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Wednesday, 11 February 2015

(First edited)) Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Fibromyalgia


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By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                       Fibromyalgia
 
Fibromyalgia, according to the American College of Rheumatology 1990 criteria for the Classification of Fibromyalgia fibromyalgia are
(1) Widespread pain in combination with
(2) Tenderness at 11 or more of the 18 specific tender point sites(a) as a result in responding to pressure.

I. Symptoms
Symptoms of Fibromyalgia may be depending to the patients' gender
According to College of Medicine at Peoria, University of Illinois, women experienced significantly more common
1. Fatigue,
2. Morning fatigue,
3. Hurt all over, total number of symptoms, and
4. irritable bowel syndrome. Women had significantly
5. More tender points pain
6. Tension headache
7. Migraine
8. Temporomandibular disorder
But significantly different between the sexes, for the below symptoms
 6. Pain severity,
7. Physical functioning
8. psychologic factors, such as anxiety, stress, and depression(1)(2).

Other symptoms may include widespread musculoskeletal pain, multiple “tender points”, sleep disturbance, stiffness,  headache, dizziness, trouble with concentration, urinary urgency(3).

According to the American College of Rheumatolog disordered sleep is a prominent symptom in fibromyalgia, others included symptoms such as waking unrefreshed, fatigue, tiredness, and insomnia(4).
II. Causes and Risk factors
A. Causes

1. Oxidative stress
Stronger evidences demonstrated that oxidative stress is associated to clinical symptoms in FM fibromyalgia(5).

2. Chronic stress
The relationship between stress, depression and functionality seems to be part of a complex mechanism,  affecting the quality of life of patients with FM(6).

3. Alpha1-Antitrypsin (AAT) 
There is a a possible relationship between AAT deficiency (AAT-D) and fibromyalgia (FM)(7).

4. Inflammatory rheumatic disorders
Demonstrated evidences suggested that fibromyalgia occurs much more frequently than expected in individuals with inflammatory rheumatic disorders(8).

5. Sleep disturbance
There is a reciprocal relationship exists between pain and sleep. Treatment targeted insomnia may improve pain(9).

6. Etc.
B. Risk factors
1. Gender 
If you are women, you are at higher risk than men to develop Fibromyalgia(10).

2. Family history
According to the study whether Fibromyalgia (FM) patients differ from their first-degree relatives with and without FM regarding the four personality traits, based on Cloninger’s TPQ questionnaire, there are factors in this personality trait that are hereditary and that may contribute to the development of FM(11).

3. Environmental susceptibility may be the possible causes of Fibromyalgia(12).

4. Other illness
Certain illness are associated to the increased risk of Fibromyalgia, such as diseases of infection.
5. Etc.

III. Complications
1. Negative impact in relationships

According to survey a large community sample of adults with fibromyalgia about the impact on the spouse/partner, children and close friends,  beside well documents of physical impairments, the disease can result in a substantial negative impact on important relationships with family and close friends(13).

2. Psychological problem
According to the study by Monash University and Monash Medical Centre, patients with FM are experiences complications of  pain, perceived stress, fatigue, confusion, and mood disturbance(14).

3. Pain disability, depression, and pressure sensitivity differences in genders
According to the study of differences complications of men and women with fibromyalgia syndrome (FMS), there is a the differences in pain, disability, depression, and pressure sensitivity between men and women with fibromyalgia syndrome (FMS)(15).

4. Impaired functionality, and impact on the quality of life
 FM group, has a positive correlation observed between the depressive symptoms and perceived stress , pain, impaired functionality, and impact on the quality of life(16).

5. Fall risk
There were significant relationships between fall risk and pain score (NRS scores, the Numeric Rating Scale) and Fibromyalgia Impact Questionnaire(FIQ) fatigue sub-scores in the fibromyalgia patients according to the study by Pamukkale University Medical School(17).

6. Postural control deficits
According to study, middle-aged FM patients have consistent objective sensory deficits on dynamic posturography, despite having a normal clinical neurological examination and suggested that the development of interventions to improve balance and reduce falls in FM patients may need to combine balance training with exercise and cognitive training(18).

