More research is needed, particularly on why men who reported FM symptoms were less likely than women to receive a FM diagnosis, says lead author of a recent study, Ann Vincent, M.D., medical director of Mayo Clinic‘s Fibromyalgia and Chronic Fatigue Clinic. “Health care providers may not think of this diagnosis when face to face with a male patient with musculoskeletal pain and fatigue,” Dr. Vincent says. “These findings need to be explored further.”
Researchers focused on Olmsted County, Minn., home to the comprehensive medical records pool known as the Rochester Epidemiology Project, and used two methods to try to discover the number of people over age 21 with FM.
To the best of my knowledge, this is the first report of the rate at which FM is being diagnosed (or undiagnosed) in a community. This is also the first report of prevalence as assessed by the FM research survey criteria.
Firstly, they used the epidemiology project to identify just over 3,000 patients who looked like they might have FM: only a third had a documented FM diagnosis. That amounted to 1.1 per cent of the county’s population 21 and older.
In the second method, researchers randomly surveyed Olmsted County adults using the American College of Rheumatology‘s fibromyalgia research survey criteria. The criteria include the hallmarks of FM: widespread pain and tenderness, fatigue, feeling unrested after waking, problems with memory or thinking clearly and depression or anxiety, among other symptoms. Of the 830 who responded to the survey, 44, or 5.3 per cent, met those criteria, but only a dozen had been diagnosed with FM.
Based on the study’s findings, the researchers estimate that 6.4 per cent of people 21 and older in Olmsted County have FM—far more than have been officially diagnosed with it.
The study found that the discrepancy between the number of people reporting FM symptoms and the number actually diagnosed with the condition was greatest among men. Twenty times more men appeared to have FM based on their survey response than had been diagnosed, while three times more women reported FM symptoms than were diagnosed.
“It is important to diagnose fibromyalgia because we have effective treatments for the disorder,” says co-author Daniel Clauw, M.D., director of the University of Michigan Health System Chronic Pain & Fatigue Research Center. Do we?
- Research Mad! (fibromodem.wordpress.com)
This image, from a Brigham and Women’s Hospital study, shows the Default Mode Network in patients with chronic low back pain (cLBP) and in healthy subjects (CONTROLS) before and after manoeuvres which are painful for the cLBP but not for the CONTROLS.
Notice that after the manoeuvres, the cluster in the front of the brain is disrupted (it shows less colour) in the cLBP patients, but not in the CONTROLS. This supports the study finding that pain changes brain connectivity.
Scientists have long searched for a method to objectively measure pain and a new study from Brigham and Women’s Hospital advances that effort. The study appears in the January 2013 print edition of the journal Pain.
“While we need to be cautious in the interpretation of our results, this has the potential to be an exciting discovery for anyone who suffers from chronic pain,” said Marco Loggia, PhD, the lead author of the study and a researcher in the Pain Management Center at BWH and the Department of Radiology at Massachusetts General Hospital. “We showed that specific brain patterns appear to track the severity of pain reported by patients, and can predict who is more likely to experience a worsening of chronic back pain while performing manoeuvres designed to induce pain. If further research shows this metric is reliable, this is a step toward developing an objective scale for measuring pain in humans.”
Specifically, researchers studied 16 adults with chronic back pain and 16 adults without pain and used a brain imaging technique called arterial spin labelling to examine patterns of brain connectivity (that is, to examine how different brain regions interact). They found that when a patient moved in a way that increased their back pain, a network of brain regions called Default Mode Network exhibited changes in its connections. Regions within the network (such as the medial prefrontal cortex) became less connected with the rest of the network, whereas regions outside the network (such as the insula) became connected with this network. Some of these observations have been noted in previous studies of FM patients, which suggests these changes in brain connectivity might reflect a general feature of chronic pain, possibly common to different patient populations.
“This is the first study using arterial spin labelling to show common networking properties of the brain are affected by chronic pain,” said study author Ajay Wasan, MD, MSc, Director of the Section of Clinical Pain Research at BWH. “This novel research supports the use of arterial spin labelling as a tool to evaluate how the brain encodes and is affected by clinical pain, and the use of resting default mode network connectivity as a potential neuro-imaging biomarker for chronic pain perception.”
- Discovery could eventually help diagnose and treat chronic pain (eurekalert.org)
- Why Do We Feel Pain? (everydayhealth.com)
- Default-Mode Network (dranilj1.wordpress.com)
Now, I jotted down notes about what happened last night (in really bad hand-writing). I’ll let you know why at the end but here are my contemporaneous notes:
- Dinner – 6pm
- Bing for My Nurse (MN) – tummy cannula hurting. Unknown Nurse (UN) arrives – MN is on dinner break: wait ‘til then? Sure, ok.
