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.
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.
Pain is one of the most troubling and hard-to-manage symptoms of ME/CFS and FM. Dr. Bateman teaches about the various types of pain, how pain is amplified, and treatment strategies to improve your own pain management.
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.
This document discusses sleep disturbances in ME/CFS and fibromyalgia. It notes that sleep issues are included in the diagnostic criteria for both conditions and are present in over 90% of patients. Unrefreshing sleep is the most commonly reported symptom. Polysomnography can show increased light sleep and fragmentation, though results may be affected by sleep study conditions. Primary sleep disorders should be ruled out. Monitoring devices like FitBit and Oura Ring can help patients track sleep quality and disruptions at home. Lifestyle changes, relaxation techniques, and medications are recommended to achieve more restorative sleep.
OI, Postural Orthostatic Tachycardia Syndrome (POTS), neurally mediated hypotension (NMH), and orthostatic hypotension can all be manifestations of ME/CFS and FM. In this class you will learn to access orthostatic intolerance objectively, how to differentiate between these syndromes and strategies to manage the symptoms they present.
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.
Activity intolerance and PEM are often misunderstood aspects of ME/CFS and FM. Learn why physical and cognitive activities can cause symptoms to worsen and how to identify and improve the “threshold” of relapse. Review the importance of pacing and realistic expectation setting that can minimize and even improve symptoms.
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.
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.
1. Diabetic peripheral neuropathy (DPN) is damage to nerves caused by high blood sugar levels from diabetes, resulting in pain symptoms.
2. DPN is diagnosed clinically based on symptoms of numbness, tingling, and pain in a glove/stocking distribution, especially in the feet. Sensory testing and nerve conduction studies can support the diagnosis.
3. Screening tools that incorporate both patient interviews about sensory symptoms and physical exams of nerve function have high sensitivity and specificity for diagnosing neuropathic pain compared to tools relying only on interviews.
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
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.
Pain is one of the most troubling and hard-to-manage symptoms of ME/CFS and FM. Dr. Bateman teaches about the various types of pain, how pain is amplified, and treatment strategies to improve your own pain management.
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.
This document discusses sleep disturbances in ME/CFS and fibromyalgia. It notes that sleep issues are included in the diagnostic criteria for both conditions and are present in over 90% of patients. Unrefreshing sleep is the most commonly reported symptom. Polysomnography can show increased light sleep and fragmentation, though results may be affected by sleep study conditions. Primary sleep disorders should be ruled out. Monitoring devices like FitBit and Oura Ring can help patients track sleep quality and disruptions at home. Lifestyle changes, relaxation techniques, and medications are recommended to achieve more restorative sleep.
OI, Postural Orthostatic Tachycardia Syndrome (POTS), neurally mediated hypotension (NMH), and orthostatic hypotension can all be manifestations of ME/CFS and FM. In this class you will learn to access orthostatic intolerance objectively, how to differentiate between these syndromes and strategies to manage the symptoms they present.
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.
Activity intolerance and PEM are often misunderstood aspects of ME/CFS and FM. Learn why physical and cognitive activities can cause symptoms to worsen and how to identify and improve the “threshold” of relapse. Review the importance of pacing and realistic expectation setting that can minimize and even improve symptoms.
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.
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.
1. Diabetic peripheral neuropathy (DPN) is damage to nerves caused by high blood sugar levels from diabetes, resulting in pain symptoms.
2. DPN is diagnosed clinically based on symptoms of numbness, tingling, and pain in a glove/stocking distribution, especially in the feet. Sensory testing and nerve conduction studies can support the diagnosis.
3. Screening tools that incorporate both patient interviews about sensory symptoms and physical exams of nerve function have high sensitivity and specificity for diagnosing neuropathic pain compared to tools relying only on interviews.
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
Neuropathic pain:
- Affects 1-8% of the general population, but is more common in specific groups like those with diabetes, HIV, or spinal cord injuries.
- Has a significant negative impact on quality of life, mobility, employment, and mental health for those affected.
- Places a large burden on healthcare systems and society. The prevalence of neuropathic pain is expected to rise due to increasing rates of conditions like diabetes mellitus.
This document discusses the management of diabetic peripheral neuropathic pain. It begins by outlining the size and costs of the problem, noting that diabetic neuropathy affects approximately 30% of diabetes patients. It then covers the pathophysiology of diabetic neuropathy, including factors like high blood glucose and impaired nerve repair mechanisms. Risk factors discussed include glucose control, diabetes duration, age, and lifestyle factors. The document outlines the classification, presentations, diagnosis and screening recommendations for diabetic neuropathy. It discusses the pathophysiology of neuropathic pain in more depth. Prevention strategies focus on glucose control while treatment recommendations are provided for pharmacological management of neuropathic pain symptoms.
