Neuroacupuncture for Central Nervous System Disorders
Len Wisneski in The Scientific Basis of Integrative Health, 2017
Fibromyalgia is a chronic disorder characterized by diffuse or nonspecific musculoskeletal pain. Patients also experience multiple tender body points and fatigue. Fibromyalgia affects more women than men. Symptoms and signs can vary depending on stress, physical activity, weather changes, or even the time of day. Common symptoms and signs include widespread pain and stiffness, fatigue and sleep disturbances, heightened sensitivity of the skin, headache and facial pain, irritable bowel syndrome, weakness of limbs, muscle spasms, and impaired concentration and short-term memory. The degree of symptoms may also vary greatly from day to day with periods of flare-ups or remissions. Fibromyalgia often starts as a result of some mental or physical trauma, major surgery, or disease. Symptoms are often aggravated by unrelated illness or changes in the weather. The cause of fibromyalgia is still unknown. One theory suggests that patients with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals. Other theories include abnormalities of the autonomic nervous system, changes in muscle metabolism, injury, infection, psychological stress, capillary ischemia, sleep disorders, or hormonal changes.
What do diagnoses mean, and does it matter?
Rolf Ahlzén, Martyn Evans, Pekka Louhiala, Raimo Puustinen in Medical Humanities Companion, 2018
It is questionable, however, whether they are terms that describe natural kinds. The question of natural kinds is another classical philosophical problem which is hard to define exactly and to which there are no final solutions. For the purposes of this paper it may be sufficient to say that:Natural kind terms constitute a class of general terms and include both mass terms, like ‘gold’ and ‘water’ and certain sortal terms like ‘tiger’ and ‘apple’. Loosely, they may be said to denote types of naturally occurring stuffs and things. The same book defines sortal as:a type of term, usually a noun, e.g. ‘cat’ or ‘person’ that supplies a single principle of individuating and counting the instances it applies to. In the history of medical classification there are some famous figures who thought that diseases are natural kinds. Carl von Linne, for example, classified diseases in the same way he had successfully classified plants. ‘Gold’, ‘water’, ‘tiger’ and ‘apple’ are terms that refer to ‘naturally occurring stuffs and things’, but ‘fibromyalgia’ or ‘Asperger’s syndrome’ hardly do so. An essential feature of the diagnosis of fibromyalgia is that it is a diagnosis of exclusion, i.e. it should only be made when no other medical disease can explain the symptoms. The DSM- IV diagnostic criteria of Asperger’s syndrome include, for example (italics mine),A. Qualitative impairment in social interaction, as manifested by at least two of the following:Marked impairment in the use of multiple nonverbal behaviours such as eye- to- eye gaze, facial expression, body postures, and gestures to regulate social interaction…C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. …F . Criteria are not met for another specific Pervasive Developmental Disorder, or Schizophrenia. The terms in italics demonstrate the difference between the definitions of some diagnoses and the definitions in, e.g., botany. The criterion F is again one of exclusion.
Fibromyalgia
Sahar Swidan, Matthew Bennett in Advanced Therapeutics in Pain Medicine, 2020
Due to the difficulty of diagnosis, some estimates have determined an average of 5 years from the time a patient first reports symptoms to the time a diagnosis of fibromyalgia is made. According to the 2010 American College of Rheumatology fibromyalgia diagnostic criteria, patients are asked if they have had chronic widespread pain and tenderness, defined as pain and tenderness on both sides of the body, above and below the waist including the axial spine (usually the paraspinal, scapular, and trapezium muscles), over 19 different regions of their body during the past week using the widespread pain index (WPI).The symptom severity (SS) scale is used to quantify problems with fatigue, unrefreshed sleep, cognitive dysfunction, and a number of somatic symptoms over the previous week.A diagnosis of fibromyalgia is made based on the following criteria:WPI score ≥7 and SS scale score ≥5 or WPI score 3–6 and SS scale score >9Symptoms have been present at a similar level for at least 3 monthsPatient does not have a disorder that could otherwise explain the painThe causes of fibromyalgia are not clear and can vary among different people. Fibromyalgia is considered its own entity as it does not fit an autoimmune, inflammation, joint, or muscle disorder in the classic sense. Research suggests that the central nervous system in particular plays an active role in fibromyalgia pain. Fibromyalgia likely has a genetic component, making some people more prone to acquiring the disease and other comorbidities. There are also triggers that can worsen symptoms including diet, hormones, schedule, sleep, weather, and physical and emotional stress. Patients often experience a decreased quality of life due to discomfort and pain. A variety of possible mechanisms have been proposed but, because these mechanistic abnormalities are not found in all patients, finding effective treatments has been difficult (Table 7.1). There is increasing evidence that changes in inflammatory mediators and a disturbed balance of pro- and anti-inflammatory cytokines can occur. Fibromyalgia has also been considered a stress-related disorder with dysfunction of the hypothalamic pituitary adrenocortical (HPA) axis. Some researchers have shown increases in oxidative stress and toxic metabolites of lipid peroxidation, while others have studied the idea that fibromyalgia could be a sympathetically maintained neuropathic pain syndrome. It has also been proposed that dorsal root ganglia and peripheral sensory neuron sodium channels may play a major role in fibromyalgia pain transmission.
Aspects of the Epidemiology of Fibromyalgia
Published in Journal of Musculoskeletal Pain, 1994
Most information about fibromyalgia derives from the clinic, and it is not known how persons with fibromyalgia in the community might differ from clinic patients, and whether their illness syndromes might be more or less severe. Additionally, the outcome of fibromyalgia in the community as well as the clinic is not known. Findings: The prevalence of fibromyalgia in the general population appears to around 2%, with more than 90% of those being female. Fibromyalgia occurs more frequently in the elderly than previously supposed. Fibromyalgia in the clinic is associated with self-reported disability, but little is known about fibromyalgia disability in the community. Conclusions: Fibromyalgia can be identified in the community at rates in excess of the rheumatoid arthritis, and constitutes a significant public health concern. Additional studies of fibromyalgia disability and outcome are required.
Periodic Leg Movements in Sleep in Patients with Fibromyalgia
Published in Annals of Clinical Psychiatry, 1991
Douglas H. Finestone, Barbara A. Sawyer, Scott K. Ober, Gail R. Marsh, Lori B. Oshrain, Thomas J. Hoelscher, Michael D. Webb, Thomas C. Chenier, Richard M. Bloch
Periodic leg movements in sleep (PLMS) has been reported in patients with fibromyalgia. We carried out overnight polysomnography to determine the prevalence of PLMS in 15 inpatients with fibromyalgia, 7 of whom (47%) were discovered to have PLMS. Patients with PLMS and fibromyalgia did not clinically differ from patients with only fibromyalgia. Polysomnography was necessary to establish the Presence of PLMS. The recognition of LMS in patients with fibromyalgia is consequential because PLMS is usually treated with clonazepam, and fibromyalgia is often treated with antidepressants. In addition, antidepressants may precipitate or intensify PLMS. Polysomnography should be considered to detect PLMS in patients with fibromyalgia; patients with PLMS should be examined for fibromyalgia.
Current trends in fibromyalgia research
Published in Expert Opinion on Pharmacotherapy, 2003
The development of standardised criteria for the diagnosis of fibromyalgia in 1990 has allowed careful study of this chronically painful syndrome. Epidemiological studies show increased symptoms and disability in patients with fibromyalgia, compared with other conditions associated with chronic, widespread pain. In addition, prevalence and severity of fibromyalgia symptoms are increased in women. Current studies have identified strong evidence for central sensitisation in fibromyalgia. Data from these studies may expand effective treatment options for fibromyalgia.