- Ketamine alarm goes off – empty bag. UN comes in, turns off alarm: will be back to change bag.
- Alarm goes off again. UN returns: right back with another nurse (Ketamine protocol)
- Alarm goes off again. UN changes bag. MN will still come in after her dinner break.
- Wait 15 minutes – pain increasing. No, it is not the drugs making me feel things!
- Bing for MN: no-one comes.
- Get up to go to nurse’s desk. MN and I return to room to check out site.
- Need to change cannula site. Try 4 different places before finding good vein.
- Ice tummy site as all swollen, inflamed and burning.
- Feels like site is being torn open. Very hot!
- Ask to see member of the pain team.
- New Nurse (BN – Bitch Nurse) appears: Are you crying? Yes. Crying will make you feel worse. I know, but I hurt – I would like to see a member of my pain team. We have paged some-one, now stop crying!
- 8.30pm – ask BN for valium. Told to stop crying again.
- Between 10-10.30pm – Pain member arrives and prescribes antihistamine. Between BN and pain member, I feel like they think I am making up the pain; that I’m crazy but even I can see that my tummy is swollen, red, lumpy and burning hot.
- Midnight – ask for seroquil when vitals being taken
- 1.10am – BN changes bag without another nurse (protocols?)
- 2.30am – ask for another valium
- 4am – BN takes vitals – hoping to just get through the night. Have never felt this kind of pain before.
- 7am – BN changes bag, still without another nurse!
- 8am – Morning nurse takes vitals – Yippee! I survived!
Now the main reason I wrote all of this down was because I seriously thought something major was wrong with me and that I was being held prisoner in my hospital room. I could have called Mommy to take me away but where were we going to go? A hospital?
Supposedly, I had an allergic reaction – it could have been to the dressings, the cannula or the ketamine – and 24 hours later, I am still in pain (but much less, thank you). Just like I would never complain to a waitress before I had completed my meal (she might spit in my food!), I didn’t complain or make a scene but, needless to say, I have written an appropriate complaint to the hospital management.
Gotta say – so far, I would NEVER, EVER do this again!
- Treading Murky Waters (fibromodem.wordpress.com)
- Abracadabra! And the Pain has Disappeared? (fibromodem.wordpress.com)
Tender points are pain points or localized areas of tenderness around joints, but not the joints themselves. These tender points hurt when pressed with a finger. Tender points are often not deep areas of pain. Instead, they are superficial areas seemingly under the surface of the skin, such as the area over the elbow or shoulder.
The actual size of the point of most tenderness is usually very small, about the size of the tip of your thumb. These areas are much more sensitive than other nearby areas. In fact, pressure on one of the tender points with a finger will cause pain that makes the person flinch or pull back. Tender points are scattered over the neck, back, chest, elbows, hips, buttocks, and knees.
The cause of these pressure points is not known. Even though it feels like these areas are inflamed, researchers have not found particular signs of inflammation when examining the tissue. What is known is that the locations of tender points are not random. They occur in predictable places on the body. That means many people with FM experience similar symptoms with tender points.
There are 18 tender points important for the diagnosis of FM (see illustration below).
These tender points are located at various places on your body. To get a medical diagnosis of FM, 11 of 18 tender point sites must be painful when pressed. In addition, the symptom of widespread pain must have been present for three months.
Your doctor can test the painful tender points during an examination. Yet even with tender points, you need to tell your doctor about the exact pain you feel in those areas. You also need to tell the doctor about your other symptoms, such as deep muscle pain, fatigue, sleep problems, depression, irritable bowel syndrome, and more. It is often best you maintain a symptom diary/log and take it with you to your doctor (see Improving Patient-Doctor Communication)
If you don’t explain all your symptoms fully to your doctor, the doctor will not be able to effectively(?) treat the FM. As a result, you won’t get any relief from the chronic pain and other symptoms.
When a doctor tests tender points for pain, he or she will also check “control” points or other non-tender points on your body to make sure you don’t react to these as well. Some physicians use a special instrument called a ‘doximeter’ or ‘dolorimeter’ to apply just the right amount of pressure on tender points.
Pain management for tender points with FM involves a multifaceted treatment program that employs both conventional and alternative therapies. While the reason is not entirely clear, FM pain and fatigue sometimes respond to low doses of antidepressants. However, the treatment forFM and tender points involves medications, daily stress management, exercise, hydrotherapy using heat and ice, and rest. Other remedies for symptoms may also be used.
