FIBROMYALGIADR. OSCAR MENDIZABAL POLANCOMÉDICO CIRUJANO UNAM

ESPECIALISTA EN ACUPUNTURA HUMANA IPN

WHAT IS IT?

Clinical syndrome defined by:

• WIDESPREAD PAIN

• Fatigue

• Sleep disturbances

• Variable somatic complaints

• Cognitive dysfunction

• Mood disturbances

Clauw DJ, Arnold LM, McCarberg BH. The Science of Fibromyalgia. Mayo Clin Proc. 2011;86(9): 907-9011

EPIDEMIOLOGY

2-5% of general population 2ª cause of rheumatologic

consultations (EUA) 6 times more frequent in women > prevalence between ages 20-50

Clauw DJ, Arnold LM, McCarberg BH. The Science of Fibromyalgia. Mayo Clin Proc. 2011; 86(9): 907-9011.

ETHIOLOGY

Genetic factors

Neuroendocrine factors

Environmental factors

Close relationship

Russell IJ, Larson AA. Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheum Dis Clin North Am. 2009;35(2):421-435.

GENETIC FACTORS

Positive family history Monoamine related genes:

• HTR2A

• HTTLPR

• D4R

• COMT

Central pain processing

abnormalities

Staud R. Abnormal pain modulation in patients with spatially distributed chronic pain: Fibromyalgia. Rheum Dis Clin North Am. 2009;35(2):263-274.

NEUROENDOCRINE FACTORS

P substance Hypothalamic-Pituitary-Adrenal axis activity

reduction

 Diminished release of CRH and GH

Hypothalamic-Pituitary-Adrenal axis hyperactivity

    Augmented serum cortisol

Staud R. Abnormal pain modulation in patients with spatially distributed chronic pain: Fibromyalgia. Rheum Dis Clin North Am. 2009;35(2):263-274.

ENVIRONMENTAL FACTORS

Child abuse history

Physical violence in adulthood

Emotional stress situations

Arnold LM. The pathophysiology, diagnosis, and treatment of fibromyalgia. Psychiatr Clin North Am. 2010;33(2):375-408

SIMPTOMS

Allodynia Sleep disturbances (+/-) Fatigue Weakness Cognitive dysfunction Headache (tensional or migraine) Depression IBS Paresthesia

Arnold LM. The pathophysiology, diagnosis, and treatment of fibromyalgia. Psychiatr Clin North Am. 2010;33(2):375-408

AllodyniaAbnormal pain processing

Clauw DJ, Arnold LM, McCarberg BH. The Science of Fibromyalgia. Mayo Clin Proc. 2011; 86(9): 907-9011

DIAGNOSIS

1990 ACR criteria:

• Widespread pain for 3 or more months

• Pain in 11 of 18 points

Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classiication of fibromyalgia: report of a multi-center criteria committee. Arthtiis Rheum. 1990;33(2):160-172.

DIAGNOSIS

At least 4 of the following:

• Fatigue

• Sleep disturbances

• Neuropsychiatric symptoms

• Headache

• Paresthesia

• IBS

• Not caused by other condition

Arnold LM. The pathophysiology, diagnosis, and treatment of fibromyalgia. Psychiatr Clin North Am. 2010;33(2):375-408.

OTHER SYMPTOMS

Articular stiffness Cold sensation Raynaud’s fenomena Cystitis Temporo – mandibular dysfunction Chronic pelvic pain Multiple chemical sensitivity

Arnold LM. The pathophysiology, diagnosis, and treatment of fibromyalgia. Psychiatr Clin North Am. 2010;33(2):375-408.

DIAGNOSIS

ACR 2010 preliminary criteria:

• Widespread index (WPI) of > 7 and

• Symptom severity scale (SS) > 5

• Or WPI 3-6 y SS > 9

• 3 months or more

• Not caused by other conditions

Wolfe F, Clauw DJ, Fitzcharles M, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB. The American College of Rheumatology preliminary diagnostic driteria for dibromyalgia and measurement of symptom

severity. Arthritis Care Res. 2010;62:600–610. 

LAB WORKUP

CBC ESR PCR Blood Chem. TSH

Longo DL, Fauci AS, et al. Harrison’s Principles of Internal Medicine. 2012. 18 ed. Ch. 335. Mc Graw Hill.

DIFERENTIAL

RA Polymyalgia rheumatica SLE HIV HCV Lyme Hypothyroidism Etc.

Clauw DJ, Arnold LM, McCarberg BH. The Science of Fibromyalgia. Mayo Clin Proc. 2011; 86(9): 907-9011.

TREATMENT

PHARMACOLOGIC TREATMENT

Aimed to symptom control

• Paint management

• Sleep improvement Antidepressants (tricyclic, SSRI) Anticonvulsants Central acting analgesics

Arnold LM. The pathophysiology, diagnosis, and treatment of fibromyalgia. Psychiatr Clin North Am. 2010;33(2):375-408.

NON PHARMACOLOGIC TREATMENT

Symptom control and improvement of life quality

• Exercise (yoga, tai-chi)

• Group therapy

• Cognitive-conductual therapy

• Acupuncture

Rakel D. Integrative Medicine. 2012. 3rd ed. Saunders. Ch. 46, pp 438-455.

ACUPUNCTURE AND FIBROMYALGIA

WHAT IS ACUPUNCTURE?

TCM discipline

• Yin/Yang theory

• Jing-luo theory

• Zang fu theory

• Wu xing theory

Maciocia G. The Foundations of Chinese Medicine. 2 ed. Elsevier. 2005. Ch 1-4, pp 1-92.

WHAT IS ACUPUNCTURE? Needle

insertion at specific sites (acupoint)

Point selection according to TCM diagnosis

Reestablish Qi/Xue circulation

Maciocia G. The Foundations of Chinese Medicine. 2 ed. Elsevier. 2005. Ch 1-4, pp 1-92.

HOW DOES IT WORK? Multiple

action mechanisms

Mostly mediated by endorphin release

Regulates ANS

Stux G; Hammerschlag R. Clinical Acupuncture: Scientific Basis. 2001. Springer. Ch. 1-3, pp 1-68.

IN FIBROMYALGIA…

Inhibits ascending pathways (endorphins) Stimulates descending pathways

(serotonin) Regulates cortisol production Increases GH production Improves sleep quality

Han JS. Acupuncture and Endorphins. Neurosci Lett. 2004. May 6;361 (1-3): 258-261

Lin JG, Chen WL. Acupuncture analgesia: A review of its mechanisms of action. 2008. Am J Chin Med. 2008;36(4):635-45.

Zhao ZQ. Neural Mechanisms underlying acupuncture. Prog Neurobilol. 2008 Aug;85(4):355-75.

Thank you

¡GRACIAS!

/DrMendizabal

@Dr_Mendizabal