1. BIOL 218 HUMAN ANATOMY F 2011 Diagnostic Image PowerPoint on Fibromyalgia

2. Fibromyalgia in the Human Body Diagnostic Image Compendium Introduction The following 12 images/slides show how Fibromyalgia can affect someone with the disease. The intention for this selection of images is to show people where tender points can be found and possible hormone links to increase in pain. Another thought to cause of pain in FM patients is overactive nerves which is shown. Fibromyalgia is still very new and being intensely researched, and researchers have yet to find a test to definitively diagnose this. Fibromyalgia can be a vicious cycle to manage and control, but with the correct team of Doctors it can be managed.

3. What is Fibromyalgia? Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. This image shows the 18 possible tender points, not to be confused with trigger points, that when pressed are painful in a person with Fibromyalgia. Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event. Women are much more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression. The disorder most commonly has its onset in middle adulthood, but can occur in adolescence and old age. Those who have a rheumatic disease such as osteoarthritis, lupus, rheumatoid arthritis, or ankylosing spondylitis also are at higher risk for developing fibromyalgia. symptomlog.com

4. The Stress-Hormone-Fibromyalgia Link The master gland that controls our hormones is called the hypothalamus. Situated deep within our brain, the hypothalamus sends biochemical messages to the thyroid, adrenal glands, and ovaries (among others) through the pituitary gland, to regulate our metabolic balance, immune system, autonomic nervous system, and more. In turn, our tissues talk back to the hypothalamus by way of chemical messaging. Adrenal Glands: Responsible for releasing cortisol and controlling our daily cortisol cycle. Many Fibromyalgia patients describe “crashing” under stress which is most likely an adrenal imbalance. The research suggests a connection between past emotional trauma and disrupted cortisol rhythms in fibromyalgia patients. But what’s remarkable is that when a person takes steps to heal toxic emotions and support their adrenal health, not only does their stress response dramatically improve, but so do their fibromyalgia symptoms. womentowomen.com

5. Stress-Hormone-Fibromyalgia Link Ovaries: Women with fibromyalgia experience more severe symptoms premenstrually, and sometimes after menopause as well. This is because estrogen, progesterone, and possibly even testosterone can all affect pain and fatigue in the body. A study done in 2005 looked at these connections, and around 50% of the women in the study said they experienced more pain and fatigue during their periods, 25% stated that their fibromyalgia symptoms started with menopause, and 26.4% said the severity of their symptoms increased after menopause. So it makes sense that by gently balancing our hormones through adrenal, thyroid, and ovarian support, we can lessen the burden of fibromyalgia. But here’s some good news to keep in mind: function in fibromyalgia patients does tend to improve over the years, and symptoms decrease with age as patients develop effective coping strategies. Thyroid: Once a woman’s HPA axis is off-kilter, it’s much more likely her hypothalamic- pituitary-thyroid (HPT) axis will suffer, too. The two are intimately connected. Very often when the thyroid is imbalanced, it actually stems from an adrenal imbalance. Recent research has been demonstrating an association between thyroid conditions and fibromyalgia, which seems more prevalent in women in menopause. While these relationships remain poorly understood, the symptoms we see with hypothyroidism — low body temperature, poor immune function, fatigue, and achiness — can certainly contribute to more intense fibromyalgia symptoms. So the good news is that when we address the hypothyroidism, again, fibromyalgia symptoms can also improve.

6. Causes and risk factors Doctors don’t know exactly what causes Fibromylagia, but it most likely involves a variety of factors working together. These may incude:  Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.  Infections. Some illnesses appear to trigger or aggravate fibromyalgia.  Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia. Current thinking centers around a theory called central sensitization. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals.

7. Symptoms Pain is the main symptom of Fibromyalgia. Painful areas are called tender points. Tender points are found in the soft tissue on the back of the neck, shoulders, chest, lower back, hips, shins, elbows, and knees. The pain then spreads out from these areas. The pain may feel like a deep ache, or a shooting, burning pain. People with fibromyalgia tend to wake up with body aches and stiffness. For some patients, pain improves during the day and gets worse at night. Some patients have pain all day long. Pain may get worse with activity, cold or damp weather, anxiety, and stress. Fatigue, depressed mood, and sleep problems are seen in almost all patients with fibromyalgia. Many say that they can't get to sleep or stay asleep, and they feel tired when they wake up. Irritable Bowel Syndrom (IBS) Memory and Concentration problems Numbness and tingling in hands and feet. Palpitations Reduced ability to exercise Tension or Migraine headaches

8. Complications Fibromyalgia generally doesn't lead to other conditions or diseases. But the pain and lack of sleep associated with fibromyalgia can interfere with your ability to function at home or on the job. The frustration of dealing with an often-misunderstood condition also can result in depression and health-related anxiety.

9. Treatments In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include: Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve, others) — in conjunction with other medications. Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or fluoxetine (Prozac) to help promote sleep.

10. Treatments cont’d Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia. Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.

11. Alternative Medicine Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit. Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety. Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.

12. Fibromyalgia Diagnostic Image Compendium Summary and Conclusions This Diagnostic Image Compendium on Fibromyalgia is intended to educate and inform people on the real pain of Fibromyalgia. There is still so much researchers are trying to learn about Fibromyalgia and then pass it on to patients. Arthritis or Rheumatalogical Disorders would be interesting to compare with Fibromyalgia since the symptoms are so close. Mayo Clinic has some great research and I believe everyone that is looking for medical information should visit their website.

13. Fibromyalgia in the Human Body Diagnostic Image Compendium Research List / References 1. Location of Tender Points symptomlog.com 2. Stress-Hormone-Fibromyalgia Link womentowomen.com 3. Overactive Nerve Impulse rncasemanager.com 4. Fibromyalgia vicious cycle headachetreatmentbellevernonpa.com