptoms seen with it
are also present in other medical conditions
such as:
Lupus, Rheumatoid Arthritis, Osteoarthritis,
Lyme Disease, Hypothyroidism, CFS, TMJ, IBS,
Restless legs Syndrome, Polymyalgia
Rheumatica, Sjogren's Syndrome, Hepatitis C,
Diabetes, Parathyroid Disease & Ankylosing
Spondylitis.
9. What about ME/CFS?
Myalgic Encephalomyelitis or “ME”
My = muscle
Algic = pain
Encephalo = brain
Mye = spinal cord
Itis = inflammation
Chronic Fatigue Syndrome or “CFS”
10. Difference in conditions
ME/CFS typically starts after an infection
Fibro typically starts after a trauma
Fibro - more pain as well as fatigue
ME/CFS – more fatigue as well as pain
Fibro more responsive to GET (Graded Exercise)
ME/CFS exercise intolerance or post-exertional
malaise
Different biochemistry
12. The 3 Ps
Predisposition
Genetics, being female, personality traits, early trauma.
Precipitating
These are events that precede the onset of Fibromyalgia. They
represent a change in situation, either biologically or
environmentally, and are often quite identifiable.
Perpetuating
These are the factors which can stop us from recovering. Unless
addressed, they can erode and destroy the efforts being made by
the person, their family and their doctor in overcoming
Fibromyalgia.
13. How do you get it?
1. Cervical trauma - 25% developed it as a result of a neck trauma.
2. Toxic exposure - E.g. a mechanic breathing in exhaust fumes 8 hrs a day.
3. Stress based - Exposure to long-term stress leads to adrenal fatigue and
interferes with sleep creating a pain-stress cycle.
4. Food – allergies, intolerance and poor nutrition.
5. Perimenopause - Hormonal disturbances and chemical imbalances affect
nerve signaling.
6. Immunisation - Bad reaction to immunisation and never fully recover.
7. Genetic predisposition - Family history of diabetes, thyroid, hypermobility and
scoliosis.
8. Gender - If you're female you are more likely to get it. Ratio is 6:1
9. Insect Bite- Lyme disease or associated co-infections
15. Great…but where do I start?
Consider how personal relationships are
affecting recovery.
Designate a partner in wellness.
Prioritise symptoms and deal with most
troublesome ones first.
Get a good health care team in place
e.g. GP, consultant, manual therapist &
counsellor.
Review your sleep, nutrition, movement,
medications and stress management.
Remember…Action before motivation.
18. Get moving
Movement helps release dopamine
Graded exercise
Dance to your favourite song
Tai chi
Have sex!
Salsa
Laughing
19. Tai Chi
Raising your Chi
Circle of light
Push pull
Flying
Passing clouds
Namaste
20. Diet
Limit intake of carbohydrate, wheat, sugar, alcohol,
chocolate, diary, caffeine, tomatoes, potatoes and
citric fruits.
30% of people with FMS are also hypoglycemic. If
you fall into this category you need to keep your
blood sugars constant.
Diets to consider: Anti-candida, Low Oxalate, Stone
Age, Paleo & FODMAPS
Keep a food diary and note what works for you and
what doesn't.
Supplements: CQ10, Fish Oils, Vit D, Vit B,
Magnesium, Zinc, Calcium, Selenium, Iron &
Pro-biotics.
24. Medications cont.
Neurofen
Ibruprofen
Stilnoct
Zimovane
Zopitan
LDN (Low-dose naltrexone )
- Doctors 'practise' medicine. You can have 6 patients and they will
react differently to medication.
Anti-inflammatory
Sleeping pills
Opiate- Agonist
25. Counselling/CBT/AT
Cognitive Behavourial Therapy
Deals with the here and now
Set realistic goals
Identify triggers
Understand dysfunctional thought patterns
Counteract negative automatic thoughts
Autogenic Training
Relaxation technique to improve skills in
stress and/or pain management.
27. Sleep
No caffeine after 4pm. No liquids after 7pm
Bedroom is only for the 3 S’s - Sleep, sex & sick
No naps
Establish a regular go to bed time & wake up time
Change the stress to ‘enjoy the rest’
Dump your day
Exercise but not too close to bed time
If you are not asleep within 20 mins get up
No heavy meals before bedtime
Is snoring or sleep apnea a problem?
28. Latest Research
Pridgen and Duffy (USA)
Stressors could result in recurrent reactivations of latent
herpes virus infections, which could lead to the development
of fibromyalgia
Famciclovir + celecoxib combination treatment currently in
phase III trials.
Dr. Minerbi (Canada)
A research team has shown, for the first time, that there are
alterations in the bacteria in the gastrointestinal tracts of
people with fibromyalgia. Approximately 20 different species
of bacteria were found in either greater or are lesser
quantities in the microbiomes of participants suffering from
the disease than in the healthy control group.
29. Conclusion
Fibromyalgia is real and is manageable
It is different from ME/CFS
Get an accurate diagnosis
Utilise a multidisciplinary approach
You are what you eat
You are what you think
Learn to say No!
Get a partner in wellness
Find true connection with yourself and others
Action before motivation