CHRONIC FATIGUE SYNDROME,FIBROMYALGIA and RELATED CONDITIONS. Rosamund Vallings MB BS
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1 CHRONIC FATIGUE SYNDROME,FIBROMYALGIA and RELATED CONDITIONS Rosamund Vallings MB BS
2 Tired all the time
3
4 Who gets CFS/FM
5 PREDISPOSING FACTORS VIRAL ILLNESS STRESS PERSONALITY SEX OVER-EXERCISE/INJURY SLEEP DEFICIT GENETIC
6 CDC Criteria (Fukuda et al) Unexplained persistent or relapsing fatigue, of new or definite onset, not due to ongoing exertion, not relieved by rest, and results in substantial reduction in previous levels of activity 4 or more of defined symptoms concurrently present for 6 months or longer:
7 CDC Criteria defined symptoms 1. impaired memory/concentration 2. sore throat 3. tender cervical or axillary nodes 4. muscle pain 5. multi joint pain (no redness/tenderness) 6. new headache 7. unrefreshing sleep 8. post-exertional malaise
8 DIAGNOSIS OF FM EXCLUSION OF OTHER DISORDERS ASSOCIATION WITH OTHER ILLNESS (eg CFS,PPS,SLE,LYME etc) STAND ALONE CONDITION CHRONIC PAIN SYNDROME VALIDITY OF PRESSURE POINTS
9 DIAGNOSIS (CDC criteria) History Examination Laboratory testing Other available tests Specific symptom related screening Psychological assessment
10 DIAGNOSIS A DIAGNOSIS OF EXCLUSION SUB-CATEGORIZATION ONGOING SURVEILLANCE 30% EVENTUAL ALTERNATIVE DIAGNOSES
11
12 CARDIOVASCULAR RESEARCH BP, TILT TABLE (Rowe) BLOOD VOLUME (Bell) ECG (Lerner) RBC RHEOLOGY (Simpson)
13 RESPIRATORY STUDIES HVS (Clifton) EXERCISE TESTS (McCluskey) SINUS ISSUES (Bartley)
14 NEUROLOGICAL RESEARCH BRAINSCANS:CT, MRI, SPECT (Mena) ION CHANNELOPATHY (Chaudhuri)
15 GASTRO-ENTEROLGY RESEARCH E.COLI /ENTEROCOCCUS (Butt et al) H PYLORI GIARDIA (Snow) MOTILITY (Burnett) FOOD INTOLERANCES (Burnett) NB candida NOT involved
16 BIOCHEMISTRY ELECTROLYTES: Mg (Cox), K (Burnett) LIPIDS (McGregor) AMINO ACIDS (Dunstan) CARNITINE (Kuratsune) B12/HOMOCYSTEINE (Snorrasen, Lapp)
17 IMMUNOLOGY CYTOKINES (Klimas) NK CELLS (Klimas) IMMUNOGLOBULINS (Dwyer) RNaseL (Suhadolnik) ALLERGY/SENSITIVITY
18 MICROBIOLOGY VIRAL BACTERIAL Mycoplasma (Nicholson) Staph toxin (Roberts) Lyme disease (Harvey) FUNGAL PARASITES Giardia (Snow)
19 TOXICOLOGY CIGUATERA (Pearn) MERCURY (Dunstan) LEAD
20 RHEUMATOLOGY FM POINTS STRENGTH/WEAKNESS EXERCISE Muscle fatigue (Natelson) REE (Watson) Lactate Carnitine (Kuratsune) Endurance (Behan)
21 SLEEP STUDIES LOSS OF LEVEL 4 SLEEP (Moldofsky) DECREASED REM SLEEP (Moldofsky)
22 Normal sleep cycle
23 Psychological testing COGNITION (de Luca) REACTION TIMES DEPRESSION/ANXIETY SCALES BIPOLAR DISORDER
24 GENETIC STUDIES TWINS (Buchwald) FAMILY TREES (Levine) SPECIFIC GENES (Behan, Kerr) LINKS WITH OTHER DISEASES GENE ARRAY (Kerr,Gow)
25 H0RMONE STUDIES HPA (Cleare, Demitrack)) GROWTH HORMONE THYROID (Teitelbaum) OESTROGEN (Studd)
26 TESTS OF LITTLE USE (Shepherd) HAIR ANALYSIS SALIVARY TESTS MERCURY AMALGAM EAV
27
28 MANAGEMENT CORRECT DIAGNOSIS ACKNOWLEDGEMENT/SUPPORT EDUCATION LIFESTYLE Stress (Friedberg, Sharpe) Exercise/rest (Fulcher&White, Lapp) Nutrition Supplements Sleep management
29 STRESS MANAGEMENT ACKNOWLEDGE DEFINE CATEGORISE MANAGE RELAXATION STRATEGIES COUNSELLING
30 EXERCISE NONE LEADS TO POOR OUTCOME TOO MUCH LEADS TO RELAPSE NEEDS TO BE REGULAR/OUTSIDE START AT LOW LEVEL LITTLE and OFTEN PREPARATION and REST BUILD SLOWLY AVOID CRASH and BURN
31 NUTRITION BALANCED DIET/VARIETY SMALL REGULAR MEALS MINIMISE ALCOHOL, CAFFEINE AVOID RICH FATTY FOODS PLENTIFUL FLUIDS (not excess) SALT SUNSHINE
32 SUPPLEMENTS BETTER ABSORBED VIA FOOD DEFICIENCIES IN BLOOD DEFICIENCIES IN DIET TREATMENT OF CONDITION OMEGA 3/OMEGA 6 OILS B VITAMINS (B12 INJECTIONS) MAGNESIUM (MALIC ACID) COENZYME Q-10 AVOID VIT C EXCESS
33 SLEEP MANAGEMENT GOOD ROUTINE SLEEP HYGIENE TRICYCLICS MELATONIN ANTIHISTAMINES MUSCLE RELAXANTS BENZODIAZEPINES
34 MEDICATION SLEEP DEFICIT INCREASE BLOOD VOLUME PAIN CONTROL DEPRESSION and ANXIETY HRT (Studd) CENTRAL ACTIVATION ANTIMICROBIALS (Straus, Nicholson) AMPLIGEN ISOPRINOSINE
35 PAIN CONTROL WARMTH, MASSAGE, RELAXATION ACUPUNCTURE, HYPNOSIS SIMPLE ANALGESICS STRONG ANALGESICS OPIOIDS RELAXANTS ANTI-EPILEPTICS
36 NATURAL/HERBAL MEDICATION BEWARE OF FALSE CLAIMS, EXPENSE CARE WITH MIXED CONCOCTIONS SLEEP (kava, valerian) PAIN (willow bark) DEPRESSION (St Johns wort) COGNITION (gingko) AVOID: adrenal support, immune boosters?dhea
37 ONGOING ISSUES AVOIDANCE OF RELAPSE REGULAR REVIEW MULTIDISCIPLINARY TEAM RECOVERY RATES GENE STUDIES
38 PATIENT PROFILES GENUINE CLASSIC CFS/FM FIT CRITERIA but SUBCATEGORISED CFS/FM + PSYCHIATRIC PROBLEM THICKFILE COMPLEX PATIENT with FUNCTIONAL SOMATISATION DISORDER OTHER DIAGNOSIS
39 Rehabilitation
40
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