This document discusses the use of antidepressants to treat neuropathic pain. It begins with background on depression and types of pain, focusing on neuropathic pain. Neuropathic pain results from nerve damage and is described as burning or shocking. The document then discusses the link between depression and pain, and the use of tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) to treat pain. TCAs like amitriptyline are effective for some neuropathic pain cases by inhibiting norepinephrine reuptake. SNRIs like duloxetine and venlafaxine may also help by increasing norepinephrine and serotonin levels in the descending pain pathway. The pharmacology, dos
This document discusses neuropathic pain, including its classification, signs and symptoms, diagnosis, and management. Some key points:
- Neuropathic pain arises from lesions or diseases affecting the somatosensory system and is often chronic in nature. Common causes include low back pain, diabetes, herpes zoster infections, and postsurgical pain.
- Both nociceptive and neuropathic pain components may co-exist in conditions like low back pain. Neuropathic pain is often described as burning, electric shock-like, or tingling and may occur in areas distant from the site of injury.
- Diagnosis involves listening to the patient's descriptions of their pain, locating areas of abnormal sensation, and looking for signs
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.
- Neuropathic pain is caused by damage or disease affecting the somatosensory nervous system and is difficult to diagnose due to its subjective nature. It can be central (originating from the central nervous system) or peripheral (originating from the peripheral nervous system) in nature.
- Pathophysiological mechanisms involve hyperactivity of nociceptors leading to secondary changes in neurons processing somatosensory information. Diagnosis involves detailed history, neurological exam, and assessment tools to identify neuropathic features.
- Treatment includes pharmacological interventions like antidepressants, anticonvulsants, opioids, and topical agents as well as physical therapy modalities like exercise, stretching, strengthening, hydrotherapy, graded motor imagery,
Neuropathic Pain
Causes, Mechanisms and Treatment of Neuropathic Pain
Presented At Primed, QE2 Conference Centre, Westminster, London to National Audience of Primary Care Doctors
5th November 2009
Firmly palpates each of the 18 tender points with the thumb or finger, pressing into the muscle/fascia approximately 4 kg of pressure.
Patient: Rates pain on a scale of 0-3:
0 = No pain
1 = Mild pain (patient states "that's tender")
2 = Moderate pain (patient grimaces or withdraws)
3 = Severe pain (patient cries out)
*11/18 tender points must be rated 2/3 for diagnosis of FM per ACR criteria
Adapted from: Wolfe F, et al. Arthritis Rheum. 1990;33:160-172. 20
Diagnostic Criteria for FM
This document discusses neuropathic pain and its treatment. It begins by defining pain and describing the differences between nociceptive and neuropathic pain. Neuropathic pain arises from abnormal neural activity secondary to disease, injury, or dysfunction of the nervous system. The document then discusses the pathogenesis and physiology of pain perception. It provides examples of conditions that can cause central or peripheral neuropathic pain such as diabetes, shingles, spinal cord injury and stroke. The document reviews potential treatment options for neuropathic pain which include medications, physical therapies, and surgery. It provides details on several pharmacological treatments for neuropathic pain including capsaicin, lidocaine, various antidepressants, anticonvulsants, gabapentin, pregabalin, tramadol
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.
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
Multiple Sclerosis and Sleep - A Different PerspectiveMS Trust
Neil Stanley is an independent sleep expert with over 37 years of experience in sleep research. He has worked at several research institutions and hospitals and is a member of several sleep societies. Sleep disorders in people with conditions like multiple sclerosis often remain underreported, underdiagnosed, and undertreated. A recent study found that 74% of MS patients studied had sleep disorders. Sleep plays an important role in the immune system, endocrine system, and brain function. Multiple sclerosis can cause or exacerbate existing sleep problems like insomnia, sleep apnea, and restless legs syndrome. Effective treatment of sleep disorders and underlying MS symptoms is important for managing pain, fatigue, mood, and daytime sleepiness in patients.
The document discusses diabetic peripheral neuropathy (DPN), including its prevalence, impact, signs and symptoms, and strategies for management. DPN is nerve damage caused by diabetes that affects around 50-90% of patients. It can lead to foot ulcers and amputations, as well as other complications. DPN produces both positive symptoms like pain and negative symptoms like numbness. Disease modifying strategies aim to slow progression while symptomatic strategies target pain and other sensations. Diagnostic tests are needed to detect and monitor DPN.
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)
Neuropathic pain is caused by damage or disease of the somatosensory nervous system. It is estimated to affect around 9% of the general population. Neuropathic pain has a significant burden and can reduce quality of life more than death for some patients. Conditions associated with nerve damage, such as diabetes and HIV, are increasing globally. While first-line treatments for neuropathic pain like antidepressants and anticonvulsants can provide some relief, their effects are limited. More research and access to existing treatments is still needed to help manage this challenging problem.
