A Simple Guide to Fibromyalgia II
----------------------------------
What are the investigations needed in assessment of Fibromyalgia?
-------------------------------------------------------------------------------------
These criteria for diagnosis of Fibromyalgia:
1.history of widespread pain lasting more than three months-affecting all four quadrants of the body, i.e., both sides, and above and below the waist.
2.Tender points-there are 18 designated tender or trigger points
During diagnosis, four kilograms-force is exerted at each of the 18 points
The patient must feel pain at 11 or more of these points for fibromyalgia to be diagnosed.
3.fibromyalgia patients show sensitivity to pressure, heat, cold, electrical and chemical stimulation.
4.hyperactivity of the sympathetic nervous system
lower heart rate variability,
sympathetic hyperactivity,
5.laboratory blood testing appears normal
6.Cerebrospinal fluid abnormalities
cerebrospinal fluid levels of substance P, a putative nociceptive neurotransmitter, is raised.
Metabolites for monoamine neurotransmitters serotonin, norepinephrine, and dopamine are lower,
Nerve growth factor, a substance known to participate in structural and functional plasticity of nociceptive pathways within the dorsal root ganglia and spinal cord, is higher
Excitatory amino acid release within cerebrospinal fluid is higher
7.Brain imaging studies
Abnormal brain involvement in fibromyalgia has been provided via functional neuroimaging
decreased blood flow within the thalamus and elements of the basal ganglia and mid-brain.
Hippocampal disruption is shown by reduced brain metabolite ratios
Normal age-related brain atrophy occur with areas of reduced gray matter located in the cingulate cortex, insula and parahippocampal gyrus.
Dopamine synthesis in the brainstem is reduced.
What is the treatment for Fibromyalgia?
-------------------------------------------
There is no cure for fibromyalgia,
B.Medical treatment:
-------------------------
1.corticosteroid seems to help especially to those with adrenal dysfunction and low blood pressure.
Injection of steroids with local anethestics at trigger points or nodules can help relieve pain.
2.Analgesics are able to relieve pain:
a.NSAID medications
b.COX-2 inhibitors,
c.tramadol
3.Muscle relaxants
Muscle relaxants, such as cyclobenzaprine or tizanidine to treat the muscle pain associated with the disorder.
4.Tricyclic antidepressants
Low doses of sedating antidepressants (e.g. amitriptyline and trazodone) help to reduce the sleep disturbances associated with fibromyalgia
Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain.
5.Anti-seizure medication
Anti-seizure drugs are also sometimes used, such as gabapentin and pregabalin
Pregabalin, originally used for the nerve pain suffered by diabetics, has been approved for treatment of fibromyalgia.
6.Dopamine agonists
Dopamine agonists (e.g. pramipexole (Mirapex) and ropinirole(ReQuip)) have been studied for use in the treatment of fibromyalgia with good results
7.Combination therapy
A combination of amitriptyline and fluoxetine appeared to be more effective in relieving pain.
8.Central nervous system stimulants
Cognitive dysfunction in fibromyalgia may be treated with low doses of central nervous system (CNS) stimulants such as modafinil, adderall or methylphenidate.
Stimulants may be habit forming and can have other serious side effects
9. Cannabis and cannabinoids
Cannabis is used therapeutically to treat symptoms of the disorder.
Cannabinoid agonists can also help in the treatment of chronic pain conditions
B.Non-drug treatment
------------------------
1. regular floatation tank sessions substantially improves sleep patterns leaving users more optimistic and with reduced nervousness, tension and pain.
Relaxing in a weightless state in the silent warmth of a floatation tank activates the body's own system for recuperation and healing
2..Whirlpool therapy is very beneficial.
C.Psychological therapies
------------------------------
1.Cognitive behavioral therapy has help to improve quality of life
2.Neurofeedback has also shown to provide temporary and long-term relief
3.Biofeedback and self-management techniques such as pacing and stress management can help ,
D. Healthy lifestyle
--------------------------
1. Stop smoking in smokers.
2. Reduce weight in the obese
3. Exercise to improve blood flow can improve symptoms(sleep , pain and fatigue)
4..heat to painful areas.
