1. Pain and Fatigue in Neuromuscular Disorders Marina Di Marco Principal Neuromuscular Physiotherapist West of Scotland 1 st May 2014

2. How does the patient present? FATIGUE LOW ACTIVITY LEVELS QoL PAIN

3. How does the patient present? Fatigue –Difference between fatigue and tiredness –Variable, Progressive and Persistent –Muscle weakness –Mechanical disadvantage –Ageing process –Falls Management Pain –Specific and /or General –Joint and /or muscle / soft tissue –Frequency / Intensity / Duration –When is it best / worst –What do you do when you have pain

4. Fatigue Management Information and Knowledge –Muscle damage –Battery life –Static and Dynamic postures –Temperature changes Tune into your body regularly as there are differences day to day. –Identify triggers such as shaking / burning / pain/ weakness/ psychological factors Pacing –Switching activities Dispelling Myths and Changing Attitudes –Afraid if it’s easier they will become lazy / weaker

5. Awareness PacingDelegateTime

6. Pain Management Information and Knowledge –Honesty –Pain mechanism –Individual –Changing the brain’s response to the pain experience Types of Pain –Nocigenic Pain- Nociceptors are sensitive to tissue injury (paracetomol / NSAID’s) –Neurogenic Pain – nerve dysfunction / neuropathy (anti-dpressants / anti-epileptic drugs) –Affected by emotions such as anger, anxiety and stress and factors such as fatigue and depression.

7. Pain and Fatigue Management Postural management Activity Orthotics OT Healthy Lifestyle Sleep Psychological Factors such as CBT, Distraction, Group work

8. Marina Di Marco Clinical Genetics Dept. of Laboratory Medicine Southern General Hospital Glasgow, G51 4TF Tel: 0141 354 9205 marina.dimarco@nhs.net