Presentation on theme: " What is Fibromyalgia? Evidence base for treatment Assessment Occupational & Physical Therapy Spreading the word (and getting paid!) Conclusion."— Presentation transcript:
What is Fibromyalgia? Evidence base for treatment Assessment Occupational & Physical Therapy Spreading the word (and getting paid!) Conclusion
Describe someone you know with Fibromyalgia. How do people (including therapists) respond to hearing the word ‘Fibromyalgia’?
“I always feel like I have the flu.” “I hurt all over. My muscles are always sore.” “I feel like I am in a fog. I can’t think straight.” “ I used to be a type A person. Now I can’t get out of bed.” “If I could just sleep for a week.”
Widespread Pain Index and Symptom Severity 10 9 8 7 6 5 4 3 2 1 First dgSecond dg WPI SS Wolfe et al 2010
Jaw: left, right Chest, Neck Shoulder girdle: left, right Upper arm: left, right Lower arm: left, right Back: upper, lower Hip (buttock, trochanter): left, right Upper leg: left, right Lower leg: left, right
Severity over past week: 0 no problem 1 slight or mild problems, generally mild or intermittent 2 moderate, considerable problems, 3 severe: pervasive, continuous, life-disturbing problems Somatic symptoms: 0 no symptoms 1 few symptoms 2 a moderate number of symptoms 3 a great deal of symptoms FatigueWaking un-refreshedCognitive
Hypothalamus- control of ANS and hormones Anterior Pituitary- master gland Adrenal Cortex- sit on top of kidneys Hippocampus- memory and reward, dampens anxiety Limbic system- emotions and central relay station
Serotonin- mood, sleep, depression Dopamine- reward chemical, runner’s high Norepinephrine- stress, flight or fight Glutamate- excitatory amino acid Endorphins- reduce pain Substance P- binds with pain neurons Cortisol- stress hormone, released by adrenal cortex
What we know Increased amount of Substance P in CSF Pain uniquely related to NMDA receptor fxn Serotonin levels abnormal Multi-neuroendocrine disturbances, day-night rhythms, too much estrogen
EULAR (European League Against Rheumatism) Carville et al 2008 APS (American Pain Society) Buckhardt, 2005 evidence source I to V evidence strength A to D
Spirituality Cognitive Affective Physical Self-care Productivity Leisure Physical Institutional Cultural Social Person Environment Occupation
non-pharmacological and pharmacological treatment modalities tailored according to pain intensity, function, associated features, such as depression, fatigue and sleep disturbance in discussion with the patient.
Improved pain and function Drop-out was low EULAR II B APS A
Can benefit some Evidence is not as strong EULAR II C APS mostly B
Expert opinion Evidence is strong for other types of pain conditions APS A
Tramadol Mirapex Elavil Prozac Cymbalta Trazodone EULAR I A PAS B-C Navoban Lyrica Savella Aurorix, Manerix
Life roles Habits Self-efficacy Values Interests Life Skills Goals Interpretation of Past Experiences Physical Environment Social Environment Readiness for Change www.moho.uic.edu
Score: 0-100 X = 50 Severe impact = 70 Most commonly used Free http://www.myalgia.com/FIQ/fiq.pdf
Beck Depression Inventory II www.ibogaine.desk.nl/graphics/3639b1c_23.pdf www.ibogaine.desk.nl/graphics/3639b1c_23.pdf Hamilton Rating Scale for Depression healthnet.umassmed.edu/mhealth/HAMD.pdf Zung Self-rating Depression Scale healthnet.umassmed.edu/mhealth/ZungSelfRatedD epressionScale.pdf
www.cebp.nl/vault_public/filesystem/?ID=1478 Visual Analog Scale (VAS) Place a mark on the line to indicate how severe your pain is today. no pain ___________________________ severe pain
ROM Grip Strength Timed Stair Test No statistical differences: Self-efficacy Milwaukee O’Connor
Avoid: MSG (“natural seasonings”) Aspartame Caffeine Use: Splenda instead of sugar & cruciferous vegetables Smith et al 2001
Magnesium Citrate- Mg is natural antagonist of the NMDA receptor Dextromethorphan- post exertional burn Delsyn cough syrup Patrick Wood, MD Talk to FM support group 2004 OTC
Fibromyalgia Cocktail Beta blocker like pindolol, 2.5 – 10 mg at bedtime Tricyclic antidepressant like imipramine. Low dose at first and work up to as high as you can. Melatonin – 3 mg at bedtime DHEA – Have your physician monitor your levels. You can get too much DHEA and then you get a beard. B Complex Omega 3 fish oil
Mind and Body
92 degrees BP: not more than 150/98 or so Exercise below the point of fatigue or pain Dopamine Stress Hormones
Everyday 30 minutes (40 minutes to lose wt.) stretching 20% strength 40% aerobic 40% (Raise your heartbeat by 50%)
Moshe Feldenkrais Painful movement due to improper sensory motor self-image Cervical eye ball exercise!
Gentle movements Balance & ROM Breathing & awareness Resist the Tiger
Describe how this experience felt to you. How real did the beach seem to you? What was in the box? What did it look like? How did it feel to receive this gift? What special meaning does this gift have for you? What did you do on the beach? How did that feel? What are some ways you could incorporate some of that into your life right now? What are some circumstances in which you might want to return to this place?
Therapeutic relationship Positive self-esteem is highly correlated with internal locus of valuation i.e. self worth not dependent on what other people think
And getting paid!
Rheumatologists Family Medicine Internal Medicine Pain Specialists Support Groups
Group Neuromuscular Re-education Activities of Daily Living Warm Water Exercise Client education must take place during normal billable sessions. 2 hours 3x week for 6 weeks if possible
Buckhardt CS, Goldenberg D, Crofford L, et al. Guideline for the management of fibromyalgia syndrome pain in adults and children. Glenview (IL): American Pain Society (APS); 2005. as summarized in National Guideline Clearinghouse 2005 Sep 19:7298National Guideline Clearinghouse 2005 Sep 19:7298 Carville, S. F., Arendt-Nielsen, S., Bliddal, H., Blotman, F., Branco, J. C., Buskila, D., et al. (2008). EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Annals of the Rheumatic Diseases, 67(4), 536-541. R. C. Cork, P. Wood, N. Ming, C. Shepherd, J. Eddy & L. Price : The Effect of Cranial Electrotherapy Stimulation (CES) on Pain Associated with Fibromyalgia. The Internet Journal of Anesthesiology. 2004 Vol 8 Number 2 Smith, J., Terpening, C., Schmidt, S., & Gums, J. (2001). Relief of Fibromyalgia symptoms following discontinuation of dietary excitotoxins. Ann Pharmacother, 35, 702-706. Wilke, W. Cleveland Clinic Journal of Medicine June 2009 vol. 76 6 345-352 Wood, P. B., Holman, A. J. (2009). An Elephant Among Us: The Role of Dopamine in the Pathophysiology of Fibromyalgia. The Journal of Rheumatology 36: 221-224 Wolfe, F. Clauw, D., Fitzcharles, M., Goldenberg, D., Katz, R., Mease, P, Russell, A, Russell, J, Winfield, J., Yunus, M. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research, 62 (5), 600-610.