fibromyalgia and acupuncture
DESCRIPTION
Review of pathophisiology of Fibromyalgia and its therapy with acupunctureTRANSCRIPT
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.
¡GRACIAS!
/DrMendizabal
@Dr_Mendizabal