This document provides information on diabetic neuropathy including:
1. It defines diabetic neuropathy as the presence of peripheral nerve dysfunction symptoms and/or signs in people with diabetes after excluding other causes.
2. It lists risk factors for developing diabetic neuropathy such as poor glycemic control, alcohol use, hypertension, smoking, and longer duration of diabetes.
3. It describes the pathogenesis of diabetic neuropathy including increased aldose reductase activity and non-enzymatic glycation of proteins.
The document discusses neuropathic pain, defining it and differentiating it from other types of pain. It provides statistics on the prevalence of acute and chronic pain. Neuropathic pain is very common, affects 1 in 7 people in the UK, and has both acute and chronic time courses. It has a massive socioeconomic impact. Treatment involves multiple modalities including pharmacological, physical, and psychological approaches.
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.
Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and tender points. The pathogenesis involves central sensitization leading to amplification of pain signaling and processing in the central nervous system. It is diagnosed based on chronic widespread pain for at least 3 months and tenderness in at least 11 of 18 tender point sites. Management includes non-pharmacological approaches like exercise, cognitive behavioral therapy, and education, as well as medications to reduce pain and improve sleep, mood, and function.
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 is a chronic disease characterized by widespread pain, fatigue, and sleep disturbances. It is thought to involve central nervous system changes that lead to amplified pain response and central sensitization. The prevalence is estimated to be 2-5% of the general population, affecting mostly women aged 35-50. Etiology may include genetic and environmental factors. The 2010 diagnostic criteria from the American College of Rheumatology do not require tender point examination. Treatment involves non-pharmacological therapies like exercise and cognitive behavioral therapy as well as medications like duloxetine, pregabalin, and amitriptyline to help alleviate pain and improve function.
Neuropathic pain:
- Affects 1-8% of the general population, but is more common in specific groups like those with diabetes, HIV, or spinal cord injuries.
- Has a significant negative impact on quality of life, mobility, employment, and mental health for those affected.
- Places a large burden on healthcare systems and society. The prevalence of neuropathic pain is expected to rise due to increasing rates of conditions like diabetes mellitus.
This document discusses the management of diabetic peripheral neuropathic pain. It begins by outlining the size and costs of the problem, noting that diabetic neuropathy affects approximately 30% of diabetes patients. It then covers the pathophysiology of diabetic neuropathy, including factors like high blood glucose and impaired nerve repair mechanisms. Risk factors discussed include glucose control, diabetes duration, age, and lifestyle factors. The document outlines the classification, presentations, diagnosis and screening recommendations for diabetic neuropathy. It discusses the pathophysiology of neuropathic pain in more depth. Prevention strategies focus on glucose control while treatment recommendations are provided for pharmacological management of neuropathic pain symptoms.
This document discusses the use of antidepressants to treat neuropathic pain. It begins with background on depression and types of pain, focusing on neuropathic pain. Neuropathic pain results from nerve damage and is described as burning or shocking. The document then discusses the link between depression and pain, and the use of tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) to treat pain. TCAs like amitriptyline are effective for some neuropathic pain cases by inhibiting norepinephrine reuptake. SNRIs like duloxetine and venlafaxine may also help by increasing norepinephrine and serotonin levels in the descending pain pathway. The pharmacology, dos
This document discusses neuropathic pain, including its classification, signs and symptoms, diagnosis, and management. Some key points:
- Neuropathic pain arises from lesions or diseases affecting the somatosensory system and is often chronic in nature. Common causes include low back pain, diabetes, herpes zoster infections, and postsurgical pain.
- Both nociceptive and neuropathic pain components may co-exist in conditions like low back pain. Neuropathic pain is often described as burning, electric shock-like, or tingling and may occur in areas distant from the site of injury.
- Diagnosis involves listening to the patient's descriptions of their pain, locating areas of abnormal sensation, and looking for signs
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.
- Neuropathic pain is caused by damage or disease affecting the somatosensory nervous system and is difficult to diagnose due to its subjective nature. It can be central (originating from the central nervous system) or peripheral (originating from the peripheral nervous system) in nature.
- Pathophysiological mechanisms involve hyperactivity of nociceptors leading to secondary changes in neurons processing somatosensory information. Diagnosis involves detailed history, neurological exam, and assessment tools to identify neuropathic features.
- Treatment includes pharmacological interventions like antidepressants, anticonvulsants, opioids, and topical agents as well as physical therapy modalities like exercise, stretching, strengthening, hydrotherapy, graded motor imagery,
Neuropathic Pain
Causes, Mechanisms and Treatment of Neuropathic Pain
Presented At Primed, QE2 Conference Centre, Westminster, London to National Audience of Primary Care Doctors
5th November 2009
Firmly palpates each of the 18 tender points with the thumb or finger, pressing into the muscle/fascia approximately 4 kg of pressure.
