1) Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and other symptoms. It is considered a central sensitization syndrome where the central nervous system amplifies sensory processing and pain perception.
2) Treatment involves both pharmacological and non-pharmacological strategies including exercise, stress management, cognitive behavioral therapy, and acupuncture. Acupuncture aims to regulate the central neurotransmitters involved in pain processing and sensory amplification associated with fibromyalgia.
3) Management of fibromyalgia requires a multimodal approach targeting symptoms like pain and fatigue, as well as underlying mechanisms of central sensitization. The goal is to improve patient function through a combination of lifestyle management and integrated medical therapies.
Fibromyalgia: Fact or Fiction? A Multi-disciplinary ApproachMedicineAndHealthUSA
Fibromyalgia is a chronic pain condition defined by widespread muscle pain and tender points. It has overlapping symptoms with conditions like chronic fatigue syndrome, irritable bowel syndrome, and depression or anxiety. Treatment requires a multidisciplinary approach including medications, exercise, stress management, and sleep improvement to help manage pain and associated symptoms.
I was asked to present something on Fibromyalgia during a Pain Summit. I ended up describing what we know so far about clinical features, evolution of diagnostic criteria and synthesized some recent guidelines.
Fibromyalgia is a clinical syndrome characterized by widespread pain, fatigue, sleep disturbances, and other somatic and cognitive symptoms. It affects 2-5% of the general population and is more prevalent among women ages 20-50. The cause is unclear but may involve genetic and environmental factors as well as abnormalities in central pain processing and neuroendocrine function. Diagnosis is based on symptoms and involves assessing pain levels and tender points. Treatment focuses on managing symptoms and includes pharmacologic approaches like antidepressants as well as non-pharmacologic options such as exercise, therapy, and acupuncture. Acupuncture is thought to help fibromyalgia by inhibiting pain pathways, stimulating pain modulation pathways, and regulating neuroendocrine function like cortisol and growth hormone levels
Pain is common in elderly patients due to age-related changes in peripheral nerves and the central nervous system. Chronic pain is prevalent, with about 1 in 5 elderly patients experiencing pain for over 24 hours in the past month. Common causes of pain include arthritis, fractures, and neuropathies. Untreated pain can lead to depression, sleep disturbances, functional impairment, and reduced quality of life. Treatment involves both pharmacological and non-pharmacological approaches, with special considerations for age-related changes impacting drug metabolism and side effects.
Was recently asked to discuss whether there is evidence to support the use of B vitamins in managing different aches and pains. Here's my talk delivered last 16 Sept 2016 at the 12th Post Graduate Course of the East Avenue Medical Center Department of Internal Medicine.
Pain is common in elderly patients, with osteoarthritis, neuropathies, and cancer being leading causes. It is often undertreated in this population due to attitudes that pain is normal with age and concerns about side effects of pain medications. A comprehensive assessment involves evaluating location, intensity, and impact of pain, as well as cognitive and functional status. Treatment should begin with non-pharmacological options and follow the WHO analgesic ladder when drugs are needed. Careful medication management is especially important due to changes in pharmacokinetics and risk of delirium. Effective pain control improves quality of life while communication between providers and education of patients and caregivers are also crucial.
- Fibromyalgia affects 3 to 6 million Americans, with 80-90% being women who are usually diagnosed in middle age.
- It is characterized by widespread pain in the muscles and soft tissues. Common symptoms include fatigue, sleep issues, headaches, and tender points in various areas of the body.
- While drugs can help manage symptoms, natural therapies like exercise, stress reduction, and nutrition have shown more long-term promise for fibromyalgia sufferers. Regular exercise in particular can help reduce pain and fatigue and improve overall health.
Fibromyalgia: Fact or Fiction? A Multi-disciplinary ApproachMedicineAndHealthUSA
Fibromyalgia is a chronic pain condition defined by widespread muscle pain and tender points. It has overlapping symptoms with conditions like chronic fatigue syndrome, irritable bowel syndrome, and depression or anxiety. Treatment requires a multidisciplinary approach including medications, exercise, stress management, and sleep improvement to help manage pain and associated symptoms.
I was asked to present something on Fibromyalgia during a Pain Summit. I ended up describing what we know so far about clinical features, evolution of diagnostic criteria and synthesized some recent guidelines.
Fibromyalgia is a clinical syndrome characterized by widespread pain, fatigue, sleep disturbances, and other somatic and cognitive symptoms. It affects 2-5% of the general population and is more prevalent among women ages 20-50. The cause is unclear but may involve genetic and environmental factors as well as abnormalities in central pain processing and neuroendocrine function. Diagnosis is based on symptoms and involves assessing pain levels and tender points. Treatment focuses on managing symptoms and includes pharmacologic approaches like antidepressants as well as non-pharmacologic options such as exercise, therapy, and acupuncture. Acupuncture is thought to help fibromyalgia by inhibiting pain pathways, stimulating pain modulation pathways, and regulating neuroendocrine function like cortisol and growth hormone levels
Pain is common in elderly patients due to age-related changes in peripheral nerves and the central nervous system. Chronic pain is prevalent, with about 1 in 5 elderly patients experiencing pain for over 24 hours in the past month. Common causes of pain include arthritis, fractures, and neuropathies. Untreated pain can lead to depression, sleep disturbances, functional impairment, and reduced quality of life. Treatment involves both pharmacological and non-pharmacological approaches, with special considerations for age-related changes impacting drug metabolism and side effects.
Was recently asked to discuss whether there is evidence to support the use of B vitamins in managing different aches and pains. Here's my talk delivered last 16 Sept 2016 at the 12th Post Graduate Course of the East Avenue Medical Center Department of Internal Medicine.
Pain is common in elderly patients, with osteoarthritis, neuropathies, and cancer being leading causes. It is often undertreated in this population due to attitudes that pain is normal with age and concerns about side effects of pain medications. A comprehensive assessment involves evaluating location, intensity, and impact of pain, as well as cognitive and functional status. Treatment should begin with non-pharmacological options and follow the WHO analgesic ladder when drugs are needed. Careful medication management is especially important due to changes in pharmacokinetics and risk of delirium. Effective pain control improves quality of life while communication between providers and education of patients and caregivers are also crucial.
- Fibromyalgia affects 3 to 6 million Americans, with 80-90% being women who are usually diagnosed in middle age.
- It is characterized by widespread pain in the muscles and soft tissues. Common symptoms include fatigue, sleep issues, headaches, and tender points in various areas of the body.
- While drugs can help manage symptoms, natural therapies like exercise, stress reduction, and nutrition have shown more long-term promise for fibromyalgia sufferers. Regular exercise in particular can help reduce pain and fatigue and improve overall health.
Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain and tenderness. It is more common in women than men. While pain is the primary symptom, it also involves fatigue, sleep issues, cognitive problems, anxiety and depression. There is no known cause but factors like genetics and abnormal pain processing in the central nervous system may play a role. Treatment involves lifestyle changes like exercise and stress management as well as medications like antidepressants. While not curable, some patients are able to adapt well through treatment, but a minority have severe, treatment-resistant symptoms.
Natural Treatments for Fibromyalgia, Diabetes, Lupus, Cancer, Multiple Sclero...Douglas Holt
Real Fibromyalgia, Treatment & Emotions
A Pituitary Endocrinology Perspective. Effective natural therapies for Fibromyalgia
Hot flashes, memory loss, and a weird polyneuropathy, polymyalgia or polyarthropathy (i.e. adds up to fibromyalgia)?
What is fibromyalgia? The great magical mystery illness! Pituitary endocrinology research.
Fibromyalgia really is…• Simply pituitary damage. • Causing a lack of several key hormones.
Few pituitary endocrinologists out there. Out of 150 endocrinologists there will be 1 true Pituitary Endocrinologist.
Fibromyalgic syndromes: could growth hormone therapy be beneficial?
