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Melissa Tucker


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Melissa Tucker

  1. 1. Fibromyalgia: Is it real? Melissa Tucker Gilbert Boissonneault March 24, 2006
  2. 2. 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>
  3. 3. 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>
  4. 4. 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>
  5. 5. 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>
  6. 6. 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>
  7. 7. 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>
  8. 8. 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>
  9. 9. 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>
  10. 10. 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>
  11. 11. 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>
  12. 12. 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>
  13. 13. 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>
  14. 15. 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>
  15. 16. 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>