Patient: Rates pain on a scale of 0-3:
0 = No pain
1 = Mild pain (patient states "that's tender")
2 = Moderate pain (patient grimaces or withdraws)
3 = Severe pain (patient cries out)
*11/18 tender points must be rated 2/3 for diagnosis of FM per ACR criteria
Adapted from: Wolfe F, et al. Arthritis Rheum. 1990;33:160-172. 20
Diagnostic Criteria for FM
This document discusses neuropathic pain and its treatment. It begins by defining pain and describing the differences between nociceptive and neuropathic pain. Neuropathic pain arises from abnormal neural activity secondary to disease, injury, or dysfunction of the nervous system. The document then discusses the pathogenesis and physiology of pain perception. It provides examples of conditions that can cause central or peripheral neuropathic pain such as diabetes, shingles, spinal cord injury and stroke. The document reviews potential treatment options for neuropathic pain which include medications, physical therapies, and surgery. It provides details on several pharmacological treatments for neuropathic pain including capsaicin, lidocaine, various antidepressants, anticonvulsants, gabapentin, pregabalin, tramadol
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.
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
Multiple Sclerosis and Sleep - A Different PerspectiveMS Trust
Neil Stanley is an independent sleep expert with over 37 years of experience in sleep research. He has worked at several research institutions and hospitals and is a member of several sleep societies. Sleep disorders in people with conditions like multiple sclerosis often remain underreported, underdiagnosed, and undertreated. A recent study found that 74% of MS patients studied had sleep disorders. Sleep plays an important role in the immune system, endocrine system, and brain function. Multiple sclerosis can cause or exacerbate existing sleep problems like insomnia, sleep apnea, and restless legs syndrome. Effective treatment of sleep disorders and underlying MS symptoms is important for managing pain, fatigue, mood, and daytime sleepiness in patients.
The document discusses diabetic peripheral neuropathy (DPN), including its prevalence, impact, signs and symptoms, and strategies for management. DPN is nerve damage caused by diabetes that affects around 50-90% of patients. It can lead to foot ulcers and amputations, as well as other complications. DPN produces both positive symptoms like pain and negative symptoms like numbness. Disease modifying strategies aim to slow progression while symptomatic strategies target pain and other sensations. Diagnostic tests are needed to detect and monitor DPN.
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)
Neuropathic pain is caused by damage or disease of the somatosensory nervous system. It is estimated to affect around 9% of the general population. Neuropathic pain has a significant burden and can reduce quality of life more than death for some patients. Conditions associated with nerve damage, such as diabetes and HIV, are increasing globally. While first-line treatments for neuropathic pain like antidepressants and anticonvulsants can provide some relief, their effects are limited. More research and access to existing treatments is still needed to help manage this challenging problem.
This document provides information on diabetic neuropathy including:
1. It defines diabetic neuropathy as the presence of peripheral nerve dysfunction symptoms and/or signs in people with diabetes after excluding other causes.
2. It lists risk factors for developing diabetic neuropathy such as poor glycemic control, alcohol use, hypertension, smoking, and longer duration of diabetes.
3. It describes the pathogenesis of diabetic neuropathy including increased aldose reductase activity and non-enzymatic glycation of proteins.
The document discusses neuropathic pain, defining it and differentiating it from other types of pain. It provides statistics on the prevalence of acute and chronic pain. Neuropathic pain is very common, affects 1 in 7 people in the UK, and has both acute and chronic time courses. It has a massive socioeconomic impact. Treatment involves multiple modalities including pharmacological, physical, and psychological approaches.
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.
Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and tender points. The pathogenesis involves central sensitization leading to amplification of pain signaling and processing in the central nervous system. It is diagnosed based on chronic widespread pain for at least 3 months and tenderness in at least 11 of 18 tender point sites. Management includes non-pharmacological approaches like exercise, cognitive behavioral therapy, and education, as well as medications to reduce pain and improve sleep, mood, and function.
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 is a chronic disease characterized by widespread pain, fatigue, and sleep disturbances. It is thought to involve central nervous system changes that lead to amplified pain response and central sensitization. The prevalence is estimated to be 2-5% of the general population, affecting mostly women aged 35-50. Etiology may include genetic and environmental factors. The 2010 diagnostic criteria from the American College of Rheumatology do not require tender point examination. Treatment involves non-pharmacological therapies like exercise and cognitive behavioral therapy as well as medications like duloxetine, pregabalin, and amitriptyline to help alleviate pain and improve function.
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.
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
This article provides an overview of fibromyalgia, including its causes, incidence, pathophysiology, clinical presentation, and treatment approaches. Some key points:
- Fibromyalgia is a disorder characterized by chronic widespread muscle pain. Its cause is unknown but may involve genetic and neurological factors.