5. physical therapy, massage, or acupuncture
6. reduce intake of monosodium glutamate
E Surgical treatment:
---------------------------
Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication.
F.Investigational treatments
------------------------------
a.Milnacipran, a serotonin-norepinephrine reuptake inhibitor (SNRI) has help patients in Europe.
b.Dextromethorphan is an over-the-counter cough medicine with activity as an NMDA receptor antagonist.
What is the prognosis for Fibromyalgia?
------------------------------------------------------
Fibromyalgia is not degenerative or fatal,
the chronic pain associated with fibromyalgia is pervasive and persistent.
Fibromyalgia can severely curtail social activity and recreation,
Some with fibromyalgia are unable to maintain full-time employment.
It rarely affects activities of daily living.
How can Fibromyalgia be prevented?
-----------------------------------------------------
1.Stop smoking
2.Reduce weight
3.Exercise
4.Avoid monosodium glutamate in diet
5.Avoid stress and depression
6.Live a healthy lifestyle
Showing posts with label chronic. Show all posts
Showing posts with label chronic. Show all posts
Friday, November 7, 2008
A Simple Guide to Fibromyalgia I
A Simple Guide to Fibromyalgia I
-----------------------------------------------------
What are Fibromyalgia?
---------------------------------------------
Fibromyalgia is a common nonspecific group of syndrome characterised by diffuse chronic pain, felt in and over muscle masses with focal trigger points or tender points in muscles, joints, tendons and ligaments.
Who is at risk of Fibromyalgia?
-----------------------------------------------------------------
1.genetically predisposed.
2.more females than males, with a ratio of 9:1
3.individuals between the ages of 20 and 50
4.Increased psychosocial stress
5.Excessive physical exertion
6.Lack of slow-wave sleep
7.Changes in humidity and barometric pressure
8.Lack of normal energy
What are the causes of Fibromyalgia?
-------------------------------------------------------
The exact cause of fibromyalgia is unknown.
Fibromyalgia is almost always a combination of several disorders:
1.Genetic predisposition
There is a polygenic predisposition to Fibromyalgia with high aggregation of Fibromyalgia in families
2. Stress
Stress can affect cortisol levels in the body leading to widespread pain.
3.Sleep disturbance
People with fibromyalgia has short wave sleep that do not reach stage four sleep .
4.Dopamine abnormality
Dopamine is a catecholamine neurotransmitter which can cause schizophrenia, Parkinson's disease and addiction.
Abnormality in dopamine cause increased pain perception and analgesia.
5.Serotonin
Serotonin is a neurotransmitter important in regulating sleep patterns, mood, feelings of well-being, concentration and descending inhibition of pain.
Poor uptake of serotonin can cause pain and poor sleep.
6. Human growth hormone
Stress-induced problems in the hypothalamus may lead to reduced sleep and reduced production of human growth hormone during slow-wave sleep.
People with fibromyalgia has low levels of HGH.
Treatment with exogenous HGH or growth hormone secretagogue reduces fibromyalgia related pain and restores slow wave sleep.
7.Chronic fatigue syndrome patients has been known to develop fibromyalgia between onset and the second year of illness
8.Irritable bowel syndrome is found at high frequency in fibromyalgia.
9.Deposition disease
Fibromyalgia is an inherited disorder which cause gradual phosphate build-up in cells but can be accelerated by trauma or illness.
10.Other causes:
a.viral causes such as the Epstein-Barr Virus,
b.disease affecting the hypothalamus gland,
c.immune response to intestinal bacteria
d.neurotransmitter disruptions in the central nervous system
What are the symptoms of Fibromyalgia?
----------------------------------------------
Symptoms can have a slow onset
Many patients have mild symptoms beginning in childhood.
Pain:
1.Onset of pain may be sudden
2.chronic, widespread pain and tenderness to light touch
3.muscle aches(especially lower back, gluteal, neck, chest wall)
4.prolonged muscle spasms,
5.nerve pain,
6.needle-like tingling of the skin,
Fatigue:
7.moderate to severe fatigue,
8.weakness in the limbs,
Psychosomatic disturbances:
9.functional bowel disorders
10.chronic sleep disturbances.