Diabetes, Lupus, Cancer, multiple sclerosis, gout, rheumatoid arthritis, arthritis, lymphoma, glucose, osteoarthritis, type 2 diabetes, fatigue, chronic fatigue syndrome, dizziness, autoimmune disease, adrenal fatigue, polymyalgia rheumatica, depression, why am I so tires
Actual Causes of Fibromyalgia?
The pituitary secretes hormones that are essential to growth and reproduction. Hormones and vasculature.
Problems that can cause stalk or pituitary damage:
• Whiplash or any MVA
• TBI – even mild (Australian Rules Football would qualify)
• Air Bag Deployment to face or head
• Any Mild to Moderate Blows To The Head – heading a soccer ball! Any concussion!
• Sexual abuse as a child
• Stroke
• Tumors – if you can’t find anything else!
• Sheehan’s Syndrome
• Snorting or huffing drugs (i.e. cocaine)
• Radiation exposure (i.e. MD/DO/DC/DDS)
• Prolonged High Stress (i.e. MD/DO/DC/DDS)
Pituitary Dysfunction = Fibromyalgia = Maybe Even Multiple Sclerosis (MS)
Fibromyalgia Really Occurs from a Lack of Healing Hormones
Occurrence of pituitary dysfunction following traumatic brain injury. “subjects with a history of TBI frequently develop pituitary dysfunction, especially GHD.” (GHD=Growth Hormone Deficiency)
Lack of Testosterone is a problem, too.
Sage (Salvia officinalis), fennel (Foeniculum vulgare), lavender (Lavandula angustifolia), myrtle (Myrtus communis), peppermint (Mentha piperita), and blue yarrow (Achillea millefolium), in a base of sesame seed oil.
Symptoms of Inadequate Progesterone Production?
• Hot Flashes
• Day and Night Sweats
• Migraine Headaches
• Severe PMS
• Endometriosis
• Demyelination Problems
• TMJ Problems (not usually the only cause)
• Libido Problems
For diagnoses related to hypothyroidism, typical problems include fatigue, weight gain, depression, lethargy, dry skin, cold intolerance, voice change, change in menses, muscle cramps, or treatment of a thyroid condition.
Here’s the emotional tie in
• Depression, lethargy, fatigue.
• Lack of HGH causes PTSD, depression, fatigue, confusion.
• Low testosterone causes decreased libido, fatigue, depression.
• Lack of progesterone causes depression, fatigue, PMS.
“Progesterone prevents menstrual migraine headaches in women.”
Lack of Thyroid Causes Hair Loss
Fibromyalgia is a disease, which is difficult to diagnose. These slides include ACR criteria 1990 and 2010 with Wide spread pain index(WPI) and Symptom severity score(SSS)
Fibromyalgia syndrome is a common and chronic disorder characterized
by widespread pain, diffuse tenderness, and a number of other symptoms.
The word “fibromyalgia” comes from the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia).
Although fibromyalgia is often considered an arthritis-related
condition, it is not truly a form of arthritis (a disease of the joints)
because it does not cause inflammation or damage to the joints,
muscles, or other tissues. Like arthritis, however, fibromyalgia can
cause significant pain and fatigue, and it can interfere with a person’s
ability to carry on daily activities. Also like arthritis, fibromyalgia
is considered a rheumatic condition, a medical condition that impairs
the joints and/or soft tissues and causes chronic pain.
In addition to pain and fatigue, people who have fibromyalgia may experience a variety of other symptoms including:
-- cognitive and memory problems (sometimes referred to as “fibro fog”)
-- sleep disturbances
-- morning stiffness
-- headaches
-- irritable bowel syndrome
-- painful menstrual periods
-- numbness or tingling of the extremities
-- restless legs syndrome
-- temperature sensitivity
-- sensitivity to loud noises or bright lights.
Fibromyalgia is a syndrome rather than a disease. A syndrome is a
collection of signs, symptoms, and medical problems that tend to occur
together but are not related to a specific, identifiable cause. A
disease, on the other hand, has a specific cause or causes and
recognizable signs and symptoms.
A person may have two or more coexisting chronic pain conditions.
Such conditions can include chronic fatigue syndrome, endometriosis,
fibromyalgia, inflammatory bowel disease, interstitial cystitis,
temporomandibular joint dysfunction, and vulvodynia. It is not known
whether these disorders share a common cause.
This document provides brief guidelines for cancer pain management. It discusses the magnitude of the cancer pain problem, with 30-50% of cancer patients experiencing pain during active therapy. It then covers cancer pain classification, assessment, the WHO three-step approach, and recommendations for managing pain in opioid-naive patients versus those already taking opioids. Interventional strategies like nerve blocks and surgical procedures are also reviewed. The document provides an overview of guidelines for comprehensive cancer pain management.
it is a case study (50-year-old woman) who states she has suffered from mild muscle discomfort in her neck, spine, and upper and lower extremities for more than 6 months, but the pain has progressively gotten worse in the last 3 months.
The document discusses recommendations for treating diabetic peripheral neuropathic pain (DPNP) created by a consensus group in 2005. It provides an overview of DPNP, including definitions, incidence rates, assessment tools, management guidelines, and recommendations for first- and second-tier medication treatments. It also covers the typical clinical presentation of DPNP and importance of foot care to prevent ulcers and amputations.
Chronic Regional Pain Syndrome- A syndrome of signs and symptoms which should be diagnosed at the earliest and treated by a multidisciplinary team of experts.. This presentation gives all about the syndrome, how to treat based on the best evidence available for a physiotherapist, occupational therapist, physician, vacational therapist, etc.
Fibromyalgia & Chronic Fatigue Syndromelifeguardrx
This document reviews fibromyalgia and chronic fatigue syndrome, discussing their definitions, epidemiology, pathophysiology, symptoms, theories of causation, and treatment options. It examines various theories that fibromyalgia may be caused by abnormalities in brain chemistry, hormones, muscle and cell function. Both pharmacological and non-pharmacological therapies are considered, including medications, diet, exercise, sleep, and supplements. Specific evaluation and treatment approaches focused on the thyroid, adrenals, sleep, fatigue, stress reduction, and pain management are outlined.
The document provides an overview of pain management, defining pain, classifying different types of pain, discussing pain physiology and assessment tools, and outlining approaches for managing both acute and chronic pain, including non-pharmacological and pharmacological options following the WHO analgesic ladder. It emphasizes the importance of regular pain assessment and treatment according to the R-A-T framework of recognizing pain, assessing its cause and severity, and then treating it appropriately.
assessment and physiotherapy management of pain in elderly sunil JMI
1. Pain assessment in elderly patients requires a comprehensive evaluation of sensory, emotional, functional, and social impacts of pain. It also requires consideration of age-related changes and beliefs about pain.
2. A thorough history and physical exam are needed to identify potential causes of pain and evaluate for comorbidities. The history should address location, intensity, descriptors, relieving/aggravating factors, and impact on sleep, function, mood and quality of life.
3. Physical exam includes general exam, specific pain evaluation, neurological and musculoskeletal exams to identify potential causes and contributing factors. Assessment of psychological and cognitive factors is also important.
Fibromyalgia is a chronic disorder characterized by widespread muscle pain, tenderness, and stiffness. It predominantly affects women between 25-55 years old. Common symptoms include fatigue, headaches, sleep disturbances, and abnormal pain sensation. While the cause is unknown, genes and physical trauma may play a role. Treatments include exercise, acupuncture, massage, medications, and psychotherapy to manage pain and fatigue.
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Fibromyalgia is a disorder characterized by widespread pain, abnormal pain processing, sleep disturbances, fatigue, and often psychological distress. The cause is unknown, but may involve genetic and environmental factors. Central nervous system changes, including increased brain activity and premature gray matter loss, are believed to play a role in fibromyalgia by enhancing pain sensitivity. Diagnosis involves a history of chronic widespread pain for over 3 months, along with sleep issues and tender points found in 11 of 18 body areas upon examination.