7.  Infections, neoplastic and cardiovascular disease and mortality
 Fibromyalgia (FM) patients are more susceptible with an increase in comorbidity (infections, neoplastic and cardiovascular disease) as well as with an increase in mortality.
The association between FM and HIV and hepatitis C virus infections suggests a possible relationship between FM and chronic viral infection. Patients with FM may have an increased risk of developing cancer, accidental death and death from cancer(19).
8. Etc.
IV. Diagnosis 
  In the narrative review of the literature, consensus documents by the American College of Rheumatology (ACR), in primary care include:
1. Complete medical history including medication, complete medical examination, basic laboratory tests to screen for inflammatory or endocrinology diseases, referral to specialists only in case of suspected somatic diseases, assessment of limitations of daily functioning, and other functional somatic symptoms and mental disorders(20).

2. Other study suggested of 4 phased diagnosis.
a. In phase one, physicians undertook a self-assessment of their practice.
b. Phase two of the study involved diagnosis and treatment of a virtual case vignette.
3. The third phase consisted of analysis of the data from phase two and providing feedback from an expert rheumatologist, and
4. The fourth phase was to complete patient report forms for five patients in their practice(21).

Here, we quote the text from the study of The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgiaand Measurement of Symptom Severity by FREDERICK WOLFE,1 DANIEL J. CLAUW,2 MARY-ANN FITZCHARLES,3 DON L. GOLDENBERG,4
ROBERT S. KATZ,5 PHILIP MEASE,6 ANTHONY S. RUSSELL,7 I. JON RUSSELL,8 JOHN B. WINFIELD,9 AND MUHAMMAD B. YUNUS10
Objective. To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.
Methods. We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale.
Results. Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI >7 AND SS >5) OR (WPI 3–6 AND SS >9).
Conclusion. This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.
Please note:
This criteria set has been approved by the American College of Rheumatology (ACR) Board of Directors as Provisional.This signifies that the criteria set has been quantitatively validated using patient data, but it has not undergone validationbased on an external data set. All ACR-approved criteria sets are expected to undergo intermittent updates.As disclosed in the manuscript, these criteria were developed with support from the study sponsor, Lilly Research Laboratories.The study sponsor placed no restrictions, offered no input or guidance on the conduct of the study, did not participatein the design of the study, see the results of the study, or review the manuscript or submitted abstracts prior to thesubmission of the paper. The recipient of the grant was Arthritis Research Center Foundation, Inc. The authors receivedno compensation. The ACR found the criteria to be methodologically rigorous and clinically meaningful.ACR is an independent professional, medical and scientific society which does not guarantee, warrant or endorse anycommercial product or service. The ACR received no compensation for its approval of these criteria(22).
V. Prevention
1. Vitamin D 
Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Vitamin D deficiency is common in fibromyalgia and occurs more frequently in patients with anxiety and depression(23).

2. Omega 3 fatty acid
Regular intake of high oral doses of omega 3 fish oil (varying from 2400-7200 mg/day of EPA-DHA), showed a clinically significant in pain reduction, improved function up to 19 months after treatment initiation with no serious adverse effects(24).

3. Caffeine
According to forty-three of fifty-eight (74.1%) female patients with fibromyalgia completed an eight-week treatment period, the combination of carisoprodol and paracetamol (acetaminophen) and caffeine are effective in the treatment of fibromyalgia(25).

4. Coenzyme Q10 
CoQ10 treatment not only restored mitochondrial dysfunction and the mtDNA copy number, but also decreased oxidative stress, and increased mitochondrial biogenesis(26).
VI. Treatments
A. In conventional medicine perspective

FMS usually involves females, often appearance during menopause and diagnosed both in young as well as elderly individuals. In children with FMS, management is focus mostly on education, behavioral and cognitive change (with a strong emphasis on physical exercise), and less in medication, including muscle relaxants, analgesics and tricyclic agents(27).
A.1. Non medication
1. Psychological control
According to the study by Monash University and Monash Medical Centre, levels and type of psychological control buffer mood, stress, fatigue, and pain in FM appeared to be important “up-stream” process in FM mechanisms and amenable to intervention(28).

2.  Operant behavioural (OBT) and cognitive behavioural (CBT) therapy
OBT or CBT showed a significant reduction in pain intensity post-treatment. In addition, the CBT group reported statistically significant improvements in cognitive and affective variables and the OBT group demonstrated statistically significant improvements in physical functioning and behavioural variables, after 12 months of treatments, according to University of Heidelberg(29).