11.cognitive dysfunction
12.impaired concentration,
13.impaired speed of performance,
14.inability to multi-task,
15.diminished attention span
16.anxiety and depressive symptoms
Eye:
17.eye pain,
18.sensitivity to light
19.blurred vision,
20.fluctuating visual clarity,
-----------------------------------------------------
What are Fibromyalgia?
---------------------------------------------
Fibromyalgia is a common nonspecific group of syndrome characterised by diffuse chronic pain, felt in and over muscle masses with focal trigger points or tender points in muscles, joints, tendons and ligaments.
Who is at risk of Fibromyalgia?
-----------------------------------------------------------------
1.genetically predisposed.
2.more females than males, with a ratio of 9:1
3.individuals between the ages of 20 and 50
4.Increased psychosocial stress
5.Excessive physical exertion
6.Lack of slow-wave sleep
7.Changes in humidity and barometric pressure
8.Lack of normal energy
What are the causes of Fibromyalgia?
-------------------------------------------------------
The exact cause of fibromyalgia is unknown.
Fibromyalgia is almost always a combination of several disorders:
1.Genetic predisposition
There is a polygenic predisposition to Fibromyalgia with high aggregation of Fibromyalgia in families
2. Stress
Stress can affect cortisol levels in the body leading to widespread pain.
3.Sleep disturbance
People with fibromyalgia has short wave sleep that do not reach stage four sleep .
4.Dopamine abnormality
Dopamine is a catecholamine neurotransmitter which can cause schizophrenia, Parkinson's disease and addiction.
Abnormality in dopamine cause increased pain perception and analgesia.
5.Serotonin
Serotonin is a neurotransmitter important in regulating sleep patterns, mood, feelings of well-being, concentration and descending inhibition of pain.
Poor uptake of serotonin can cause pain and poor sleep.
6. Human growth hormone
Stress-induced problems in the hypothalamus may lead to reduced sleep and reduced production of human growth hormone during slow-wave sleep.
People with fibromyalgia has low levels of HGH.
Treatment with exogenous HGH or growth hormone secretagogue reduces fibromyalgia related pain and restores slow wave sleep.
7.Chronic fatigue syndrome patients has been known to develop fibromyalgia between onset and the second year of illness
8.Irritable bowel syndrome is found at high frequency in fibromyalgia.
9.Deposition disease
Fibromyalgia is an inherited disorder which cause gradual phosphate build-up in cells but can be accelerated by trauma or illness.
10.Other causes:
a.viral causes such as the Epstein-Barr Virus,
b.disease affecting the hypothalamus gland,
c.immune response to intestinal bacteria
d.neurotransmitter disruptions in the central nervous system
What are the symptoms of Fibromyalgia?
----------------------------------------------
Symptoms can have a slow onset
Many patients have mild symptoms beginning in childhood.
Pain:
1.Onset of pain may be sudden
2.chronic, widespread pain and tenderness to light touch
3.muscle aches(especially lower back, gluteal, neck, chest wall)
4.prolonged muscle spasms,
5.nerve pain,
6.needle-like tingling of the skin,
Fatigue:
7.moderate to severe fatigue,
8.weakness in the limbs,
Psychosomatic disturbances:
9.functional bowel disorders
10.chronic sleep disturbances.
11.cognitive dysfunction
12.impaired concentration,
13.impaired speed of performance,
14.inability to multi-task,
15.diminished attention span
16.anxiety and depressive symptoms
Eye:
17.eye pain,
18.sensitivity to light
19.blurred vision,
20.fluctuating visual clarity,
Saturday, September 27, 2008
A Simple Guide to Acne Rosacea
A Simple Guide to Acne Rosacea
-----------------------------------------------
What is Acne Rosacea?
----------------------------------
Acne Rosacea is a chronic inflammatory disease of the skin which typically redness of the cheeks with maculopapular rashes.
Who Gets Acne Rosacea?
-----------------------
Acne Rosacea occurs more in females than in males.
It is also more common in the middle ages.
It is rare in children
What causes Acne Rosacea?
-------------------------------------
The cause of Acne Rosacea is unknown.
