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.
How well is the US government addressing the needs of military personnelEMDRHAP Yusupova
How well is the US government addressing the needs of military personnel and veterans with combat PTSD? View and download this extensive overview by CDR Mark Russell USN, a leading authority, as presented at 2008 EMDRIA Conference.
Have you ever had one of those extreme headaches that ruthlessly affect your quality of work? If you are suffering from chronic widespread pain and sharp painful response to pressure, known as allodynia in medical terms, then you might be experiencing Fibromyalgia.
How well is the US government addressing the needs of military personnelEMDRHAP Yusupova
How well is the US government addressing the needs of military personnel and veterans with combat PTSD? View and download this extensive overview by CDR Mark Russell USN, a leading authority, as presented at 2008 EMDRIA Conference.
Have you ever had one of those extreme headaches that ruthlessly affect your quality of work? If you are suffering from chronic widespread pain and sharp painful response to pressure, known as allodynia in medical terms, then you might be experiencing Fibromyalgia.
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)
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.
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 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 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)
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.
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 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
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.
Peripheral neuropathy is a common condition, encountered by physicians as well as neurologists. However, a large number of challenges remain. These include difficulty in diagnosing, delay in diagnosis, investigations and lack of effective treatments. This presentation discusses these unmet needs and provides suggestions to overcome them.
Maladaptive movement and motor control impairments as underlying mechanismMeziat
Artigo (5) importante para a preparação para o curso de dor lombar crônica. "Diagnóstico e classificação da dor lombar crônica: Disfunções de movimento e de controle mal adaptativas como mecanismo principal." É antigo, algumas coisas mudaram, mas vale à pena ler.
Brief Report: OSA Evaluations for the Anaesthesiologist, Surgeon, Surgery Centresemualkaira
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This chapter describes the normal psychological response to pain, over time. The stages mimic the psucholoigcal response described by Kubler-Ross in her book on death and dying. Hendler documents that it is normal to get depressed from chronic pain, usually by the 6th month, and this depression can last 3-8 years.
Fibromyalgia can be resolved by medical herbalismmorwenna2
A recent public awareness survey by the National Fibromyalgia Association illustrates a significant lack of understanding about Fibromyalgia: nearly half of the general public (45%) has never heard of Fibromyalgia, many people who are knowledgeable about the disorder incorrectly believe that nothing can be done to manage it, and nearly half (48%) of all healthcare providers are reluctant to diagnose a patient with the condition (National Fibromyalgia Association, 2007).
ALKAMAGIC PLAN 1350.pdf plan based of door to door delivery of alkaline water...rowala30
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We are one of the top Massage Spa Ajman Our highly skilled, experienced, and certified massage therapists from different corners of the world are committed to serving you with a soothing and relaxing experience. Luxuriate yourself at our spas in Sharjah and Ajman, which are indeed enriched with an ambiance of relaxation and tranquility. We could confidently claim that we are one of the most affordable Spa Ajman and Sharjah as well, where you can book the massage session of your choice for just 99 AED at any time as we are open 24 hours a day, 7 days a week.
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Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
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Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
3. Table of Contents
1. Early Pain Models
2. Modern Pain Models
3. FMS, LBP, HA as Central
Sensitivity Spectrum Disorders
4. Neuroanatomy of Central
Sensitivity Spectrum Disorders
5. Diagnosing Central
Sensitivity Spectrum Disorders
4. 1980 Model of MSK Pain
Nociceptive Neuropathic
Primarily due to inflammation or
mechanical damage in periphery.
Damage or entrapment of peripheral
nerves.
NSAID, Opioid Responsive
Responds to both peripheral and
central pharmacological therapy.
Responds to procedures. Does not respond to procedures.
Behavioral factors minor Behavioral factors minor
Examples: Osteoarthritis, Rheumatoid
Arthritis, Cancer Pain
Examples: Diabetic neuropathy, post-
herpetic neuralgia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829161/
6. 1990 Model of MSK Pain
Nociceptive Neuropathic Central
Primarily due to
inflammation or
mechanical damage in
periphery.
Damage or entrapment of
peripheral nerves.
Primarily due to a central
disturbance in pain
processing.
NSAID, Opioid
Responsive
Responds to both
peripheral and central
pharmacological therapy.
Tricyclic Compounds.
Opioid effectiveness
questioned
Responds to procedures
Does not respond to
procedures
Does not respond to
procedures
Behavioral factors minor. Behavioral factors minor.
Behavioral factors more
prominent.
Examples: Osteoarthritis,
Rheumatoid Arthritis,
Cancer Pain
Examples: Diabetic
neuropathy, Post-herpetic
neuralgia.
Examples: FMS, IBS,
Tension HA, idiopathic
LBP
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829161/
7. Variation in Opioid Rx’ing
For FMS 2007-2009
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346177/
Mean Age = 44.7
8. High Dose CNP Patients
Often Those With FMS
http://www.ncbi.nlm.nih.gov/pubmed/24310048
Mean Age = 44.7
Mean Age = 49
9. Opioids & FMS: Once
Started Seldom Stopped
http://www.ncbi.nlm.nih.gov/pubmed/26443495
Average Age = 47
N = 96K Pt’s with FMS 59% Received Opioids
10. 0
12500
25000
37500
50000
1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 2013
US Opioid Overdose Deaths 1980-2014
Wolfe/ACR FMS
1990
IOM 100M in Pain
2011
http://www.cdc.gov/nchs/data/databriefs/db81_tables.pdf#1
http://www.cdc.gov/nchs/data/health_policy/AADR_drug_poisoning_involving_OA_Heroin_US_2000-2014.pdf
Peak Incidence of Prescription ODD Age 45-54*
*http://www.cdc.gov/drugoverdose/data/overdose.html
FDA Approves OxyContin
1995
11. ‘Fibromyalgianess’&
Comorbid Pain Syndromes
Fibromyalgia exists on a continuum
“What the results of our study showed is that we provided reasonably
good evidence that fibromyalgia exists as a continuum rather than a
dichotomous diagnosis.”