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain, stiffness, and tender points. It predominantly affects women and prevalence increases with age. The diagnosis is based on a history of widespread pain for at least 3 months and pain in 11 of 18 tender points. While the cause is unknown, it involves central sensitization and neuroendocrine abnormalities. Treatment includes medications, exercise, stress management, CBT, and alternative therapies. The ACR is proposing new diagnostic criteria incorporating symptoms like fatigue and cognitive problems in place of tender points.
Fibromyalgia is a common musculoskeletal condition characterized by widespread muscle pain and tender points. It affects over 12 million Americans, most of whom are women. Symptoms include fatigue, sleep problems, and depression in addition to muscle and joint pain. Diagnosis is difficult as the cause is unknown, but it involves evaluating symptoms and tender points. Treatment aims to minimize pain and other symptoms through lifestyle changes like exercise and stress reduction as well as medications. While symptoms cannot be cured, treatment can improve quality of life for those with this chronic condition.
This document provides a study guide for auriculotherapy, four needle technique, and extra points. It details ear anatomy and locations of points on the ear that correspond to different body systems and conditions. The four needle technique is described as a way to balance meridians based on tonifying or sedating points depending on if there is an excess or deficiency pattern. Zang and fu organ five shu points are also listed.
The document discusses acupuncture pain management and its mechanisms. It covers several theories of acupuncture including the gate control theory of pain, neurohumoral theory, and endorphin theory. It also discusses clinical applications for treating various pain conditions like headaches, arthritis, lower back pain, and more. Key acupuncture points are provided for different types of pain.
Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain and tenderness. It is more common in women than men. While pain is the primary symptom, it also involves fatigue, sleep issues, cognitive problems, anxiety and depression. There is no known cause but factors like genetics and abnormal pain processing in the central nervous system may play a role. Treatment involves lifestyle changes like exercise and stress management as well as medications like antidepressants. While not curable, some patients are able to adapt well through treatment, but a minority have severe, treatment-resistant symptoms.
Natural Treatments for Fibromyalgia, Diabetes, Lupus, Cancer, Multiple Sclero...Douglas Holt
Real Fibromyalgia, Treatment & Emotions
A Pituitary Endocrinology Perspective. Effective natural therapies for Fibromyalgia
Hot flashes, memory loss, and a weird polyneuropathy, polymyalgia or polyarthropathy (i.e. adds up to fibromyalgia)?
What is fibromyalgia? The great magical mystery illness! Pituitary endocrinology research.
Fibromyalgia really is…• Simply pituitary damage. • Causing a lack of several key hormones.
Few pituitary endocrinologists out there. Out of 150 endocrinologists there will be 1 true Pituitary Endocrinologist.
Fibromyalgic syndromes: could growth hormone therapy be beneficial?
Diabetes, Lupus, Cancer, multiple sclerosis, gout, rheumatoid arthritis, arthritis, lymphoma, glucose, osteoarthritis, type 2 diabetes, fatigue, chronic fatigue syndrome, dizziness, autoimmune disease, adrenal fatigue, polymyalgia rheumatica, depression, why am I so tires
Actual Causes of Fibromyalgia?
The pituitary secretes hormones that are essential to growth and reproduction. Hormones and vasculature.
Problems that can cause stalk or pituitary damage:
• Whiplash or any MVA
• TBI – even mild (Australian Rules Football would qualify)
• Air Bag Deployment to face or head
• Any Mild to Moderate Blows To The Head – heading a soccer ball! Any concussion!
• Sexual abuse as a child
• Stroke
• Tumors – if you can’t find anything else!
• Sheehan’s Syndrome
• Snorting or huffing drugs (i.e. cocaine)
• Radiation exposure (i.e. MD/DO/DC/DDS)
• Prolonged High Stress (i.e. MD/DO/DC/DDS)
Pituitary Dysfunction = Fibromyalgia = Maybe Even Multiple Sclerosis (MS)
Fibromyalgia Really Occurs from a Lack of Healing Hormones
Occurrence of pituitary dysfunction following traumatic brain injury. “subjects with a history of TBI frequently develop pituitary dysfunction, especially GHD.” (GHD=Growth Hormone Deficiency)
Lack of Testosterone is a problem, too.
Sage (Salvia officinalis), fennel (Foeniculum vulgare), lavender (Lavandula angustifolia), myrtle (Myrtus communis), peppermint (Mentha piperita), and blue yarrow (Achillea millefolium), in a base of sesame seed oil.
Symptoms of Inadequate Progesterone Production?
• Hot Flashes
• Day and Night Sweats
• Migraine Headaches
• Severe PMS
• Endometriosis
• Demyelination Problems
• TMJ Problems (not usually the only cause)
• Libido Problems
For diagnoses related to hypothyroidism, typical problems include fatigue, weight gain, depression, lethargy, dry skin, cold intolerance, voice change, change in menses, muscle cramps, or treatment of a thyroid condition.
Here’s the emotional tie in
• Depression, lethargy, fatigue.
• Lack of HGH causes PTSD, depression, fatigue, confusion.
• Low testosterone causes decreased libido, fatigue, depression.
• Lack of progesterone causes depression, fatigue, PMS.
“Progesterone prevents menstrual migraine headaches in women.”
Lack of Thyroid Causes Hair Loss
Fibromyalgia is a disease, which is difficult to diagnose. These slides include ACR criteria 1990 and 2010 with Wide spread pain index(WPI) and Symptom severity score(SSS)
Fibromyalgia syndrome is a common and chronic disorder characterized
by widespread pain, diffuse tenderness, and a number of other symptoms.
The word “fibromyalgia” comes from the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia).
Although fibromyalgia is often considered an arthritis-related
condition, it is not truly a form of arthritis (a disease of the joints)
because it does not cause inflammation or damage to the joints,
muscles, or other tissues. Like arthritis, however, fibromyalgia can
cause significant pain and fatigue, and it can interfere with a person’s
ability to carry on daily activities. Also like arthritis, fibromyalgia
is considered a rheumatic condition, a medical condition that impairs
the joints and/or soft tissues and causes chronic pain.
In addition to pain and fatigue, people who have fibromyalgia may experience a variety of other symptoms including:
-- cognitive and memory problems (sometimes referred to as “fibro fog”)
-- sleep disturbances
-- morning stiffness
-- headaches
-- irritable bowel syndrome
-- painful menstrual periods
-- numbness or tingling of the extremities
-- restless legs syndrome
-- temperature sensitivity
-- sensitivity to loud noises or bright lights.
Fibromyalgia is a syndrome rather than a disease. A syndrome is a
collection of signs, symptoms, and medical problems that tend to occur
together but are not related to a specific, identifiable cause. A
disease, on the other hand, has a specific cause or causes and
recognizable signs and symptoms.
A person may have two or more coexisting chronic pain conditions.
Such conditions can include chronic fatigue syndrome, endometriosis,
fibromyalgia, inflammatory bowel disease, interstitial cystitis,
temporomandibular joint dysfunction, and vulvodynia. It is not known
whether these disorders share a common cause.
This document provides brief guidelines for cancer pain management. It discusses the magnitude of the cancer pain problem, with 30-50% of cancer patients experiencing pain during active therapy. It then covers cancer pain classification, assessment, the WHO three-step approach, and recommendations for managing pain in opioid-naive patients versus those already taking opioids. Interventional strategies like nerve blocks and surgical procedures are also reviewed. The document provides an overview of guidelines for comprehensive cancer pain management.
it is a case study (50-year-old woman) who states she has suffered from mild muscle discomfort in her neck, spine, and upper and lower extremities for more than 6 months, but the pain has progressively gotten worse in the last 3 months.
The document discusses recommendations for treating diabetic peripheral neuropathic pain (DPNP) created by a consensus group in 2005. It provides an overview of DPNP, including definitions, incidence rates, assessment tools, management guidelines, and recommendations for first- and second-tier medication treatments. It also covers the typical clinical presentation of DPNP and importance of foot care to prevent ulcers and amputations.