- It affects about 10 million Americans, predominantly women. Symptoms include muscle pain, fatigue, sleep issues, and cognitive difficulties.
- New research suggests abnormalities in central pain processing and immune system function may contribute to fibromyalgia.
- Treatment involves a multidisciplinary approach including medications, physical/occupational therapy, stress management, and addressing potential sensitivities.
This article provides an overview of fibromyalgia, including its causes, incidence, pathophysiology, clinical presentation, and treatment approaches. Some key points:
- Fibromyalgia is a disorder characterized by chronic widespread muscle pain. Its cause is unknown but may involve genetic and neurological factors.
- It affects about 10 million Americans, predominantly women. Symptoms include muscle pain, fatigue, sleep issues, and cognitive difficulties.
- New research suggests abnormalities in central pain processing, immune function, serotonin and catecholamine levels may be involved.
- Treatment involves a multidisciplinary approach including medications, cognitive behavioral therapy, exercise, and addressing potential sensitivities or imbalances.
This document summarizes information about fibromyalgia syndrome (FMS), including its classification, symptoms, pathogenesis, diagnosis, and treatment. FMS is characterized by widespread pain, joint stiffness, and other symptoms like fatigue, sleep issues, and mood disorders. It affects 2-8% of the population. The cause is unclear but may involve central and peripheral nervous system sensitization. Diagnosis involves evaluating symptoms and tender points while ruling out other conditions. Treatments aim to reduce pain and improve sleep, mood, and function, and may include medications like duloxetine, milnacipran, and gabapentin.
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.
- 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.
This document discusses chronic musculoskeletal pain conditions, including fibromyalgia, low back pain, and headaches, which are now considered central sensitivity spectrum disorders. Brain imaging shows these conditions involve central pain processing regions rather than just peripheral regions. A phenotype for central sensitivity includes widespread pain, family history of chronic pain, high self-reported pain/distress, and sensitivity to other stimuli. Treatments target central mechanisms like CBT and medications rather than just peripheral mechanisms. The case study involves a patient meeting criteria for central sensitivity disorders based on her history and assessments. Recommendations focus on managing her condition as a central sensitivity disorder rather than just her hand pain.
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.
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.
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.
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.
Steven Smith presents a continuing education lecture on fibromyalgia syndrome (FMS) for nurses and nurse practitioners. He begins by providing his conflict of interest statement, then asks a series of questions about what FMS is and whether it is a musculoskeletal, mental, or inflammatory condition. He explains that FMS is thought to be an illness of the central nervous system, specifically the neuroendocrine system. Smith discusses central sensitization syndrome and concepts like wind-up phenomenon and neurotransmitters involved in ascending and descending pain pathways. He emphasizes the importance of understanding the pathophysiology of FMS in order to properly treat it. Smith stresses that FMS is diagnosed through a thorough history and physical exam to rule out other conditions. He provides examples of
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.
Similar to BHC Getting the Right Diagnosis 2018 (20)
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
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Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
7. FIBROMYALGIA IS NOT PRIMARILY A MUSCULOSKELETAL DISORDER
FM is a nervous
system disorder that
creates
musculoskeletal pain,
along with global
pain amplification,
physical and mental
fatigue.
FM might be
considered a
neuroimmune or
neuroinflammatory
condition in the
future.
FM
The exact cause(s) of
FM---still unclear.
7
8. Chronic widespread
amplified pain and other
sensory signals between
the body, the spinal cord
and the brain
(the central nervous system)
FIBROMYALGIA IS CHARACTERIZED BY:
Hyperalgesia---amplified pain.
Allodynia---the sensation of pain
from a milder stimulus, such as
touch or pressure.
8
9. Fibromyalgia Diagnostic Criteria (ACR* 1990)
Chronic (>3 months)
Widespread Pain (pain involving 4 quadrants of body & the spine)
Tenderness (>11/18 tender points)
PAIN amplification results in:
»stiffness, achiness, sharp shooting pains…
»muscles, joints, bowel, bladder, pelvis, chest, head…
»tingling and numbness…light and sound sensitivity…etc
FATIGUE, BRAIN FOG and SLEEP disturbances
are described in Wolfe et al but not required.
9
Wolfe F, et al. The *American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the
Multicenter Criteria Committee. Arthritis Rheum 1990;33:160–72.
Not just low back pain
10. FM is
a generalized pain condition
that involves
four quadrants of the body
and the spine
10
11. The 1990 ACR
FM Criteria also
require presence of
at least 11 of the 18
TENDER POINTS
(9 pairs)
12. USE CHARTS TO EXPLAIN YOUR IDEAS
2% of
all
adults
12
3-4% of
adult
women
0.5-1% of
adult men
The prevalence and characteristics of fibromyalgia in the general
population. Arthritis Rheum. 1995 Jan;38(1):19-28. Wolfe F, et al.
