Ruth Werner Author A Massage Therapist s Guide to Pathology 5 th Edition Things to Watch For What is the difference between allodyniaand hyperalgesia? What are some other central sensitization disorders? What are some differences between tender points and trigger points? What are five symptoms of fibromyalgia? What is a major factor in the traditional fibromyalgia diagnostic criteria that is no longer considered necessary for a diagnosis? 1
Fibromyalgia Review Key components: Neuroendocrine problem Sleep disorder Tender points Add them up These add up to Central sensitization All senses are amplified, especially pain Inhibitory neurotransmitters are in low supply Hyperalgesia+ allodynia 2
Central Sensitization Pain is invisible; doesn t show on tests (except for fmri, spinal taps ) Central Sensitization Other central sensitization disorders: Post-herpetic neuralgia Diabetic neuropathy Migraine headache Complex regional pain syndrome/reflex sympathetic dystrophy syndrome 3
Central Sensitization Once the pain is self-generating, it is very hard to interrupt! Common Fibro Comorbidities Myofascial pain syndrome Depression Anxiety Myofascial Pain Syndrome Diagnosis: lots o trigger points It is common for a person with fibro to also have trigger points Pain begets pain Some controversy over whether MPS is a distinct entity 4
Trigger Point Etiology: ATP Energy Crisis Tender point etiology Non-specific histological changes Some indication of vasoconstriction in skin above tender points hypoxia an issue? Histologically normal ARRRGGGHH! Tender Points vs Trigger Points Tender points Occur in all 4 quadrants Pain is localized Hypotonic, or no palpatory phenomenon Pressureat site only causes more pain THEY ARE NOT THE SAME Trigger points Occur in clusters Pain refers to distant locations Hypertonic, twitch response Pressure at site causes local and referred pain; can interrupt contraction cycle Etiology is NOT understood Etiology is well-understood 5
Depression, Anxiety Not technically the same as major depressive disorder Leads to isolation, lack of community, poor self-care Perpetuates pain perception Fibromyalgia Symptoms Stiffness after rest Poor stamina Fatigue Fibro fog Widespread, changing pain Tender points Sensitivity amplification GI pain Diagnostic Criteria Developed for research purposes Has been used for diagnosis 6
Traditional Fibromyalgia Diagnostic Criteria Rule out other causes of pain Chronic pain, 3+ months 11/18 active tender points Persistent fatigue, non-refreshing sleep More Current Diagnostic Criteria American College of Rheumatology 2010 update Widespread Pain Index (WPI) score of 7+ Symptom Severity (SS) score of 5+ Or WPI = 3-6 and SS = 9 And Pain pattern for 3 months or more Other causes ruled out Will this solve the problem? Next Time Fibromyalgia coping and treatment strategies Conventional and complementary approaches Where does massage fit? Research findings Risks Benefits 7
Questions? Werner Workshops MT and Pathology: Cardiovascular Conditions MT and Pathology: HIV/AIDS and other Public Health Issues MT and Pathology: Gender-Based Issues MT and Pathology: Psychiatric Disorders MT and Pathology: Common and Contagious Skin Disorders The Ethics of Client Communication: Talking to Clients About Their Health Introduction to Pharmacology Webinar s Av ailable On Demand Dr. Ben Benjamin Unraveling the Mystery Series: Low Back Pain Cervical Pain Shoulder Pain Knee Pain Ankle Pain Hip & Thigh Pain Tom Myers Anatomy Trains: Clinical Applications of Myofascial Meridians Beyond Good Posture And Many More Whitney Lowe Orthopedic Approaches to Upper Body Disorders Orthopedic Approaches to Lumbo-Pelvic Pain Carole Osborne Pregnancy Massage 101 Tracy Walton Massage in Cancer Care Cardiovascular Conditions & Massage All Webinars Available at www.benbenjamin.com 24 8
Join Tom Myers & Ben Benjamin in Costa Rica Two Integrated Approaches to Shoulder Pain: Anatomy Trains & Orthopedic Massage Optional Ethics Course: Managing Challenging Conversations in Your ProfessionalLife January 5-12, 2013 25 JOIN The Benjamin Institute E-Mailing List & Receive a FREE Ebook on the Low Back 26 9