pathology - Advanced Holistic Healing Arts

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.

TIDBITS, UPDATES AND RESOURCES

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

1. A small, preliminary study, (published in Pain) of the effectiveness of Memantine (a drug used for Parkinson’s and Alzheimer), showed significant improvement in pain. The study included only 63 participants and lasted 6 months. Additionally, larger studies of longer duration are needed, but the results are encouraging.

2. The University of Cincinnati and 15 other centers are conducting a clinical trial designed to test the safety and efficacy of a device for possible approval by the FDA. The Device, called the NeuroPoint, and manufactured by Cerephex, delivers gentle electrical stimulation to specific areas in the brain that may be involved in overactive pain perception for fibromyalgia sufferers. The goal is to reduce the overactivity in a way that might help reduce the perception of pain.

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.

Professor Jarred Younger’s laboratory is looking for volunteers who have fibromyalgia, chronic fatigue, and several other conditions. If you are in the area and interested in participating in potential studies, then you may want to explore the official website and contact the researchers about your interest. You should be aware that, similar to other clinical trials, you may be asked to record your reactions, take medications, provide blood samples and attend appointments on a frequent basis. Before joining any research study, you may also want to consult your doctor.

4. An article Are Both Small AND Large Fiber Neuropathy Present in Fibromyalgia?, posted on Prohealth in June written by Cort Johnson postulates that many people diagnosed with Fibromyalgia may, either be misdiagnosed, or have a concomitant condition manifesting as small and large fiber neuropathy, including demyelination of larger nerves. The article summarizes the results of studies leading to this conclusion and points to the new direction of study.

ALTERNATIVE AND COMPLEMENTARY MEDICINE

1. An article, titled Qigong and fibromyalgia: randomized controlled trials and beyond published in Evid Based Complement Alternat Med. By Sawynok J, Lynch M, found qi gong to provide significant benefit to those practicing regularly. However, the number of studies and participants are small, so larger scales studies are needed to verify the information.

2. An article, titled Acupuncture in fibromyalgia: a randomized, controlled study addressing the immediate pain response Published in Rev Bras Reumatol. (in Portuguese) found acupuncture to be very effective in producing immediate pain reduction in patients with fibromyalgia.

3. An article, titled Mindfulness Meditation Alleviates Fibromyalgia Symptoms in Women: Results of a Randomized Clinical Trial published in the Ann Behav Med. Found MBSR ameliorated some of the major symptoms of fibromyalgia and reduced subjective illness burden but did not significantly alter pain, physical functioning, or cortisol profiles.

4. The National Center for Complementary and Alternative Medicine published an article, Mind and Body Practices for Fibromyalgia: What the Science Says, in June summarizing study results on complementary practices for Fibromyalgia. The article indicates that Tai Chi, qi Gong and Yoga show the best efficacy of CAM treatments.

Here is some of the information I recently shared in my November newsletter. Each newsletter has a specific focus. This month is focused on rotator cuff and shoulder injury information. If you would be interested in receiving my newsletter, please head over to my contact page and sign up.

TIDBITS and UPDATES

I have been taking an in-depth anatomy of the upper limb class recently, and a couple of key points have really stuck out for me. These points might help understand some of your client/patient’s symptoms.

The Brachial plexus contains two divisions: the Anterior and the Posterior (corresponding to the area enervated by the branches)
The Brachial plexus received nerves from C5-T1.
There is a proximal to distal hierarchy in the nerve roots. The more superior the nerve root (C5), the more superior the structures enervated (the pectoral girdle) and the more distal the nerve root (T-1), the more distal the structures (the hand).
The Musculocutaneous nerve (part of the anterior branch with roots at C5 & C6) acts on the shoulder at the biceps, brachialis, and coracobrachialis
The Musculocutaneous nerve has cutaneous sensors at the lateral forearm.
Injury to the Musculocutaneous nerve can result in weak anterior arm movements (shoulder flexion, elbow flexion) and altered sensation on the lateral forearm.
The Axillary Nerve (part of the posterior branch with roots at C5 &C6), enervates the deltoid and teres minor muscles and wraps around the neck of the humerus in close proximity to the Posterior circumflex artery.
The Axillary nerve has cutaneous sensors at a small part of the arm at the deltoid attachments, so injury can result in weakness in abduction and altered sensation on the lateral aspect of the upper arm.

STUDIES, ARTICLES, and RESOURCES

I receive a weekly update on anything published anywhere on the internet that includes information about rotator cuffs and shoulders. Much of it is personal blogs, stories about athletes that are injured, etc., but some of the information can be helpful to practitioners. I try to glean the best of the information at provide a brief synopsis of the information and a link to find the full item yourself. If you have any problems with the links, please let me know, or if you come across any information that you think would be good to share, please also feel free to pass that information along to: info@holistichealingarts.net

1. Recently, the Moon Shoulder Group through Vanderbilt University Medical Center released the results of two studies on the Rotator Cuff.

a. The study focused on relieving shoulder pain in patients with rotator cuff tendon tears without surgery.

b. The study involved a specific exercise protocol provided by physical therapists with home work as well.

c. The specific exercises were compiled in a booklet available for download for free on the Moonshoulder website.

d. The study indicates that the protocol designed had an 85% success rate without surgery.

e. For a synopsis and discussion of the studies, check out the website Healthnewsdigest.com

2. A Number of booklets and small books with rehab protocols, exercises and lifestyle changes to heal and prevent shoulder injuries can be found on the GoBookee site

3. While there are some great stretches in the book you received in class, and more stretches in the Releasing the Rotator Cuff Book and DVD by Peggy Lamb, as well as the Stretch Your Clients book by Peggy Lamb, the Chron.com website has some excellent PNF stretches for the rotator cuff for those who might want a specific stretching routine.

4. For those working with athletes who are looking for fitness routines to help with rehab or strengthening, a great variation on routine exercises can be found at Stack.com

5. For those interested in providing some support, such as Kinesiotaping the shoulder, a great video of kinesiotape application to support the rotator cuff can be found on youtube.