3. Exercise
Exercise therapy showed a strong dysfunctional response of patients with chronic pain and aberrations in central pain modulation(30).

4. Other therapies
According to the  University of Munich
a. Physiotherapy may reduce overloading of the muscle system, improve postural fatigue and positioning, and condition weak muscles, localized as well as generalized pain in short term.
b. Trigger point injection may reduce pain originating from concomitant trigger points in selected FM patient.
c. Massage may reduce muscle tension and may be prescribed as a adjunct with other therapeutic interventions.
d. Acupuncture may reduce pain and increase pain threshold.
d. Biofeedback may positively influence subjective and objective disease measures.
f. TENS may reduce localized musculoskeletal pain in fibromyalgia(31).

5. Ozone therapy
 Ozone therapy significantly improves both depression scores and the Physical Summary Score, after  24 sessions of ozone therapy during a 12-week period, with most frequently side-effec of transient meteorism after ozone therapy sessions(32).

A.2. Medications
The aim of medicine is to relieve the symptoms of the disease
According to meta-analyses and systematic reviews published since 2005, stepped care approach based upon existing evidence includes(33)
(1) Simple analgesics (acetaminophen or nonsteroidal anti-inflammatory drugs);
(2) Tricyclic antidepressants (if neuropathic, back or fibromyalgia pain) or tramadol;
(3) Gabapentin, duloxetine or pregabalin if neuropathic pain;
(4) Cyclobenzaprine, pregabalin, duloxetine, or milnacipran for fibromyalgia;
(5) Topical analgesics (capsaicin, lidocaine, salicylates) if localized neuropathic or arthritic pain; 
(6) Opioids

C. Alternative treatments
Regarding alternative treatments,
1. Acupuncture and several types of meditative practice show the most promise for in scientific investigation.
2. Magnesium, l-carnitine, and S-adenosylmethionine are nonpharmacological supplements with the most potential for further research.
3.  Individualized treatment plans that involve several pharmacological agents and natural remedies appear promising as well.(34).
Other study insisted
4. Some herbal and nutritional supplements (magnesium, S- adenosylmethionine) and massage therapy have the best evidence for effectiveness with FM. Other CAM therapies such as  
5. Chlorella, biofeedback, relaxation have either been evaluated in only one randomised controlled trials (RCT) with mixed results(34a).

D. In Herbal medicine perspective
According to St. Joseph's Healthcare Hamilton
1. Glucosamine, echinacea, and garlic were the most frequently used products.
2. Women reported NHP use more frequently than men (11.5% vs. 7.1%).
3. As compared to young adults, NHP use was about 50% higher in middle-aged and older Canadians. with fibromyalgia achieves a prevalence of 23.3%(35).

1. Ginkgo biloba
 Coenzyme Q10 combined with a Ginkgo biloba extract showed a progressive improvement in the quality-of-life scores, compared to those at the start with mild adverse effects(36).

2. Harpagophytum procumbens (Devil’s claw), Salix alba (White willow bark), and Capsicum frutescens (Cayenne)
 Harpagophytum procumbens (Devil’s claw), showed significantly in reduced pain but additional trials testing these herbal medicines against standard treatments will clarify their equivalence in terms of efficacy(37).
C. In traditional Chinese medicine perspective
1. Acupuncture

Acupuncture significantly improved symptoms of fibromyalgia, not restricted to pain relief but most significant for fatigue and anxiety, according to Mayo Clinic College of Medicine(39).
2. Combination of acupuncture and cupping therapy
A combination of acupuncture and cupping therapy was better than conventional medications for reducing pain,  improving depression scores with related to FM with no adverse effects, according to the study by The Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine(40).