13. Awareness of FM skyrocketed after use of gabapentin for pain
and subsequent FDA approval of 3 FM drugs
Neurontin/gabapentin-- 2004 (never FDA approved for FM) The pharmaceutical
company, Pfizer, was fined $430 million by the FDA for off-label marketing of the anti-seizure drug.
The unprecedented fine came after promotion for “unapproved uses” including migraines and chronic
pain (doctors discovered that gabapentin worked for “nervous system” pain!)
Lyrica/pregabalin-- 2007 (Pfizer)
Cymbalta/duloxetine– 2008 (Eli-Lilly)
Savella/milnacipran– 2009 (Forest/Cypress)
14. $ millions were spent
by 3 pharmaceutical companies
To educate the PUBLIC and PRIMARY CARE PROVIDERS
about FM from 2007-2012. FM became a household word.
14
15. Dr. Oz: July 23, 2013
The Disease Doctors Miss Most:
Fibromyalgia
15
16. $ millions were spent
by 3 pharmaceutical companies
16
1) Widespread Pain Index (WPI)
See diagram (0-19 points)
7+ or 3-6
2) Symptom Score (SS):
0=none, 1=mild, 2=mod, 3=severe
a. Chronic fatigue (0-3)
Unrefreshing sleep (0-3)
Cognitive complaints (0-3)
b. Multisystem complaints (0-3)
Max SS = 12 5+ and 9+
> 3 months in duration and without other explanation FM FM
Alternate “new” FM Diagnostic Criteria (ACR* 2010)
Wolf F, et al. The American College of Rheumatology* Preliminary Diagnostic Criteria for Fibromyalgia
and Measurement of Symptom Severity. Arthritis Care & Research. Vol. 62, No. 5, May 2010, pp 600–610
17. Alternate “new” FM Diagnostic Criteria
Part 1: WPI (widespread pain index) 19 pain areas pain17
18. $ millions were spent
by 3 pharmaceutical companies
18
1) Widespread Pain Index (WPI)
See diagram (0-19 points)
7+ or 3-6
2) Symptom Score (SS):
0=none, 1=mild, 2=mod, 3=severe
a. Chronic fatigue (0-3)
Unrefreshing sleep (0-3)
Cognitive complaints (0-3)
b. Multisystem complaints (0-3)
Max SS = 12 5+ and 9+
> 3 months in duration and without other explanation FM FM
Alternate “new” FM Diagnostic Criteria (ACR* 2010)
Wolf F, et al. The American College of Rheumatology* Preliminary Diagnostic Criteria for Fibromyalgia
and Measurement of Symptom Severity. Arthritis Care & Research. Vol. 62, No. 5, May 2010, pp 600–610
19. FM is an illness of
central sensitivity and sympathetic overdrive
Common Manifestations include:
»Migraine and tension headaches
»TMJ/TMD
»Paresthesia (numbness and tingling)
»Restless legs syndrome
»Irritable bowel syndrome, IBS-D, IBS-C
»Irritable bladder or interstitial cystitis
»Painful menstruation, pelvic pain, vulvodynia
»Heart palpitations, sinus tachycardia, orthostatic intolerance
»Sicca syndrome (dry eyes and mouth)
»Light, noise and chemical sensitivities
19
20. Who develops chronic widespread pain and why? 20
• Women > Men. Children.
• Susceptible individuals (genetic?)
• Sleep deprived or chronically sleep disturbed
• Emotionally stressed
• Physically depleted or overextended
• Physical insults:
hormonal changes
viral infections
inflammation and autoimmunity
physical trauma
exposures…
21. FM is more prevalent in people experiencing:
Mental health problems:
»Anxiety
»PTSD
»Bipolar disorder
»Depression
Medical conditions:
»Localized pain conditions
»Hormone deficiencies
»Nutritional deficiencies
»Sleep disorders
»Inflammatory and
autoimmune disorders
21
22. Examples of FM prevalence among various groups:
»General population à
»Women ---------------à
»Men--------------------à
»IM & Rheum clinics à
»IBS---------------------à
»Hemodialysis---------à
»Type 2 diabetes------à
»Behcet’s syndrome à
2%
4%
0.01%
15%
13%
6%
15%-23%
80%
22
Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis.
Heidari F1, Afshari M2, Moosazadeh M3. Rheumatol Int. 2017 Apr 26. doi: 10.1007/s00296-017-3725-2.
23. Research findings led to drug development to improve FM pain
»Functional MRI---activation of multiple areas of the brain
related to pain, and more areas than normal controls.