Chronic Regional Pain Syndrome- A syndrome of signs and symptoms which should be diagnosed at the earliest and treated by a multidisciplinary team of experts.. This presentation gives all about the syndrome, how to treat based on the best evidence available for a physiotherapist, occupational therapist, physician, vacational therapist, etc.
Fibromyalgia & Chronic Fatigue Syndromelifeguardrx
This document reviews fibromyalgia and chronic fatigue syndrome, discussing their definitions, epidemiology, pathophysiology, symptoms, theories of causation, and treatment options. It examines various theories that fibromyalgia may be caused by abnormalities in brain chemistry, hormones, muscle and cell function. Both pharmacological and non-pharmacological therapies are considered, including medications, diet, exercise, sleep, and supplements. Specific evaluation and treatment approaches focused on the thyroid, adrenals, sleep, fatigue, stress reduction, and pain management are outlined.
The document provides an overview of pain management, defining pain, classifying different types of pain, discussing pain physiology and assessment tools, and outlining approaches for managing both acute and chronic pain, including non-pharmacological and pharmacological options following the WHO analgesic ladder. It emphasizes the importance of regular pain assessment and treatment according to the R-A-T framework of recognizing pain, assessing its cause and severity, and then treating it appropriately.
assessment and physiotherapy management of pain in elderly sunil JMI
1. Pain assessment in elderly patients requires a comprehensive evaluation of sensory, emotional, functional, and social impacts of pain. It also requires consideration of age-related changes and beliefs about pain.
2. A thorough history and physical exam are needed to identify potential causes of pain and evaluate for comorbidities. The history should address location, intensity, descriptors, relieving/aggravating factors, and impact on sleep, function, mood and quality of life.
3. Physical exam includes general exam, specific pain evaluation, neurological and musculoskeletal exams to identify potential causes and contributing factors. Assessment of psychological and cognitive factors is also important.
Fibromyalgia is a chronic disorder characterized by widespread muscle pain, tenderness, and stiffness. It predominantly affects women between 25-55 years old. Common symptoms include fatigue, headaches, sleep disturbances, and abnormal pain sensation. While the cause is unknown, genes and physical trauma may play a role. Treatments include exercise, acupuncture, massage, medications, and psychotherapy to manage pain and fatigue.
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Fibromyalgia is a disorder characterized by widespread pain, abnormal pain processing, sleep disturbances, fatigue, and often psychological distress. The cause is unknown, but may involve genetic and environmental factors. Central nervous system changes, including increased brain activity and premature gray matter loss, are believed to play a role in fibromyalgia by enhancing pain sensitivity. Diagnosis involves a history of chronic widespread pain for over 3 months, along with sleep issues and tender points found in 11 of 18 body areas upon examination.
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain, stiffness, and tender points. It predominantly affects women and prevalence increases with age. The diagnosis is based on a history of widespread pain for at least 3 months and pain in 11 of 18 tender points. While the cause is unknown, it involves central sensitization and neuroendocrine abnormalities. Treatment includes medications, exercise, stress management, CBT, and alternative therapies. The ACR is proposing new diagnostic criteria incorporating symptoms like fatigue and cognitive problems in place of tender points.
Fibromyalgia is a common musculoskeletal condition characterized by widespread muscle pain and tender points. It affects over 12 million Americans, most of whom are women. Symptoms include fatigue, sleep problems, and depression in addition to muscle and joint pain. Diagnosis is difficult as the cause is unknown, but it involves evaluating symptoms and tender points. Treatment aims to minimize pain and other symptoms through lifestyle changes like exercise and stress reduction as well as medications. While symptoms cannot be cured, treatment can improve quality of life for those with this chronic condition.
This document provides a study guide for auriculotherapy, four needle technique, and extra points. It details ear anatomy and locations of points on the ear that correspond to different body systems and conditions. The four needle technique is described as a way to balance meridians based on tonifying or sedating points depending on if there is an excess or deficiency pattern. Zang and fu organ five shu points are also listed.
The document discusses acupuncture pain management and its mechanisms. It covers several theories of acupuncture including the gate control theory of pain, neurohumoral theory, and endorphin theory. It also discusses clinical applications for treating various pain conditions like headaches, arthritis, lower back pain, and more. Key acupuncture points are provided for different types of pain.
Acupuncture is an ancient Chinese medical practice with a scientific basis. Traditional Chinese Medicine views the body as having meridians and qi that acupuncture can influence to promote health and treat illness. Recent biomedical research shows acupuncture may work through peripheral sensory stimulation and modulating pain pathways in the central nervous system. Theories on how acupuncture relieves pain include stimulating the release of endogenous opioids, blocking pain transmission, vasodilation effects, and autonomic nervous system regulation.
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain, stiffness, paresthesia, and non-restorative sleep. It affects 2-8% of the population, predominantly women. While the causes are unknown, fibromyalgia is diagnosed based on a patient history meeting the 1990 American College of Rheumatology diagnostic criteria of widespread pain and tenderness in at least 11 of 18 tender point sites. Treatments include medications, exercise, cognitive behavioral therapy, and supportive group therapy to manage symptoms.
Este documento presenta información sobre los criterios de diagnóstico para patologías articulares. Describe factores etiológicos, signos y síntomas de trastornos temporomandibulares (TTM), y explica las diferentes etapas de progresión de desórdenes internos de la articulación temporomandibular. También cubre trastornos articulares específicos como luxaciones discales, adherencias, subluxaciones y trastornos inflamatorios.
This document provides an overview of the sections and functionality available on the CADAL Digital Library website. It includes sections for browsing and searching information on herbal medicines, prescriptions, diseases/symptoms, as well as performing data analysis. Video lectures and books can also be accessed. Additional functions include health tests, acupuncture information, and a questions and answers section. The document was created by Wei Wang from Zhejiang University.
Body's Pre-Image and Five Elements (CH 15, P2, Garuda Puran)Pardeep Sehgal
A treatise on 'self' and 'not-self'. By wilful drawing of life force by attention to outside world and its activities, we deprive our inner organs of their share of life force which shows up as disease.
This document describes the services of Malou Acupuncture. Malou treats a variety of stress-related conditions like anxiety, depression, and insomnia, as well as menopause, cancer care, and other issues through acupuncture and other traditional Chinese medicine techniques. Malou has experience in areas like inducing labor, infertility, headaches, and back pain. Appointments typically involve diagnosis of pulses and tongue, followed by acupuncture needle insertion or moxa heat therapy.
The document provides a timeline of Chinese dynasties from pre-dynastic periods to the present day People's Republic of China. It then discusses how an understanding of Chinese history can assist modern clinical practice and society. Specifically, it outlines how traditional Chinese medicine originated from phenomena during early dynasties such as ancestor worship, philosophical schools like yin-yang and wu xing, and magical or spiritual practices involving demons, spirits, and healing. Elements of these early concepts and beliefs relate to aspects of modern TCM practice such as treatment of emotions, energy flow, and view of disease causation.
Chinese Five Elements: Application to Human InterrelationshipsThesigan Nadarajan
Even without going into human personality comparisons, just from the five Chinese elements, the interrelationships of Mr. XX and Ms. A was predictable. The human personality comparisons only confirmed what we already knew. It is in this manner that the application of five Chinese elements of Wood, Fire, Earth, Metal, and Water is employed to human interrelationships.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help alleviate symptoms of mental illness and boost overall mental well-being.
The document discusses finding accurate acupuncture points. It states that correctly locating points is important for practicing acupuncture according to the principles of balancing qi. It advises that points can be found by palpating the skin and feeling for movements of qi, as points are areas where qi exits and enters rather than being confined to skin, flesh, or bones. Properly detecting the flow of qi using one's fingertips is key to accurately finding acupuncture points.
This document discusses acupuncture points and techniques for treating neck pain. It lists various acupuncture points in the head and neck region along with their locations, functions, and indications. Specific points like Jingbailao, Yiming, and Fengchi are described in detail. Common causes of chronic neck pain like muscle strain, cervical foraminal stenosis, and disc injury are outlined. The document also reviews how acupuncture can be used to treat neck pain by stimulating acupuncture points to promote blood flow and affect the central nervous system. Pressure points like Drilling Bamboo and Wind Mansion that can relieve neck and head pain are also mentioned.