- Hi Ho! Hi Ho! Off to the Doc We Go! (fibromodem.wordpress.com)
- A Magic Pill? Not! (fibromodem.wordpress.com)
After another uncomfortable visit to the toilet, I decided to Google ‘Focal Nodular Hyperplasia’ and ‘IBS.’ I found absolutely nothing that linked the two but I did find another study that shows that nearly all patients with Irritable Bowel Syndrome and Diarrhea (IBS-D) actually have a different condition!
It was found that patients thought to have IBS-D – a condition which affects up to 15 per cent of the US population (35 million Americans (US study so US statistics – I’m sure the figures apply to other countries, too)) – may in fact have a different condition altogether.
This was the largest study to date and indicates that doctors may use IBS-D as a blanket diagnosis, rather than cite a collection of separate medical conditions.
According to the study, 98 per cent of participants were found to have a diagnosis different from the initial presentation of IBS-D. This study refutes the existence of IBS-D as a single medical entity and implies that this diagnosis is simply a catch-all diagnosis. The findings also revealed that 68 per cent of the participants actually had conditions related to treatable (that means that 68 per cent of us could actually feel better!) bile acid induced diarrhea as a result of gallbladder dysfunction.
A dysfunctional gallbladder that produces an abnormal amount of bile causing chronic diarrhea can be very treatable, as opposed to IBS, for which physicians and patients often search for treatment to alleviate the discomfort, often to no avail.
According to the study, once patients were accurately diagnosed, 98 per cent experienced a favourable response (that is, the elimination of urgency and incontinence for at least three months). Wouldn’t that be nice? The end of a lifetime of discomfort, unease and frustration!
“The results of this study demonstrate quite convincingly that many patients may needlessly be going through the physical and emotional pain of IBS and functional diarrhea when, in reality, they may be afflicted with something else that is easily treatable,” said Saad F. Habba, M.D., gastroenterologist at Overlook Hospital and the study author.
- 41 per cent were found to have Habba Syndrome (a relatively new entity relating dysfunctional gallbladder with chronic diarrhea , which is successfully treated with bile acid binding agents);
- 23 per cent of the study subjects were diagnosed with post cholecystectomy diarrhea;
- 8 per cent had lactose intolerance; and
- 7 per cent had microscopic colitis.
Doesn’t quite add up to the 98 per cent – but it still shows that there is some hope!
- And It All Comes Back to the Poo! (fibromodem.wordpress.com)
- IBS Affects from 10% to 15% of the U.S. Population, Says the International Foundation for Functional Gastrointestinal Disorders (prweb.com)
Today is MRI (Magnetic resonance imaging) day.
I received a phone call, from the place where it is all happening, telling me that, because the MRI is on my liver, I am not permitted to be sedated via IV, although I am permitted to have an oral sedative. (It seems that I have to be awake enough to breathe in when they tell me.)
An MRI is a scan used for a medical imaging procedure. It uses a magnetic field and radio waves to take pictures inside the body. It is especially helpful to collect pictures of soft tissue such as organs and muscles that don’t show up on x-ray examinations. It is especially loud, too.
That is why I needed to be sedated – I can’t handle the noise. The term for this is “misophonia,” where sounds can cause severe reactions in people. For me it is the clicking of heels on pavement, a lawn mower, too many people talking at once, humming of a motor or heating system, a baby crying, the car radio when I enter a car…the list is endless. Even more alarming is an unexpected loud noise, such as a motorcycle or firecrackers. I realise that most people can find many of these sounds alarming, but for those with misophonia, the auditory nervous system is in overdrive. I believe that those of us with a hyper-aroused nervous system suffer universally from anxiety and not only do we experience a visceral response to violence, but to anything that startles or is grating to the ears and can raise our anxiety level.
Dr Aage Moller, the neuroscientist at the University of Texas who specializes in the auditory nervous system, believes there is “no known effective treatment”. Dr Moller “believes the condition is hard-wired, like right, or left-handedness, and is probably not an auditory disorder but a “physiological abnormality” that resides in brain structures activated by processed sound”.
My strategy (perhaps the only one) is to fill my day with lovely sounds that bring about joy instead of irrational fear, such as certain music, and listen to people who have soothing voices; but, tomorrow, I’m not going to have a choice.
So, half an hour before this MRI, I have been told to take 5 of my Valium by my GP. I think I’ll take a Panadeine Forte, too, for just in case.
How an MRI works
The MRI scan consists of a table that slides into a large cylinder. Inside the cylinder is a magnet that, when operated, creates a powerful magnetic field.
Soft tissue contains water molecules and the magnetic field acts upon microscopic substances (called protons) found in water. The magnetised protons in the soft tissue send out an echo in response to the MRI scan’s radio waves. A computer then organises these echoes into images.
The MRI scan operator (radiographer) will take cross-sectional images of my body from almost every angle.