Presentation on theme: "LOTA Spring Conference 2009. What is Fibromyalgia? Evidence base for treatment Assessment Occupational Therapy Spreading the word (and getting."— Presentation transcript:
LOTA Spring Conference 2009
What is Fibromyalgia? Evidence base for treatment Assessment Occupational 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.”
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
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
Can benefit some Evidence is not strong
Expert opinion Evidence is strong for other types of pain conditions
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
Significant relief for pain, fatigue, anxiety but not function
cranial electrotherapy stimulation
transcutaneous electrical nerve stimulation High vs. Low frequency
3-Planar Fascial Fulcrum Approach Integrative Manual Therapy Technique Soft Tissue Myofascial Release Approach. Indirect neuromusculoskeletalfascfial augmentation. Integrates with other manual techniques. Utilized for acute and severe inflammatory. Fibromyalgia, edema, adhesions, venous, and lymphatic congestion. Myofascial Release- Harriet Leggett, LOTR
Occupational Therapy and Myofascial Release (MFR) Focus on client’s structure and function. Motor function includes: mobility, flexibility, strength, endurance, balance, coordination, proprioception, and more. Function is defined as the requirements for ADL: strength, balance, coordination, exteroception, proprioception, and other functions. Structure includes: systems on a cellular level which may include dysfunctions of the joints, organ, circulatory, ligaments, tendons, capsule tissues, muscle fibers, neural tissues, connective tissue, and fascia.
Fascia Tough specialized connective tissue. Functions in a 3-dimensional web from our head to toe. Separates, supports, binds, connects, and defends the entire body.
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