There are 12 back shu points on the bladder meridian that correspond to each of the 12 zang-fu organs. Back shu points, also called associated points, are located along the spine and can indicate disorders in their related organs. Tenderness at these points suggests either a deficiency or excess of energy in the associated meridian and organ. Alarm points are located on the front of the body near their related organs and may become tender if the organ is imbalanced. Both back shu and alarm points can be used diagnostically and therapeutically for their related organs.
This document discusses pain in children and adolescents, including musculoskeletal pain, fibromyalgia, and central pain processing disorders. It notes that 25% of new patients seen by pediatric rheumatologists have childhood pain syndromes, with average age of onset being 12 years old. Musculoskeletal pain affects 6% of pediatric primary care visits. The document defines different types of pain including nociceptive, neuropathic, and central pain processing. It discusses how conditions like fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome may involve central pain processing and sensitization. Treatment options discussed include validation, education, exercise, cognitive behavioral therapy, and various pharmacologic approaches.
This document provides information about fibromyalgia including its definition, symptoms, diagnosis, treatment, and prognosis. Fibromyalgia is defined as a chronic pain condition characterized by widespread muscle aches, pain and tenderness in at least 11 of 18 tender points. It predominantly affects women and has no known cause but may involve abnormalities in how the brain processes pain signals. Treatment involves lifestyle modifications like exercise, stress management and adequate sleep, along with medications to reduce pain and improve symptoms. While there is no cure for fibromyalgia, treatment can help manage symptoms and many people are able to lead active lives.
Fibromyalgia syndrome is a common chronic pain condition that affects at least 2% of the adult population. Chronic widespread pain is the defining feature of FM, but patients may also exhibit a range of other symptoms, including sleep disturbance, fatigue, irritable bowel syndrome, headaches and mood disorders. While the aetiology of the condition is not completely understood, it is believed that a number of factors (rather than one in isolation) are most likely to lead to its development. Thus, the onset of fibromyalgia syndrome can be influenced by hormonal and/or chemical imbalances, chronic stress and/or a traumatic event, genetic predisposition and even pre-existing illness.
In this hour-long webinar, Dr Nina Bailey covers:
• An overview of the aetiology of fibromyalgia
• The signs and symptoms of fibromyalgia
• Factors that can contribute to or exacerbate fibromyalgia syndrome
• Managing symptoms via dietary manipulation and lifestyle change
• Supporting nutrients/supplements for those with fibromyalgia syndrome
Fibromyalgia, Bell's Palsy and Parkinson's DiseaseTeMz Gordonas
This document contains a written report on Fibromyalgia, Bell's Palsy, and Parkinson's Disease submitted by a physical therapy intern. For Fibromyalgia, it provides definitions, characteristics, prevalence, diagnostic criteria, contributing factors, and management approaches. For Bell's Palsy, it describes the anatomy of the facial nerve, signs and symptoms, prognosis, and physical therapy management. For Parkinson's Disease, it outlines the anatomy of the basal ganglia and striatal motor system involved.
The document discusses pain and psychological perspectives in terminal Motor Neurone Disease (MND) sufferers. It defines terminal illness and MND, describing the physical and psychological pain associated with MND. Regarding physical pain, it discusses types, measurement using scales like the SF-36, and pharmacological and non-pharmacological management approaches. For psychological pain, it covers measurement using tools like the BDI and management methods. The document also addresses comorbidities like depression, desire for death, and suicidal thoughts in terminal MND patients. It concludes that managing pain in terminal illness requires a multidisciplinary approach including both medical and psychological support.
ME/CFS and FM present as complicated illnesses and getting the right diagnosis can be challenging or seem like an impossibility. Learn how to distinguish between these two diseases and recognize other conditions that may play a role in illness presentation.
Compassionate patient care is at the heart of what we do.
We set the standard for excellence in patient care through early diagnosis and evidence-based precision medicine. We reject the current healthcare system’s model of 10 minute visits. That doesn’t work for our patients. Our patient care is methodical, in-depth and allows us to really understand an individual and their illness.
We are a 501 c(3) dedicated to improving the lives of those that suffer from these devastating diseases.
Visit Batemanhornecenter.org to learn more.
ME/CFS and FM present as complicated illnesses and getting the right diagnosis can be challenging or seem like an impossibility. Learn how to distinguish between these two diseases and recognize other conditions that may play a role in illness presentation.
Compassionate patient care is at the heart of what we do
We set the standard for excellence in patient care through early diagnosis and evidence-based precision medicine. We reject the current healthcare system’s model of 10 minute visits. That doesn’t work for our patients. Our patient care is methodical, in-depth and allows us to really understand an individual and their illness.
We are a 501 c(3) dedicated to improving the lives of those that suffer from these devastating diseases.
Visit Batemanhornecenter.org to learn more.
The document discusses various topics related to pain, including definitions, types, causes, symptoms, investigations, and treatments. It defines pain and differentiates it from nociception. It describes acute and chronic pain, as well as types including malignant and non-malignant pain. Physiological pain origins like cutaneous, somatic, and visceral pain are explained. Common and serious causes of pain in different body regions are listed. Investigations and various allopathic and alternative pain treatment methods are also outlined.
What is Chronic Causes Symtoms and Relief Treatment Options - CureEZ.pdfCureEZ
Chronic pain is a complex and pervasive medical condition that affects millions of
individuals worldwide, significantly impacting their quality of life and overall well-being. Chronic pain is characterized by persistent discomfort that lasts for an extended period, typically exceeding three to six months. Unlike acute pain, which serves as a warning signal of injury or illness and usually resolves as the body heals, chronic pain persists long after the initial injury has healed. It can affect various parts of the body and may stem from a wide range of underlying causes, including nerve damage, inflammation, or dysfunction in the central nervous system. It may significantly impact an individual's physical and emotional well-being, as well as their daily activities and quality of life.
Managing chronic pain effectively often requires a multidisciplinary approach involving medical intervention, lifestyle modifications, and psychological support to improve the individual's quality of life and overall well-being.
This document provides information on neuropathic pain diagnosis and management, with a focus on diabetic peripheral neuropathy. It discusses:
- The different types of pain (nociceptive, neuropathic, central sensitization) and characteristics of each. Neuropathic pain is caused by damage to the somatosensory nervous system and is often chronic.
- Neuropathic pain is prevalent in many conditions including diabetes, cancer, HIV, post-surgical, and postherpetic neuralgia. Over 50% of people with diabetes experience painful diabetic peripheral neuropathy.
- The pathophysiology of neuropathic pain involves peripheral and central nervous system changes that lead to hypersensitivity and abnormal pain response. Sleep disruption and anxiety/depression can
This document reviews central sensitization syndrome and how to initially evaluate patients presenting with fibromyalgia. Central sensitization is a condition where the central nervous system amplifies sensory input across organ systems, resulting in increased pain perception. Many chronic pain conditions like fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome overlap due to shared symptoms of central sensitization. The evaluation of fibromyalgia should involve focused history taking including symptom onset, pain behaviors, emotional responses, comorbid psychiatric disorders, and past treatments. Identifying features of central sensitization can improve the efficiency and accuracy of the clinical evaluation.
Management oF Chronic Pain-- Seminar.pptxssusera931bd
This document discusses the management of chronic pain. It begins with definitions and classifications of different types of pain. It then discusses the epidemiology, anatomy, pathophysiology, diagnosis, and common causes of chronic pain such as low back pain, peripheral neuropathies, postherpetic neuralgia, migraines, and fibromyalgia. The document also covers pharmacological treatments including analgesics like NSAIDs and opioids as well as psychological treatments.