Some possible causes are:
1.menopause with flushing of the face due to hormonal
2.Excessive sebum production in the sebaceous glands
3.stress aggravate the condition
4.Alcohol and certain foods(seafood with its high histamine content, spicy food) can cause flushing
What are the symptoms of Acne Rosacea?
-------------------------------------------------
Onset is sudden or gradual.
They may last weeks or months and be recurrent.
Frequently they become chronic.
The typical rash of Acne Rosacea is well-defined :
1.red (rosy cheek)
2.small blood vessel seen in rashes
3.hypertrophic sebaceous glands without blockage of ducts
4.papular rash.
5.Typically on forehead, cheeks, nose, chin or center of face
6.Associated seborrheic dermatitis of the scalp(dandruff)and eyelids (blepharitis)
7.Eye lesions may include:
tearing of eyes
photophobia
visual disturbances
corneal infections
conjunctivitis
How does Acne Rosacea affects the Patient?
-----------------------------------------
All types of Acne Rosacea can affect a person’s quality of life.
1.Appearance of face
2.Blood vessel on nose
3.papular rashes on the face
What is the Treatment of Acne Rosacea?
-----------------------------------
Treatment depends on the severity and type of Acne Rosacea.
1.mild cases may not require any treatment
2.Avoid food that can cause flushing such as alcohol, spicy foods, hot drinks
3.Avoid stress and tension
Treatments:
1.Topical Medicines include:
sulphur containing creams and shampoo to dry the oil from the skin
2.Systemic antibiotics like tetracycline or erythromycin
3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A radiation)
4.Avoid corticosteroids which usually make the condition worse
5.Surgical treatment of rhinophyma and laser treatment of dilated blood vessels
At the present moment there is no known cure for Acne Rosacea.
Medicines have been able to reduce the severity of inflammation and improve the quality of life.
What is the Prognosis of Acne Rosacea?
-----------------------------------------------
There is generally no cure for Acne Rosacea.
Treatment is good with prolonged antibiotic therapy.
Lifelong treatment may be necessary to control signs and symptoms.
-----------------------------------------------
What is Acne Rosacea?
----------------------------------
Acne Rosacea is a chronic inflammatory disease of the skin which typically redness of the cheeks with maculopapular rashes.
Who Gets Acne Rosacea?
-----------------------
Acne Rosacea occurs more in females than in males.
It is also more common in the middle ages.
It is rare in children
What causes Acne Rosacea?
-------------------------------------
The cause of Acne Rosacea is unknown.
Some possible causes are:
1.menopause with flushing of the face due to hormonal
2.Excessive sebum production in the sebaceous glands
3.stress aggravate the condition
4.Alcohol and certain foods(seafood with its high histamine content, spicy food) can cause flushing
What are the symptoms of Acne Rosacea?
-------------------------------------------------
Onset is sudden or gradual.
They may last weeks or months and be recurrent.
Frequently they become chronic.
The typical rash of Acne Rosacea is well-defined :
1.red (rosy cheek)
2.small blood vessel seen in rashes
3.hypertrophic sebaceous glands without blockage of ducts
4.papular rash.
5.Typically on forehead, cheeks, nose, chin or center of face
6.Associated seborrheic dermatitis of the scalp(dandruff)and eyelids (blepharitis)
7.Eye lesions may include:
tearing of eyes
photophobia
visual disturbances
corneal infections
conjunctivitis
How does Acne Rosacea affects the Patient?
-----------------------------------------
All types of Acne Rosacea can affect a person’s quality of life.
1.Appearance of face
2.Blood vessel on nose
3.papular rashes on the face
What is the Treatment of Acne Rosacea?
-----------------------------------
Treatment depends on the severity and type of Acne Rosacea.
1.mild cases may not require any treatment
2.Avoid food that can cause flushing such as alcohol, spicy foods, hot drinks
3.Avoid stress and tension
Treatments:
1.Topical Medicines include:
sulphur containing creams and shampoo to dry the oil from the skin
2.Systemic antibiotics like tetracycline or erythromycin
3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A radiation)
4.Avoid corticosteroids which usually make the condition worse
5.Surgical treatment of rhinophyma and laser treatment of dilated blood vessels
At the present moment there is no known cure for Acne Rosacea.