»Spinal fluid---elevated levels of Substance P and glutamate
(pain neurotransmitters)
»Sleep characterized by “alpha wave intrusion” (part of the
brain stays active or “awake”)
»Many FM patients have evidence of small fiber nerve damage
Pain. 2013 Nov;154(11):2310-6. doi: 10.1016/j.pain.2013.06.001. Epub 2013 Jun 5.
Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia.
Oaklander AL, Herzog ZD, Downs HM, Klein MM.
25. Common causes of SFN
damage: diabetes or glucose
intolerance, hypothyroidism,
autoimmune diseases like
Sjögren’s Syndrome or Lupus,
nutritional deficiencies, Celiac
disease, Lyme disease, HIV,
alcoholism and many others…
Small fiber nerves (C-fibers) are in the skin and peripheral nerves but
also regulate organs and the autonomic nervous system.
Pediatrics. 2013 Apr;131(4):e1091-100. doi: 10.1542/peds.2012-2597. Epub 2013 Mar 11.
Evidence of small-fiber polyneuropathy in unexplained, juvenile-onset, widespread pain
syndromes. Oaklander AL1, Klein MM.
26. Small nerve fiber injury may result in
pain and autonomic nervous system dysregulation
»Amplification of pain and other sensations (light, sound, temp)
»dry eyes, dry mouth
»postural lightheadedness (OI: orthostatic intolerance), fainting
»abnormal sweating
»erectile dysfunction
»nausea, vomiting, diarrhea, constipation, low appetite
»difficulty with urinary function, frequency, pain
27. Small fiber nerve damage may cause only subtle
physical exam or diagnostic findings.
»Coordination, motor, and reflex examinations are normal.
»Light touch, vibratory sensation, and proprioception may be normal. Decreased
pinprick, decreased thermal (heat/cold) sensation, vibratory sensation, or
hyperalgesia are common.
»EMG and nerve conduction
may be normal
27
https://thinkingdr.files.wordpress.com/2010/04/ncv-test1.jpg
28. 28
Remember: local/regional pain syndromes are amplified by FM
»Osteoarthritis (OA)
»Cervical or lumbar disc disease
»TMJ/TMD
»Daily headache & migraine syndromes
»IBS, interstitial cystitis, endometriosis
»Carpel tunnel syndrome, bursitis, tendonitis,
plantar fasciitis, bone spurs…
»Peripheral neuropathy…
29. Making a diagnosis of
Myalgic Encephalomyelitis/
Chronic Fatigue Syndrome
ME/CFS
30. ME/CFS Historical Background
§ The term “Chronic Fatigue Syndrome” or “CFS” emerged in 1988* to replace
“Chronic Epstein Barr Virus”, or “Chronic EBV” and described a post-infection or post-
viral syndrome. [*CFS Holmes Criteria]
§ CFS is known by many other names (ME/CFS):
CFIDS- Chronic Fatigue Immune Dysfunction Syndrome
ME - Myalgic Encephalomyelitis
Post-Viral Fatigue or Post-Infectious Fatigue Syndrome
§ Not a new illness. World-wide and multicultural.
§ Myalgic Encephalomyelitis (ME) is the term used outside the U.S. to describe the more
severe form of CFS-like illness
*Holmes GP, et al. Chronic fatigue syndrome: a working case definition.
Ann Intern Med 1988;108:387-9.
31. » Clinically evaluated, unexplained, persistent or relapsing fatigue of at least 6 months
duration, that is of new or definite onset… and results in substantial reduction in previous
levels of activity, plus…
» The concurrent occurrence of at least 4 of the following 8 symptoms:
» post-exertional malaise-- post exertional pain
» impairment in short-term memory or concentration
» unrefreshing sleep
» muscle pain
» multi-joint pain
» headaches
» sore throat
» tender cervical or axillary lymph nodes.
1994 “Fukuda” CFS Criteria [or FM?]
*Fukuda et al, Annals of Internal Medicine, Vol. 121, December 15, 1994, pp. 953-959
32. CFS prevalence in the U.S.
CDC population-based epidemiology studies
1994 Fukuda criteria/ Wichita* or 2003 Revised Empiric Criteria/Georgia**
4 million CFS
2.5%**
Plus 7 million CFS-like
by **Georgia study
with revised criteria
2003.
*Archives of Internal Medicine 2003:163:1530-1536 **Population Health Metrics 2007;5:5.