Fibromyalgia is a condition characterized by widespread muscle pain and tenderness. It affects around 2% of the US population. While the cause is unknown, it is believed to involve abnormalities in the central nervous system that increase pain sensitivity. Diagnosis is based on evaluating tender points and a symptom severity scale. Treatments aim to reduce pain and improve sleep, mood, and daily functioning, and may include medications, exercise, cognitive behavioral therapy, and complementary therapies. The prognosis is not life-threatening but symptoms can fluctuate over time. More research is still needed to better understand and manage this complex condition.
This document provides an overview of fibromyalgia, including its classification, symptoms, causes, diagnosis, treatment, and the role of physical therapists. Fibromyalgia is classified as a central nervous system disorder characterized by widespread muscle pain and tender points. It commonly causes fatigue, sleep issues, and mood changes. While its causes are unclear, factors like genetics, trauma, and sleep disturbances may play a role. Physical therapists can help patients with fibromyalgia develop exercise and stretching routines to reduce pain and stiffness.
Fibromyalgia is a chronic pain condition characterized by widespread muscle aches, pain and fatigue. While the exact cause is unknown, it involves dysregulation of the autonomic nervous system and neuroendocrine changes. The American College of Rheumatology diagnostic criteria includes widespread pain for over 3 months and tender points found in 11 of 18 sites. Treatment options with mild to moderate effectiveness include low-dose antidepressants, aerobic exercise and cognitive behavioral therapy, though more research is still needed on alternative therapies.
The document discusses pain from several perspectives. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It describes the anatomy and neurophysiology of pain, how pain stimuli is transmitted through the nervous system. It discusses different types of pain such as acute, chronic, breakthrough, and psychogenic pain. It covers factors that can influence individual responses to pain like age, physiology, culture, and past experiences. Finally, it outlines several methods that are used to measure and describe pain experiences.
People with ME/CFS and FM often suffer from cognitive impairment that can lead to brain fog, trouble word finding and more debilitating symptoms. In this class, you will understand the types of cognitive issues that commonly occur, possible causes, and how to implement strategies for improving cognitive function.
Compassionate patient care is at the heart of what we do.
We set the standard for excellence in patient care through early diagnosis and evidence-based precision medicine. We reject the current healthcare system’s model of 10 minute visits. That doesn’t work for our patients. Our patient care is methodical, in-depth and allows us to really understand an individual and their illness.
We are a 501 c(3) dedicated to improving the lives of those that suffer from these devastating diseases.
Visit Batemanhornecenter.org to learn more.
Chronic pains are highly prevalent conditions that are often linked through metaflammation and lifestyle factors. When pain becomes chronic, it undergoes pathological changes including sensitization of the peripheral and central nervous system. Effective management of chronic pains requires a multimodal approach that addresses both the source of pain and pain control through non-invasive and minimally invasive methods before considering more aggressive options.
Chronic pains are highly prevalent conditions that are often linked through metaflammation and lifestyle factors. When pain becomes chronic, it undergoes pathological changes including sensitization of the peripheral and central nervous system. Effective management of chronic pains requires a multimodal approach that addresses both the source of pain and pain control through non-invasive and minimally invasive methods before considering more aggressive options.
Κάπνισμα και Βελονισμός» .
"Ένα μη φαρμακευτικό εναλλακτικό πρωτόκολλο προσέγγισης της απεξάρτησης από το κάπνισμα", μέσω βελονισμού.
☑️Οι συνέπειες του καπνίσματος στην υγεία.
☑️Η συμβολή του βελονισμού στα προγράμματα απεξάρτησης από το κάπνισμα.
Επετειακό λεύκωμα του AcuScience
Ένας φόρος τιμής για τους πρωτοπόρους του βελονισμού στην Ελλάδα:
Γιάγκος Καράβης
Νικόλαος Πάππας
Φιλήμων Ρώσσης
Χριστός Ζαχαριάδης
Έφη Ξαρχάκου
"Αυτή είναι η ιστορία του βελονισμού όπως την έζησα από το 1973 μέχρι σήμερα." Μ. Καράβης
the role of Acupuncture in the management of shoulder pathologyMiltiades Karavis
3rd ATHENS SHOULDER COURSE, Athens, Greece, 07/02/2018 - 09/02/2018
Miltiades Y. Karavis
The role of acupuncture in the management of shoulder pathology
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
1. 1) A brief introduction to
Fibromyalgia
2) Treatment strategies including
Traditional and Medical Acupuncture.
Karavis Y. Miltiades, MD, FICAE
Consultant in Physical Medicine & Rehabilitation
President Hellenic Medical Acupuncture Society
Director of acupuncture Dpt FILOKTITIS Medical Rehabilitation Center
2. Up to 2% of the general population has fibromyalgia syndrome.
The ratio of women to men equals to 7 to 1. Today (new diagnostic
criteria), 3/1. Hence, 80 to 90% of all patients are women.
Diagnosis of FMS is difficult to set. Usually, the time between the
beginning of the symptoms and the diagnosis of FMS is 5 years.
60% of patients continue to suffer from pain of mild or severe
intensity many years after diagnosis.
90% of patients remain symptomatic during all their lives.
17% of patients call themselves handicapped or disabled.
6% receive regularly a disability allowance (USA, UK, France).
3. Fibromyalgia syndrome (FMS) is a known rheumatologic condition
of unknown etiology characterized by generalized - widespread
chronic musculoskeletal pain and tenderness on palpation of
tendino-musculo-skeletal sites called tender points.
In addition to pain, the syndrome is associated with a variety of
other symptoms such as fatigue, headache, insomnia, irritable bowel
syndrome, depression and/or anxiety, dysmenorrhea, Raynaud’s like
syndromes etc.
It belongs to a specific category of chronic pain syndromes
which is called Pain Amplification Syndromes.
ACR, 1990
7. What is FM syndrome ???
Is it a musculo-skeletal disorder ?
Is it a inflammatory / rheumatologic problem ?
Is it an illness of central nervous system ?
Is it a mental condition ?
Is it a psychological disease ?
8. Fibromyalgia is a prototype of
Central Pain Syndromes.
It is a Chronic Pain
Syndrome.
Chronic Pain usually involves
CNS Changes.
Hypersensitization
(a form of neuropathic pain)
9. What is Central
Sensitization Syndrome
Central = Central nervous system (brain, Spinal cord)
Sensitization = describes the end result of a process that leaves
someone sensitive on a particular kind of input (stimulus). Neuro-
physiologically means that peripheral nociceptors could became
sensitive to stimuli.
Syndrome = Is a collection of signs and symptoms that occur
together and characterize a particular abnormality.
Manifestations = pain hypersensitivity, tactile allodynia, pressure
hyperalgesia, after-responce and temporal summation = which
characterizes a phenomenon called “wind-up”.
10. Other Central
Sensitizing Syndromes
Somatic
expression
disorders
• Irritable bowel syndrome
• Irritable bladder syndrome
• Chronic pelvic pain
• Chronic fatigue syndrome
• Chronic TMJ
• Chronic Headache
• Restless leg syndrome
• Non-cardiac chest pain
Psycho-
pathological
syndromes
• Depression
• PTSD
• Bipolar disorder
• Primary Insomnia
• OCD
• Anxiety
No tests, no biomarkers, only history ???
The main characteristic is hypersensitivity to external stimuli.
11. Nociceptive
Pain
Neuropathic
Pain
Mixed
A combination of primary
injury and secondary
effects from the CNS.
• Arthritis
• Sports injury
• Postoperative pain
• Diabetic neuropathy
• Post-herpetic neuralgia
• Trigeminal neuralgia
Chronic LBP
Fibromyalgia
Chronic neck pain
TPs
Peripheral component Neuropathic component
12. Diagnosis of FM
It is a diagnosis of EXCLUSION
There are NO specific tests (it is a syndrome, not a disease)
The diagnosis is based on History and Physical examination.
S: Subjective signs
O: Objective signs
A: Assessment
P: Plan
Rarely: The patient will say: I think I have 13/18 FM tender points
More often: I’m depressed, I can’t sleep, I’m tired all the time, I ache
all over, I'm afraid I’m going to lose my job, my nerves are shot.