Medicines have been able to reduce the severity of inflammation and improve the quality of life.
What is the Prognosis of Acne Rosacea?
-----------------------------------------------
There is generally no cure for Acne Rosacea.
Treatment is good with prolonged antibiotic therapy.
Lifelong treatment may be necessary to control signs and symptoms.
Thursday, September 4, 2008
A Simple Guide to Lichen Planus
A Simple Guide to Lichen Planus
-----------------------------------------------
What is Lichen Planus?
----------------------------------
Lichen Planus is a chronic inflammatory disease of the skin which typically consists of red small papules that joined together to from rough scaly patches.
It is often associated with lesions of the mucosal membranes.
What are the types of Lichen Planus?
--------------------------------
There are 2 main types:
1.Skin Lichen Planus is the most common type of Lichen Planus.
About 80% of people have red small papules that joined together to from rough scaly patches.
The skin usually grows very more quickly and are thicker than usual.
2.Mucosal Lichen Planus (small, red papular lesion of the mouth and mucous membranes)
Who Gets Lichen Planus?
-----------------------
Lichen Planus occurs more in females than in males.
It is also more common in the middle ages.
It is rare in children
What causes Lichen Planus?
-------------------------------------
The cause of Lichen Planus is unknown.
1.allergic reactions to medications for high blood pressure(methyl dopa) and arthritis (chloroquine and salicylates),arsenic, gold.
2.chronic hepatitis C virus infection
3.stress aggravate the condition
4.Allergic reactions to amalgam and gold filling can cause oral lesions
What are the symptoms of Lichen Planus?
-------------------------------------------------
Onset is sudden or gradual.
They may last weeks or months and be recurrent.
Frequently they become chronic.
The typical rash of lichen planus is well-defined :
1.pruritic,
2.planar,
3.purple,
4.polygonal
5.papules.
When seen under the microscope the papules have characteristic network of white lines(Wickham's striae)
Lesions are symmetrical, usually on flexor surfaces of the arm near the wrist and the ankle.
Nails are frequently involved with pitting and thinning of the nail plate.
Oral lichen planus occurs in 50% of patients:
1. reticular form - most common rash, occurs as white streaks on the mucosa (known as Wickham's striae) or papules with small raised area .
The lesions are present on the gums, the tongue, palate and lips.
The lesions are present on both sides of the mouth
2. bullous form - fluid-filled vesicles
3. erosive form - erythematous (red) areas which are ulcerated.
This form may become malignant.
Microscopic appearance is typical of lichen planus:
1.Hyperparakeratosis or thickening of the granular cell layer
There is a typical saw-tooth appearance of the rete pegs
2.Degenerated basal cell layer
3.Inflammatory cells present in subepithelial layer of connective tissue
Lichen planus may involve the glan penis and vulvovaginal mucosa
Lichen planus rarely involve the eosophagus where it can cause erosive esophagitis and stricturing.
How does Lichen Planus affects the Patient?
-----------------------------------------
All types of Lichen Planus can affect a person’s quality of life.
Itching, soreness, and ulcers of the mouth are common.
What is the Treatment of Lichen Planus?
-----------------------------------
Treatment depends on the severity and type of Lichen Planus.
1. mild cases may not require any treatment
2.severe Lichen Planus have lesions that affects most of the body and hospitalization is required.
3.Most cases of Lichen Planus lie in between.
Treatments:
1.Topical Medicines include:
topical steroids.
tar lotions, ointments, creams, and shampoo
2.Systemic therapy (oral drugs that affect the whole body system):
cyclosporins, methotrexate
immunosuppressant medications
Oral retinoids
Oral corticosteroids
hydroxychloroquine
tacrolimus
dapsone
3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A, radiation)
4.Combined therapy are frequently used.
5.new therapies such as the biologic agents has improved the condition
At the present moment there is no known cure for lichen planus.
Medicines have been able to reduce the severity of inflammation and improve the quality of life.
Other medicines are used to treat symptoms:
1.Antihistamines for itch
2.Oral topical steroids for mouth ulcers
What is the Prognosis of Lichen Planus?
-----------------------------------------------
There is generally no cure for lichen planus.