2. Chinese herbal formulas
According to the differentiation of Two TCM practitioners conducted baseline TCM diagnostic examinations on 56 women with FM,
There are three primary TCM diagnoses of FM were found in the population:  
2.1. Qi and Blood Deficiency
2.2. Qi and Blood Stagnation 
2.3. Liver Qi Stagnation .
Other study showed that FM are also associated to
2.4. Yin and blood deficiency of the liver 

2.5. Yang-weakness of the spleen and kidney
2.6. Yin-weakness of the kidney(41).

Dr. Shen in the article of Chinese Herbs & Chinese Medicine for Fibromyalgia, suggested the below formula to relieve pain
Bai shao – 20%, qin jiao – 10%, du huo – 10%, yan hu sou – 10%, yu jin – 10%, tao ren – 10%, hong hua – 10%, mu dan pi – 10%, da zao – 5%, gan cao – 5%,
Basic Pain Formula; Take 3-4 grams (scoops), 3 times a day mixed with liquid or food.
Preferably on an empty stomach. (Should not be taken by pregnant women)(42).

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References
(a) http://www.ncbi.nlm.nih.gov/pubmed/2306288
(1) http://www.ncbi.nlm.nih.gov/pubmed/11286669
(2) http://www.ncbi.nlm.nih.gov/pubmed/11974674
(3) http://www.ncbi.nlm.nih.gov/pubmed/15074033
(3a) http://www.ncbi.nlm.nih.gov/pubmed/19333104
(3b) http://www.ncbi.nlm.nih.gov/pubmed/24870121
(4) http://www.ncbi.nlm.nih.gov/pubmed/21594765
(5) http://www.ncbi.nlm.nih.gov/pubmed/22532869
(6) http://www.ncbi.nlm.nih.gov/pubmed/22641587
(7) http://www.ncbi.nlm.nih.gov/pubmed/15694694 
(8) http://www.ncbi.nlm.nih.gov/pubmed/19078011
(9) http://www.ncbi.nlm.nih.gov/pubmed/20047347
(10) http://www.ncbi.nlm.nih.gov/pubmed/15074033
(11) http://www.ncbi.nlm.nih.gov/pubmed/21122266
(12) http://www.ncbi.nlm.nih.gov/pubmed/21594765
(13) http://www.ncbi.nlm.nih.gov/pubmed/23172797 
(14) http://www.ncbi.nlm.nih.gov/pubmed/23152697
(15) http://www.ncbi.nlm.nih.gov/pubmed/23171037
(16) http://www.ncbi.nlm.nih.gov/pubmed/22641587
(17) http://www.ncbi.nlm.nih.gov/pubmed/23179001
(18) http://www.ncbi.nlm.nih.gov/pubmed/21810264
(19) http://www.ncbi.nlm.nih.gov/pubmed/21794265
(21) http://www.ncbi.nlm.nih.gov/pubmed/23118542
(22) http://www.rheumatology.org/practice/clinical/
classification/fibromyalgia/2010_Preliminary_Diagnostic_Criteria.pdf
(23) http://www.ncbi.nlm.nih.gov/pubmed/16850115
(24) http://www.ncbi.nlm.nih.gov/pubmed/20090445
(25) http://www.ncbi.nlm.nih.gov/pubmed/2667860
(26) http://www.ncbi.nlm.nih.gov/pubmed/22898267
(27) http://www.ncbi.nlm.nih.gov/pubmed/23024967
(28) http://www.ncbi.nlm.nih.gov/pubmed/23152697
(29) http://www.ncbi.nlm.nih.gov/pubmed/16859516
(30) http://www.ncbi.nlm.nih.gov/pubmed/22786458
(31) .http://www.ncbi.nlm.nih.gov/pubmed/11028838
(32) http://www.ncbi.nlm.nih.gov/pubmed/23046293
(33) http://www.ncbi.nlm.nih.gov/pubmed/19410099 
(34) http://www.ncbi.nlm.nih.gov/pubmed/20192908
(34a) http://www.ncbi.nlm.nih.gov/pubmed/16454724
(35) http://www.ncbi.nlm.nih.gov/pubmed/16921199
(36) http://www.ncbi.nlm.nih.gov/pubmed/12025528
(37)  http://www.ncbi.nlm.nih.gov/pubmed/17202897 .
(39) http://www.ncbi.nlm.nih.gov/pubmed/16770975
(40) http://www.ncbi.nlm.nih.gov/pubmed/20423209 
(41) http://www.ncbi.nlm.nih.gov/pubmed/22026964
(42) http://www.drshen.com/herbsforfibromyalgia.htm