S.O.A.P.: A “rule” which is
followed by doctors in order
to address to chronic pain
patients…
13. What is new ???
The second exclusion refers to
Depression. Depression is a
common symptom which can be
observed in many other
rheumatological patients, such as
patients with osteoarthritis, lupus,
and rheumatoid arthritis. So, it is
not representative of FMS, and
that’s the reason why it is also
excluded.
First exclusion: the Tender Points.
Pain, fatigue, sleep disturbances,
multiple somatic symptoms, and
cognitive difficulties are now
believed to be the most
significant features of the
syndrome.
That’s why Tender Points are
excluded from the diagnostic
criteria.
ACR, 2010
14. Fibromyalgia – New definition
Fibromyalgia is a disorder
characterized by widespread
musculoskeletal pain
accompanied by fatigue, sleep,
memory and mood issues.
Fibromyalgia is a disorder of
unknown etiology
characterized by widespread
pain, abnormal pain
processing, sleep
disturbance, fatigue and
often psychological
distress.
Mayo clinic stuff.
CDC (centers for
disease control and
prevention).
ACR, 2010
15. ACR 2010 FM diagnostic criteria
• Widespread pain (the hallmark symptom)
• Fatigue
• Unrefreshing sleep
• Cognitive symptoms
Plus
• Headache
• Depression
• Lower abdominal pain / cramping
Arthritis Care Res (Hoboken). 2010 May;62(5):600-10. doi: 10.1002/acr.20140.
The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of
symptom severity.
Wolfe F1, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB
16. My preferable
Neurophysiological
definition of FM
“…A chronic disorder characterized by abnormal somatosensory
processing stemming from changing within the Central Nervous
System (brain, spinal cord.)...”
“…An imbalance between excitatory and inhibitory influences on
pain-related pathways of the CNS…”
“…A change in the way the brain and spinal cord “listen” to the
body …”
Patrick B. Wood
17. ACR 2010 FM criteria
A patient satisfies diagnostic criteria for fibromyalgia
if the following 3 conditions are met:
1.Widespread pain index (WPI) ≥7 and symptom
severity scale score (SS) ≥5 or WPI 3 - 6 and SS scale
score ≥9.
2.Symptoms have been present at a similar level for
at least 3 months.
3.The patient does not have a disorder that would
otherwise explain the pain.
Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and
measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62:600-610.
MacFarlane GJ, Croft PR, Schollum J, Silman AJ. Widespread pain: is an improved classification possible? J Rheumatol. 1996;23:1628-1632.
Wolfe F, Clauw DJ, Fitzcharles MA, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the
ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011;38:1113-1122.
- See more at: http://www.rheumatologynetwork.com/fibromyalgia/new-and-modified-fibromyalgia-diagnostic-criteria#sthash.i3bKSmH4.dpuf
18. WPI: Note the number of areas in which the patient has had pain
over the last week. Score will be between 0 and 19.
Shoulder girdle, left
Shoulder girdle, right
Upper arm, left
Upper arm, right
Lower arm, left
Lower arm, right
Hip (buttock, trochanter), left
Hip (buttock, trochanter), right
Upper leg, left
Upper leg, right
Lower leg, left
Lower leg, right
Jaw, left
Jaw, right
Chest
Abdomen
Upper back
Lower back
Neck
Example, Score = 10
19. Find and download
this form from the
internet.
Learn how to
complete the form.
Use it to your patients.
20.
21. Diffused pain which is localized in the extremities and in the central skeleton. It
is described as muscular pain.
The intensity of pain changes. Periods without pain are rare. Pain deteriorates
with cold, wet, anxiety or other somatic or psychological stress. It ameliorates
with local application of heat, massage and light physical activity (aerobic
exercise).
Morning stiffness, which in some cases lasts all day. In most of the cases lasts
half an hour up to 2 hours. It improves with activity and massage and deteriorates
with cold.
Intense physical fatigue, which leads to full inactivity.
A non revitalizing sleep. The patients do not awake refreshed but tired.
All symptoms are more intense during morning hours, they ameliorate during midday and deteriorate
again during afternoon and evening hours.
22.
23. Mechanism underline
Pain Perception
Somatic sensations
in FM patients
Enhanced pain
sensitivity to painful
stimulation:
Hyperalgesia
Painful response to
normally innocuous
stimulus:
Allodynia
Brain Function in Fibromyalgia: Altered Pain Processing and Cognitive Dysfunction
Francisco Mercado1, Paloma Barjola1, Marisa Fernández-Sánchez1, Virginia Guerra1 and Francisco Gómez-Esquer2
[1] Department of Psychology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
[2] Department of Anatomy and Human Embryology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
Are the
characteristics
of Neuropathic
Pain
24. What really happens ???
Brain Function in Fibromyalgia: Altered Pain Processing and Cognitive Dysfunction
Francisco Mercado1, Paloma Barjola1, Marisa Fernández-Sánchez1, Virginia Guerra1 and Francisco Gómez-Esquer2
[1] Department of Psychology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
[2] Department of Anatomy and Human Embryology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
Hyperalgesia / allodynia: Show a Central Sensitization Syndrome.
That means that the brain amplifies sensory information and/or pain
perception.
The “Brain factor” is more significant than “peripheral factor”
(inflammation??).
Nowadays, we believe that FM is accompanied by alterations in specific areas
of the brain.
This hypothesis is confirmed with fMRI findings.
Brain chemistry
fMRI
25. FM: chemical imbalance
• Low serotonin (deep sleep, anxiety, pain)
• Low NE (fatigue, pain)
• Low dopamine (cognitive, pleasure, increase sympathetic tone, libido)
• High SP, Glu (pain amplification)
• +/- Growth factors (nerve growth factors)
ALL OF THEM POSSES COMMUNICATING CHEMICALS
When any piece of that
system is disregulated
then, all the other
elements of the system
are disregulated at the
same time.
In order to treat: re-
regulate all of them.
27. Summary
• FMS is a neuro-biological entity.
• The Main characteristic is Pain and sensory amplification.
• There is Strong evidence of increased pro-nociceptive
neurotransmitters (glu, SP…) and decreased levels of anti-
nociceptive neurotransmitters (seroronin, NE …).
• It is Easy to diagnose, the diagnosis is history-based.
Three new concepts …
• FM patients are best managed in primary care setting.
• The ideal treatment has to be multimodal, drugs have only modest effect.
• Goals: Maintain function, control pain, remain in workforce.
Dr Ruth Dubin, 202-800 Princess St, Kingston, ON K7L 5E4;
e-mail rdubin@kingston.net
Can Fam Physician. Jul 2014; 60(7): 599–601.
Keep it simple
Easing the care burden of fibromyalgia
Ruth Dubin, MD PhD FCFP
29. Management
Modified from: R Jovey, Canadian Pain society 2009, R. Dubin, fibromyalgia: not as hard as it looks, 2013, Action Plan, Nova Scotia 2006.
30. Guide management
• There is No ideal treatment
• The approach is Symptom-based
• A combination of Non-pharmacological + pharmacological
strategies is required.
• Our goal is to maintain and improve functions of our patients
• Treat peripheral pain generators.
• Self-management is imperative
• Patient active participation
• Multimodal approach
• Realistic goals, coping strategies
• Pacing, but continue normal life
• Exercise
• Best available evidence
• Any type (aerobics, water, stretching, flexibility…)
• Movement is Key (Tai Chi, Qi Qong, Yoga, Pilates)
• CAM
• Insufficient evidence
• Symptoms oriented / acupuncture best of all
“The individual’s ability to manage
the symptoms, treatment, physical
and social consequences and lifestyle
changes inherent in living with a
chronic condition”. Barlow 2002
Active is better than passive
Keep wellness in the foreground
The patient is the expert
Patient takes responsibility for the program
Ruth E. Dubin, MD, PhD, FCFP., Karavis M. 2012
32. Non pharmacological
Therapies
Goldenberg DL et al, JAMA, 2004;292:2388-2395.
