FIBROMYALGIA
Rosamund Vallings
MB BS
FIBROMYALGIA
Is it a symptom or a disease?
CENTRAL SENSITISATION
SYNDROME
Tired and achy all the time
Fatigue/Pain
The commonest symptoms seen in
general practice
FATIGUE
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Common symptom in GP consultation
Normal fatigue
Disease related fatigue: acute or chronic
Fatigue in CFS/FM:
– Unrelieved by rest
– Worsened by exercise
– Delayed recovery
What is CFS?
CFS/FM
• Most people with CFS have FM
• Most people with FM have chronic fatigue
• Common features:
– Myalgia
– Headaches
– Generalised pain
– Sleep disorder
– Cognitive difficulties
PREDISPOSING FACTORS
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GENETIC
VIRAL
STRESS: Physical/Mental
SLEEP DEFICIT
SEX
PERSONALITY
OVEREXERCISE/INJURY
Who gets CFS/FM
IMMUNOLOGICAL CHANGES
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INCREASED CYTOKINES (Klimas)
DECREASED NK CELLS (Klimas)
ABNORMAL R-NaseL (Suhadolnik)
Raised NPY (Fletcher) etc
Associated Conditions
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Irritable bowel syndrome
Irritable bladder
Migraine
Endometriosis
Orthostatic intolerance
Hypersensitivity/allergies
?Autoimmune
ORTHOSTATIC INTOLERANCE
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LOW BLOOD VOLUME (Bell)
LOW BP (Rowe)
POOR BRAIN PERFUSION (Mena, Kuratsune)
PALPITATIONS
• Symptoms:
postural dizziness
brain fog
cold extremities
bloatedness
DIAGNOSIS OF FM
• EXCLUSION OF OTHER DISORDERS
• ASSOCIATION WITH OTHER ILLNESS (eg
IBS,CFS,PPS,SLE,LYME etc)
• STAND ALONE CONDITION
• CHRONIC PAIN SYNDROME
• VALIDITY OF PRESSURE POINTS
PAIN History(M Fitzgerald)
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Genetic predisposition
Pain is a CNS problem (microglia)
Background of trauma
Neonates
Bad experiences associated with pain
Conditioning (original site reactivation)
Diagnostic Criteria FM
• A. Widespread pain in all four quadrants of
the body, for a minimum of three months
• B. At least 11 of the 18 specified tender
points
Laboratory Findings in CFS/FM
• Typically normal
except for…
– Immune abnormalities
– Atypical lymphs
– Autoantibodies
• Anti-nuclear (ANA)
• Thyroid
Komaroff et alia, Arch IM, 155, Jan 1995
MANAGEMENT
• CORRECT DIAGNOSIS
• ACKNOWLEDGEMENT/SUPPORT
• EDUCATION
• LIFESTYLE
GENERAL MEASURES
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Stress management
Gentle exercise (breathing, sunshine)
Diet (salt, frequency, balance)
Supplements (B12, Mg, CoQ10, omega 3)
Hormones
Sleep management
Pain management
CBT/Psychotherapy
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Useful for stress management
Understanding of sleep disorder
Change in negative thinking
A focus on what is possible
Relaxation strategies
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Music
Physical relaxation/deep breathing
Creative visualisation
Meditation
Prayer
Self hypnosis
EXERCISE
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NONE LEADS TO POOR OUTCOME
TOO MUCH LEADS TO RELAPSE
NEEDS TO BE REGULAR/OUTSIDE
START AT LOW LEVEL (?lie down)
LITTLE and OFTEN
PREPARATION and REST
BUILD SLOWLY
AVOID CRASH and BURN
NUTRITION
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BALANCED DIET/VARIETY
SMALL REGULAR MEALS
MINIMISE ALCOHOL, CAFFEINE
AVOID RICH FATTY FOODS
PLENTIFUL FLUIDS (not excess)
SALT/potassium
SUNSHINE
SUPPLEMENTS
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BETTER ABSORBED VIA FOOD
DEFICIENCIES IN BLOOD
DEFICIENCIES IN DIET
TREATMENT OF CONDITION
POSSIBILITIES:
• OMEGA 3/OMEGA 6 OILS
• B VITAMINS (B12 INJECTIONS)
• MAGNESIUM (MALIC ACID)
• COENZYME Q-10
• D-RIBOSE
• AVOID VIT C EXCESS
Sleep
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Sleep is our natural restorative phase
Sleep restores, replenishes and heals
Stress, pain etc lead to disturbed sleep
FM, CFS lead to loss of sleep quality
Until sleep is corrected nothing will come right
Levels of Sleep
• Deep level 4 sleep needed for restoration of
body, healing, hormone release etc
• REM sleep required for restoration of brain,
memory, etc - associated with dreams.
• Body functions continue and use energy
Causes of abnormal sleep
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Illness – acute/chronic
Anxiety/depression
Environmental
Body clock disturbances
Hormonal
Drugs/caffeine/alcohol
Sleep disorders
Bad habit
PAIN
Management of Sleep
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Lifestyle
Sleep hygiene
Treatment of underlying disorders
Relaxation strategies
Sleep deprivation
CBT/psychotherapy
Herbal preparations
Medication
Herbal Preparations
• Tend to be mild in effect
• Maybe useful for physical symptom control
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Valerian
Kava
5HTP
Lavender
• Herbal may not mean “natural”
• Watch costs/charlatans
• NB Magnetic mattresses
Medication
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Benzodiazepines
Muscle relaxants
Tricyclics
Antihistamines
Melatonin
Gabapentin
Antipsychotics
Stimulants
Restless legs/cramps
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Supplements – magnesium, calcium, salt
Relaxation
?Co enzyme Q10
Quinine
Ropinarole
Pain
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Pain is exhausting
Pain creates stress
Pain disturbs sleep
Pain in FM resistant to normal treatments
Central sensitization
Kids’ website
http://faculty.washington.edu/chudler/pain.html
Management of Fibropain
• Non-pharmacologic
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Aerobic exercise
Cognitive therapy (CBT)
Physical therapy
Acupuncture
Biofeedback
Balneotherapy
Hypnotherapy
Massage
• Pharmacologic
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Sleep
Antidepressants
Analgesics
Antiepileptics
Naltrexone
Hormones
Realistic Goals
• Complete pain relief is rarely achieved
• Common goals include:
– Pain reduction
– Improvement in functional ability
– Improved concentration
– Improved mood
– Improved sleep
ONGOING ISSUES
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Surveillance
Report new symptoms
Multidisciplinary team
Future research
Avoidance of relapse
Balanced lifestyle
BALANCE
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