Here is some of the information I recently shared in my June newsletter. Each newsletter has a specific focus. This month is focused on fibromyalgia information. If you would be interested in receiving my newsletter, please head over to my contact page and sign up.
1. Medscape rheumatology published an interview, Fibromyalgia: The Latest in Diagnosis and Care, with Dr. Daniel Clauw and Dr. Philip Mease A summary of findings noted in the article:
a. …now in the 21st century, with the aid of sophisticated neuroimaging techniques; neurochemical studies of the CNS; genetic analyses; as well as family, developmental, and psychological studies, we are recognizing that FM results from a complex interplay of neurochemical and genetic dysregulation, perhaps in the context of psychological factors; it can occur either on its own or in association with many chronic diseases, especially chronic pain and inflammatory diseases.
b. With the change in thinking around Fibromyalgia, what is the approach to diagnosing the disorder?: We generally recommend that physicians learn to recognize the pattern of widespread pain accompanied by fatigue, sleep, memory, and mood problems and then use the FM label when that is the most likely explanation of those symptoms. … It is appropriate to remind ourselves about the difference between classification criteria, which the 1990 FM criteria are, and diagnostic criteria, which the 2010 preliminary American College of Rheumatology (ACR) criteria are intended to be. Classification criteria are intended to identify subjects with enough similar features that they can be considered reliably classified for the purposes of research on their condition…. The new criteria rely more on pattern recognition of the constellation of chronic widespread pain along with other characteristic features such as fatigue, sleep disturbance, cognitive dysfunction, and irritable bowel symptoms—symptoms that may occur either as an independent entity or in association with other chronic illnesses such as rheumatoid arthritis or osteoarthritis.
c. What is the most effective current treatment approach for fibromyalgia?: Both drug and nondrug therapies can be very effective in treating FM, and in fact, most experts believe that the best approach is to combine the two different types of therapies because they are probably working on different aspects of the disorder.
The three classes of drugs with the best evidence are tricyclics (TCAs—cyclobenzaprine, amitriptyline), serotonin-norepinephrine reuptake inhibitors (SNRIs— duloxetine and milnacipran), and gabapentinoids (gabapentin and pregabalin). Only about a third of individuals will have a meaningful improvement with any of these classes of drugs, probably because FM can be due to abnormalities in many different neurotransmitter systems that are known to regulate pain perception, sleep, mood, and alertness.
The nondrug treatments that have the best evidence for efficacy are education, exercise, and cognitive-behavioral therapy (CBT). Other treatments that can be effective include yoga, tai chi, acupuncture, and many other complementary and alternative medicine therapies.
2. FibroGuide is a free CBT program for FM patients that has been shown to be effective in a clinical trial and can give patients access to CBT treatments to which they might not otherwise have access
STUDIES AND ARTICLES
3. The University of Alabama at Birmingham (UAB) is investigating the connection between fibromyalgia and brain inflammation to fight chronic pain. The Neuroinflammation, Pain and Fatigue Laboratory at UAB will be involved in several studies, and Younger has shared details about the first one. Researchers will be exploring chemicals in the blood to see if they are affecting the immune system and making pain worse. At this time, they have found that leptin, a hormone that comes from fat cells, may be influencing pain levels and fatigue levels.