Williams DA et al, J Reumatol. 2002;29:1280-1286.
Busch AJ et al, Cochrane Database Syst Rev, 2007;(4):CD003786
33. What do we cure ???
Brain Function in Fibromyalgia: Altered Pain Processing and Cognitive Dysfunction
Francisco Mercado1, Paloma Barjola1, Marisa Fernández-Sánchez1, Virginia Guerra1 and Francisco Gómez-Esquer2
[1] Department of Psychology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
[2] Department of Anatomy and Human Embryology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
37. Basic Assumptions
Acupuncture stimulus is carried by
afferent peripheral nerves:
• The effect can be blocked by procaine.
• No Acupoints on somatosensory paralysis.
• No AP points on spinal cord injury.
• We observe profound AP effects from points
overlying major peripheral nerves.
• The 55% of the APs were located at the cluster
of the muscles.
38. Conclusions:
For Acupuncture points:
• Some acu-points are close to neuro-vascular bundles where the
nerves penetrate the body fascia (superficial nerves).
• Some of them are motor points (end-plate zone) (LI4, GB21)
• Some points where nerves bifurcate (GB 34, Per 4,6).
• Some points are associated with vascular elements and perivascular
plexuses (B 40, Lu 9).
• Some of them are in musle-tendon junction (B 57)
For acupuncture Meridians:
• Some of them have close relation with peripheral nerve pathways.
• Some of them have close relation with motor lines (mechanical
connection of the myofascial chains (lines) (ex 12 cutaneous regions
(Pi Bu) and the 12 muscle channels (Jing Jin).
40. Relation between nerves and acupuncture meridians.
We can observe the correlation between the above…
Neil R. Borley. Clinical Surface Anatomy. Manson publishing. 1997
41. Neil R. Borley. Clinical Surface Anatomy. Manson publishing. 1997
42. Neil R. Borley. Clinical Surface Anatomy. Manson publishing. 1997
43. Neil R. Borley. Clinical Surface Anatomy. Manson publishing. 1997
44. GB 20, B 10
LI 14, 15, SJ 14
LI 10, SJ 8, 9
SJ 5
SJ 5
LI 10, SJ 8, 9
SI 9, SJ 12, 13
SI, B
SI 3
SI, B
points
These muscle groups act as one muscle.
Photos from: Anatomy Trains, Thomas W. Myers, Churchill Livingstone, 1995.
Acupoints and meridians in relation to muscle
groups that have similar function.
46. We always look at the
patient’s symptoms.
Not at the name of the
disease.
TCM Acupuncture for
FMS patients
47. Diffuse - widespread pain
Musculoskeletal pain
Fatigue
Insomnia
Depression
Stiffness
Swelling
Main symptomes
of FMS
Wind
Humidity (phlegm)
Female / male = 7 / 1
Menstruation + labors =
Lowering Kidney energy=
Disequilibrium Kidney Yin - Yang =
Deficiency of Chi and blood =
Exopathic attack of wind and dump.
Wind = L 3, TW 5,6
Phlegm = SP 6,9, PER 4,6
Energy in blood = LI 4, 11, ST 36, RM 12
51. Any type of peripheral stimulation
(mechanical, thermal, chemical, injury,
touch …) is ultimately transformed into
nerve pulses that travel along the peripheral
nerves to the central neuroaxis.
Nerve signals generate electrical and
chemical events that are decoded by the
central nervous system according to the type,
frequency, duration and intensity of
stimulus.
Sensory – dependent neural plasticity
Casale R, Atzeni F, Sarzi-Puttini P, Neurophysiological background fro physical therapies in fibromyalgia,
Reumatismio, 4/2012, Department of Clinical Neurophysiology and Rehabilitation Unit.
Physical medicine / rehabilitation
52. Local (peripheral) pain = Physical therapies, acupuncture
Segmental pain = physical therapies (+/-) & acupuncture
Widespread somatic pain = exercise, pool, groups, acupuncture, drugs
Fibrofog = Systemic acupuncture points
Small fiber polyneuropathy = Anti-inflammatory acu points
55. Dermatome or
Myotome (segmental
Innervation of the …)
Acupuncture
points
Physiological
effect
Neck C4 - C7
Arm C5 - C8
Autonomic arm T1 - T3
Lumbar & leg L1 - S1
Kidneys - suprarenal
glands T11 - L1
ACTH, cortizole
Anti-inflammation
Vascularization
Analgesia
Analgesia
Analgesia
AnalgesiaLI 4, 10, TW 5, 15, GB 21, GV 14,
SI 13, 14, 15,
B 21-27, 44-47, GV 5,4,3, B 31
G 30, B 54, B 57, B 60, K 5,6,7
B 11, 12, 13, 36, 37, GV 14, 13
B 20, 21, 23, 44, 45, GV 6,7
RM 12
56. Pains in:
Cervical region
Upper Limb
Pains in:
Lumbar region
Lower Limb
Pains in:
Thoracic region
Abdominal pains
Zoster-like pain
Locations
of Segmental
Acu-points
Locations
of Systemic
Acu-points
57. GB 20, B 10
CV 5, 6
Phrenic n.
CV 22, 21, 19, 18
B 15 - 18 Esophagus
CV 17,16,15
K 22
B 15-18 Stomach
CV 11,10,9
B 18-20
Small intestine
CV 9,7,6
St 25
Sp 15
B 21-23
B 27-28
Large intestine
58. Large intestine
Th 6 – Th 5
S 1 – S 4
Esophagus
Th2 – Th 5-7
Active zones
Stomach
Th5 – Th 10-12
Small intestine
Th 5 – Th 12
Karavis M. MD, FICAE, Physiatrist, Athens 2014.
59.
60. Concha of the Ear is the only place
on the surface of the body where the
Vagus nerve can be easily stimulated
producing a broad parasympathetic
effect (Ulett et al 1998, 2002)
Anti-inflammatory regions
of the ear and mastoid
process.
Vagus
innervation
Karavis M. MD, FICAE,
Physiatrist, Athens 2012.
61. Relationship of Vagus with Ansa Cervicalis: C1 – C3
Karavis M. MD, FICAE, Physiatrist, Athens 2012.
62. Greater and lesser
Splachnic nerves
and
Right vagus nerve
Coeliac ganglion
L1
Mastoid process (ΟΚ 10, ΧΚ 12, 20, ΤΘ 17)
Shu – Mu of the Spleen, Liver, adrenal T5 – T12
OK 18, OK 20, OK 23 and CV 12, CV 6, CV 3
Celiac plexus
(or coeliac or Solar)
Karavis M. MD, FICAE, Physiatrist, Athens 2014.
Immune system
Stress response system
Hormones
Psychosomatic disorders
63. Celiac plexus area= T5-T12
Celiac ganglia – L1
(just below the 12th rib)
Anti-inflammatory areas
According to segmental innervation
B 18
B 20
B 23
CV 15
CV 12
CV 6
65. Specific effect in cerebral hemodynamics
Acupoint-brain correlation (for fibrofog)
Acupuncture points
traditionally implicated
for visual functions were
shown to modulate the
blood flow velocity of the
corresponding cerebral
arteries (Hegu, Zusanli,
Kunlun, Zhiyin).
66. Neuropetides & hormones
related with :
Pain
Emotions
Behavior
Endocrine function
Immune response
All vegetative reactions
Psycho-neuro-endocrino-immunology
The science of chemical communication between
Body (nervous, endocrine, immune system) and
Mind.
67. Per 6
TW 5
SI 3
LI 4, 10, 11
ST 36, 39, 40
SP 6, 9
L 3
K 6
GB 34, 39
Experimental data:
Modulation of pain,
emotional state and
psychic state.
Systemic action
Pain: Acupuncture points
Upper limb
Lower limb
70. Depression: some more ideas…
H 7
Per 7
Lu 9
Per 6
H 7
Per 7
Lu 9
Per 6
Points to improve deep sleep
Median nerve stimulation.
Also for fibrofog (increase NO)