1 million CFS
0.5%*
Plus 2 million CFS-like
by *Wichita study using
1994 Fukuda criteria
ME/CFS patients were not screened for FM criteria
33. 33
2003 “Canadian Consensus Criteria” for CFS/ME
1. Substantial reduction in activity level due to new onset, unexplained, persistent fatigue (at least 6 months in
duration)
2. Post exertional malaise (payback), delayed recovery (>24 hrs)
3. Sleep dysfunction (wide range). Unrefreshing or altered rhythm.
4. Pain – myalgia/arthralgia, headaches
5. Neurologic/Cognitive manifestations (concentration, short term memory, “sensory overload,”
disorientation/confusion, ataxia …)
6. Plus at least one symptom from two of the following:
»Autonomic manifestations e.g. orthostatic intolerance, POTS, IBS, vertigo, vasomotor instability, respiratory
irregularities… [ANS]
»Neuroendocrine manifestations e.g. temperature intolerance, weight or appetite changes, reactive
hypoglycemia, low stress tolerance…
»Immune manifestations e.g. tender lymph nodes, sore throat, flu-like symptoms, allergy symptoms,
hypersensitivities…
Carruthers BM et al. (2003). "Myalgic encephalomyalitis/chronic fatigue syndrome: Clinical working definition,
diagnostic and treatment protocols" (PDF). Journal of Chronic Fatigue Syndrome 11 (1): 7–36.
34. “Beyond ME/CFS: Redefining an Illness”
The Institute of Medicine* Report was published Feb 10, 2015 and
outlined new clinical diagnostic criteria for ME/CFS
www.nationalacademies.org/hmd/Reports/2015/ME-CFS.aspx
§ "Key Facts" (2 pages)
§ "MECFS Clinicians Guide" (20 pages)
§ The entire 300+ page report---(300+ pages)
The IOM* is now called the National Academy of Medicine.
35. 836,000 to 2.5 million people in the US meet criteria for ME/CFS
An estimated 84-91% not yet diagnosed (CDC 2003).
Patients struggle for years before getting a diagnosis
» 75% take >1 year to get diagnosed
» 30% took >5 years to get diagnosed
Doctors are often skeptical about the serious nature of the illness,
and have the misconception that it is a psychological illness
< 1/3 of medical schools include ME/CFS in the curriculum
<40% of medical textbooks include information on ME/CFS
IOM report pages 1-13
36. The purpose of IOM Report:
To improve clinical diagnosis and care for people
with ME/CFS.
•Common core symptoms of ME/CFS are based on research
•Focus is on illness manifestations that are objective.
•A simplified approach to increase ease of diagnosis
37. ME/CFS Clinical Diagnostic Criteria:
These CORE 4-5 criteria are required for diagnosis, must be moderate-severe, frequent in
occurrence (present >50% of time) and not otherwise explained by another condition.
1) Impaired function related to exhaustion/fatigue/fatigability (physical and cognitive)
2) PEM: post exertional malaise (illness relapse or worsening after activity)
3) Unrefreshing sleep
4) A. Cognitive impairment and/or
B. Orthostatic intolerance/autonomic dysfunction
Other common features of illness include:
---Pain: including significant overlap with FM as currently defined
---Immune or infection manifestations (allergy, inflammation, etc)
---Neuroendocrine dysregulation (brain regulation of hormones)
38. ME/CFS can be diagnosed definitively after 6 months
of supportive care and diagnostic investigations.
It is expected that a differential diagnosis, appropriate workup of symptoms and
treatment, including referral to specialists, will be directed by health care
providers.
All other identifiable illnesses should be diagnosed and treated
A working or provisional diagnosis of ME/CFS can be made earlier than 6 months.
Supportive care and management should be provided from the beginning.
39. Many infections are associated with a post-infection
fatigue syndrome… including Epstein Barr Virus (mono)
»Herpesviruses (EBV, CMV, HSV, VZV, HHV-6)
»Parvovirus B-19
»Enteroviruses (Coxsackie, Echo, Poliovirus)
»Flaviviruses (tick/mosquito---WNV, dengue)
»Giardia lamblia
»Mycoplasma and Chlamydia
»Lyme disease (Borrelia sp)
But no smoking gun…
40. New Research Breakthroughs ongoing…
»Metabolomics--- low cellular energy production
»Microbiome--- altered gut flora and immune impact
»Inflammation--- abnormal cytokine patterns, auto-
antibodies, immune cell dysfunction (NK cells)
»Genetics--- familial risk, mutations
40
41. FM ME/CFS
Symptoms respond to lifestyle
interventions and medications:
§ PEM mild-moderate and manageable
§ Pain & tenderness--- responds to many
treatments
§ Sleep—manageable with effort
§ Mental Health– linked to symptoms
§ Fatigue—tracks closely with pain
Low impact exercise helps all aspects if
pain is considered and managed.
*HUA: 10-12 hr/24 hours
Symptoms more difficult to treat and
medications are often poorly tolerated.
§ PEM severe and prolonged
§ Fatigue and cognition
§ Sleep– difficult to treat
§ OI
§ Pain– PEM and can be severe
The key to management is reduced activity
and “pacing”. Exercise can easily worsen
all aspects of illness and cause extended
relapse.
HUA: 2-8 hr/24 hour
*HUA= Hours of Upright Activity