Lichen planus may become dormant after being treated.
Recurrences are common even years after being dormant.
Lifelong treatment may be necessary to control signs and symptoms.
-----------------------------------------------
What is Lichen Planus?
----------------------------------
Lichen Planus is a chronic inflammatory disease of the skin which typically consists of red small papules that joined together to from rough scaly patches.
It is often associated with lesions of the mucosal membranes.
What are the types of Lichen Planus?
--------------------------------
There are 2 main types:
1.Skin Lichen Planus is the most common type of Lichen Planus.
About 80% of people have red small papules that joined together to from rough scaly patches.
The skin usually grows very more quickly and are thicker than usual.
2.Mucosal Lichen Planus (small, red papular lesion of the mouth and mucous membranes)
Who Gets Lichen Planus?
-----------------------
Lichen Planus occurs more in females than in males.
It is also more common in the middle ages.
It is rare in children
What causes Lichen Planus?
-------------------------------------
The cause of Lichen Planus is unknown.
1.allergic reactions to medications for high blood pressure(methyl dopa) and arthritis (chloroquine and salicylates),arsenic, gold.
2.chronic hepatitis C virus infection
3.stress aggravate the condition
4.Allergic reactions to amalgam and gold filling can cause oral lesions
What are the symptoms of Lichen Planus?
-------------------------------------------------
Onset is sudden or gradual.
They may last weeks or months and be recurrent.
Frequently they become chronic.
The typical rash of lichen planus is well-defined :
1.pruritic,
2.planar,
3.purple,
4.polygonal
5.papules.
When seen under the microscope the papules have characteristic network of white lines(Wickham's striae)
Lesions are symmetrical, usually on flexor surfaces of the arm near the wrist and the ankle.
Nails are frequently involved with pitting and thinning of the nail plate.
Oral lichen planus occurs in 50% of patients:
1. reticular form - most common rash, occurs as white streaks on the mucosa (known as Wickham's striae) or papules with small raised area .
The lesions are present on the gums, the tongue, palate and lips.
The lesions are present on both sides of the mouth
2. bullous form - fluid-filled vesicles
3. erosive form - erythematous (red) areas which are ulcerated.
This form may become malignant.
Microscopic appearance is typical of lichen planus:
1.Hyperparakeratosis or thickening of the granular cell layer
There is a typical saw-tooth appearance of the rete pegs
2.Degenerated basal cell layer
3.Inflammatory cells present in subepithelial layer of connective tissue
Lichen planus may involve the glan penis and vulvovaginal mucosa
Lichen planus rarely involve the eosophagus where it can cause erosive esophagitis and stricturing.
How does Lichen Planus affects the Patient?
-----------------------------------------
All types of Lichen Planus can affect a person’s quality of life.
Itching, soreness, and ulcers of the mouth are common.
What is the Treatment of Lichen Planus?
-----------------------------------
Treatment depends on the severity and type of Lichen Planus.
1. mild cases may not require any treatment
2.severe Lichen Planus have lesions that affects most of the body and hospitalization is required.
3.Most cases of Lichen Planus lie in between.
Treatments:
1.Topical Medicines include:
topical steroids.
tar lotions, ointments, creams, and shampoo
2.Systemic therapy (oral drugs that affect the whole body system):
cyclosporins, methotrexate
immunosuppressant medications
Oral retinoids
Oral corticosteroids
hydroxychloroquine
tacrolimus
dapsone
3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A, radiation)
4.Combined therapy are frequently used.
5.new therapies such as the biologic agents has improved the condition
At the present moment there is no known cure for lichen planus.
Medicines have been able to reduce the severity of inflammation and improve the quality of life.
Other medicines are used to treat symptoms:
1.Antihistamines for itch
2.Oral topical steroids for mouth ulcers
What is the Prognosis of Lichen Planus?
-----------------------------------------------
There is generally no cure for lichen planus.
Lichen planus may become dormant after being treated.
Recurrences are common even years after being dormant.
Lifelong treatment may be necessary to control signs and symptoms.
Subscribe to:
Posts (Atom)
Subscribe Now: Feed Icon
Click and bookmark these Social Networking Bookmarks
