1. LOTA Spring Conference 2009

2.  What is Fibromyalgia?  Evidence base for treatment  Assessment  Occupational Therapy  Spreading the word (and getting paid!)  Conclusion

3.  Describe someone you know with Fibromyalgia.  How do people (including therapists) respond to hearing the word ‘Fibromyalgia’?

5.  Restless legs  IBS  Difficulty concentrating  Headaches  Urinary problems  Numbness/tingling (non-dermatomal)  “Allergy” symptoms  Dizzy  Cold sensitivity  Anxiety  Depression & insomnia

6.  11 / 18 tender points  2009 ICD-9-CM Diagnosis 729.1 Myalgia and myositis unspecified

7.  “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.”

10.  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

11.  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

12. 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

14. ACTH CRF Stress HPN Limbic System Anterior Pituitary Hippocampus Brain Stem Cortisol Adrenal Cortex

15. Cognitive Dysfunction Stress Hormones (CRH & Cortisol) Pain Dopamine Hippocampus Stress -0.89

17. Spirituality Cognitive Affective Physical Self-care Productivity Leisure Physical Institutional Cultural Social Person Environment Occupation

18.  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.

19.  Improved pain and function  Drop-out was low

20.  Can benefit some  Evidence is not strong

21.  Expert opinion  Evidence is strong for other types of pain conditions

22.  Tramadol  Mirapex  Elavil  Prozac  Cymbalta  Navoban  Lyrica  Savella  Aurorix, Manerix

24. Roles Habits Personal Causation Values Interests Skills Goals Interpretation of Past Experiences Physical Environment Social Environment Readiness for Change www.moho.uic.edu

25. Score: 0-100 X = 50 Severe impact = 70 Most commonly used Free http://www.myalgia.com/FIQ/fiq.pdf

26.  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

27. www.cebp.nl/vault_public/filesystem/?ID=1478 Visual Analog Scale (VAS)

28.  ROM  Grip Strength  Timed Stair Test  No statistical differences: Self-efficacy Milwaukee O’Connor

29. Symptom Management: Nutritional Mind-Body Physical Lifestyle Emotional-Spiritual

31.  Avoid: MSG (“natural seasonings”) Aspartame Caffeine  Use: Splenda instead of sugar & cruciferous vegetables

32.  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

33. 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

34. Mind and Body

35.  92 degrees  BP: not more than 150/98 or so  Exercise below the point of fatigue or pain  Dopamine  Stress Hormones

36.  Everyday  30 minutes (40 minutes to lose wt.)  stretching 20% strength 40% aerobic 40% (Raise your heartbeat by 50%)

37.  Moshe Feldenkrais  Painful movement due to improper sensory motor self-image  Cervical eye ball exercise!

38.  Gentle movements  Balance & ROM  Breathing & awareness  Resist the Tiger

39.  Stretching  Core strength  Breathing & awareness  Warrior

41.  Significant relief for pain, fatigue, anxiety but not function

42. cranial electrotherapy stimulation

43. transcutaneous electrical nerve stimulation High vs. Low frequency

44. 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

45. 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.

46. 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.

47. Concepts of Soft Tissue MRF Technique  3-Planar concept  Fulcrum concept  Release

49.  Get with your flavor team

50.  Assertive communication  Time management  Day timer  To-do list  Say ‘no’ at work  Career change?

51.  Evaluate sleep  Short naps only  Regular schedule  Work smarter  Pace  Re-arrange environment

55. Dysfunctional Attitude Scale 1 = Totally agree 2 = Agree very much 3 = Agree slightly 4 = Neutral 5 = Disagree slightly 6 = Disagree very much 7 = Totally disagree

56. Husband home late He’s cheating on me. I should be more attractive. DepressionAngerGuilt Can’t Sleep, Withdraws, Interrogates A B C

57. Autogenic meditation Focused meditation Mindful meditation Visualization Guided Imagery (Belleruth Naparstek) Self-Hypnosis

58.  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?

59.  Therapeutic relationship  Positive self-esteem is highly correlated with internal locus of valuation i.e. self worth not dependent on what other people think

60. And getting paid!

61.  Rheumatologists  Family Medicine  Internal Medicine  Pain Specialists  Support Groups

62.  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

63. Questions? www.robinsteed.wikidot.com