Wolfe
Fibromyalgia co-occurs with many pain syndromes
“Data in recent years suggest that FMS is a part of a spectrum of
syndromes…”
Yunus
12. Prevalence of cLBP & HA
In FMS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829161/
2007 Internet Survey of 2,596 people with fibromyalgia.
Average Age = 47
Actual co-occurance 33%.
If due to chance alone
co-occurance of cLBP, cHA, &
FMS expected 0.1%
13. Prevalence of Migraine
In FMS Pt’s 56%
http://www.ncbi.nlm.nih.gov/pubmed/25994041
If due to chance alone .2 x .02 = .4%
Average age 56
14. Prevalence of FMS
In cLBP Pt’s 42%
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345120/
Average Age 47
If due to chance alone .3 x .02 = .6%
15. Prevalence of FMS
In Tension HA Pt’s 36%
http://www.ncbi.nlm.nih.gov/pubmed/19170692
Average Age 46
If due to chance alone .2 x .02 = .4%
16. HA & cLBP As Predictors of
FMS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715288/
Mean Age 28
17. Co-Morbid Pain in FMS is
the Norm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829161/
FMS
[M79.7]
cHA
[G44.201]
cLBP
[M54.5]
19. Co-Morbid Pain in FMS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829161/
“Overwhelming evidence reveals that what is
often labeled as a single chronic regional pain
syndrome is, upon closer evaluation, a chronic
illness beginning much earlier in life, where the
pain merely occurs at different points of the body
at different points in time and is given different
labels by subspecialists focusing on “their region”
of the body.”
Daniel Clauw, MD
32. fMRI and Central Pain
2013
http://www.ncbi.nlm.nih.gov/pubmed/23983029
Pain chronification shifts brain representation from
nociceptive to emotional circuits.
Average Age 49Average Age 42
33. fMRI and Central Pain
2013
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691100/
Dorsal Anterior Cingulate
Limbic System
34. Nucleus Accumbens
The Reward Center
http://www.nejm.org/doi/full/10.1056/NEJMra1508490
Heroin is pharmacologically similar to
prescription opioids. All these drugs produce
their action through endogenous opioid systems
that regulate a wide range of functions through
three major types of G-protein–coupled
receptors: mu, delta, and kappa, with
particularly potent agonist activity at the mu
receptor and weak activity at the delta and
kappa receptors. Mu-receptor activation by an
agonist such as heroin or a prescription opioid
triggers a complex cascade of intracellular
signaling events, which ultimately lead to an
increase in dopamine release in the shell of the
nucleus accumbens. The resulting burst of
dopamine in this critical area of the reward
circuitry becomes strongly coupled with the
subjective “high” that is caused by drugs of
abuse.
39. CSS Diagnostic
Components
http://www.ncbi.nlm.nih.gov/pubmed/26266995
1. Pain in many body regions.
2. Higher current and lifetime history of chronic pain in several
body regions.
3. Multiple somatic symptoms (e.g., fatigue, memory difficulties,
sleep problems, mood disturbance)
4. More sensitive to other sensory stimuli (e.g., bright light, loud noises,
odors, other sensations in internal organs)
5. 1.5 to 2x more common in women.
6. Strong family history of chronic pain.
7. High self-reported pain & distress (VAS/NPS/PSD/PCS)
8. Pain triggered or exacerbated by stressors.
9. Peak prevalence of FMS age 50-59 (working-age).*
10. Essentially normal physical examination +/- diffuse tenderness.
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575027/
45. Validated Instruments to
Detect Distress/CSS
“You cannot guess at the extent of fatigue,
unrefreshed sleep, cognitive problems,
multiplicity of symptoms, and extent of pain
without a detailed interview.”
Frederick Wolfe
http://www.ncbi.nlm.nih.gov/pubmed/20461781
46. Validated Instruments to
Detect Distress/CSS
1. Pain Catastrophizing Scale (PCS)
2. Fibromyalgia Survey Questionnaire (FMSQ/PSD)
3. Patient Health Questionnaire 15
4. McGill Pain Questionnaire (Sensory/Affective)
5. Modified Somatic Perceptions Questionnaire
6. Central Sensitivity Index
Measures of “Fibromyalgianess”
51. Natural Hx of FMS
https://www.researchgate.net/profile/Winfried_Haeuser/publication/
51498368_The_longitudinal_outcome_of_fibromyalgia_a_study_of_1555_patients/links/0fcfd505a26be3b078000000.pdf
Average Age = 53
57. Sample Case
Mrs. C: 50y/o WF with chronic
Lt thumb pain due to xyz. Referred for
medication recommendations.
PMH/Pain Hx
Patient denied any.
FHX of chronic pain: + Mother & Sibling
Meds: Oxycodone 5mg po TID* & Hydro-
codone -APAP 5/325 QID = MED 55
62. Sample Case
Chart Review:
Long history of chronic multifocal
pain dating back many years and
including visits to multiple pain
providers.
PMH: Neck pain, HA, Back and Leg
pain.
Epic OHSU:
15 visits to OHSU’s pain program in
2013
Dx with chronic neck pain, HA,
Depression
FMS.
63. Sample Case
Ddx:
1. Hand pain M79.6
2. Somatic Symptom Disorder
F45.42
3. Chronic Pain
G89.4
What are your recommendations
for Mrs. C?