All science is work in progress: read critically for best results.
SOME TOPICS AT THE 28th ANNUAL MTG OF THE ACADEMY OF INTEGRATIVE PAIN MANAGEMENT (AIPM), San Diego, October 19 - 22, 2017 included:
“Eliminating Opioids for Chronic Pain Unwise?” https://www.medscape.com/viewarticle/887891
“Pain Experts Push for Coverage of Alternative Therapies” https://www.medscape.com/viewarticle/887500
Clinicians, health insurers, and other stakeholders have initiated meetings that many pain experts hope will result in extending insurance coverage to include yoga, acupuncture, and other integrated approaches to pain management.
The first-ever Integrative Pain Care Policy Congress was launched ... at [AIPM 28, with] More than 50 delegates… from professional associations, public and private insurers, patient advocacy groups, and others ... meeting behind closed doors to discuss the possibility of [covering] complementary and alternative medicine (CAM) approaches to pain management.
Many experts believe such a move would improve the lives of millions of Americans who suffer from chronic pain while saving billions of healthcare dollars and reducing opioid prescribing...
“Medical Food May Help Control Inflammatory Pain” https://www.medscape.com/viewarticle/887497 [Medical foods are “specially formulated ... for the [medical] dietary management of a disease that has distinctive nutritional needs that cannot be met by normal diet alone...”]
“Heart Rate Variability Biofeedback Promising in [veterans’] Chronic Pain” https://www.medscape.com/viewarticle/887600
N.B. Medscape is a mostly-plain-English news/research-reportage/reference service geared for healthcare professionals, but FREE to all — the registration form appears when you first click on a Medscape link [if you register with a screen-name for privacy, pick one not undermining impact of your comments at the site]. Many articles combine transcript with video, slide-show, and teaching/learning quizes.
”Excess Immune Activity Can Cause Systemic Metabolic Changes”
https://medicalxpress.com/news/2017-10-immune-cells-behavioral.html
[Japan’s] RIKEN Center for Integrative Medical Sciences … and collaborators have found that T cells—immune cells that help to protect the body from infections and cancer—change the body's metabolism when they are activated, and that this activation actually leads to changes in behavior.
Knowing that infection-activated T cells change to meet their individual energy needs, researchers designed mice lacking inhibition of that response, and found that amino acids —molecules that compose proteins— became depleted in blood and many organs of the body, and increased in T cells and lymph nodes. The mice showed behavioral changes typical of increased anxiety and fear [beyond what we’d expect if WE were being used as lab rats] and their brain chemistry was found notably low in amino acids tryptophan and tyrosine. Tryptophan is a necessary precursor of serotonin [delicately balanced in bone metabolism, strongly involved in intestinal motion, vaso-modulation, mood, appetite, sleep, memory, learning, motivation, etc., etc.,], a monoamine neurotransmitter many licit and illicit drugs rely upon to affect mood, itself affected by and affecting pain…
“ 'Massive' Suffering: Pain Relief in Less Affluent Countries” https://www.medscape.com/viewarticle/887209
Palliative care and pain relief continue to remain neglected elements of global healthcare, according to a major new article published online October 13 [2917] in the Lancet. The report is the first to provide a worldwide estimate of the extent of serious suffering related to illness and injury and the resultant need for palliative care and pain relief.
More than 25.5 million people die every year without adequate relief for serious physical and psychological suffering ― nearly half of all deaths reported in 2015. The report also states that an additional 35.5 million people require pain relief for reasons other than end-of-life care. The vast majority of these patients (>80%) live in low- and middle-income countries, where access to immediate-release morphine, an essential and inexpensive drug to relieve pain, is severely lacking.
Writing in a linked commentary, Richard Horton, MD, editor-in-chief of the Lancet, notes, "Death and disability are important metrics for describing the state of the world's health. But suffering is important too...
”Blue Light-Blocking Glasses May Help With Sleep, Cognition” [and maybe pain?] https://www.medscape.com/viewarticle/887048
SOME TOPICS AT THE 2017 AMERICAN ACADEMY OF PAIN MEDICINE (AAPM) ANNUAL MTG included:
“Patients completing an outpatient interdisciplinary chronic pain rehabilitation program (iCPRP) at the Cleveland Clinic have significantly reduced self-reported central sensitization (CS) scores, preliminary research suggests.” https://www.medscape.com/viewarticle/877978
...CS is common among pain patients. It involves abnormal and intense enhancement of pain signaling in the central nervous system. It can result in pain hypersensitivity and allodynia and is believed to be involved in a multitude of conditions, including irritable bowel syndrome, fibromyalgia, temporomandibular joint disorder, migraines, and chronic low back pain….
“[Interdisciplinary] Outpatient Pain Service Cuts Costs in 'High Utilizers'” https://www.medscape.com/viewarticle/877667
AND FROM THE 2016 MTG: “Have Difficult-to-Treat Pain Patients? Try Genetic Testing” https://www.medscape.com/viewarticle/859718 and “AAPM Pain Meeting Puts Focus on Primary Care” https://www.medscape.com/viewarticle/858728
“Uruguay to Produce Medical Marijuana for Export” Reuters via Medscape https://www.medscape.com/viewarticle/887054
“Benefits of Medical Marijuana May Outweigh Risks” https://www.medscape.com/viewarticle/864710
...Pesach Shvartzman, MD, Ben-Gurion University of the Negev, Israel [and colleagues at the 6th International Jerusalem Conference on Health Policy, reported research] that using medical marijuana led to significant pain reductions within 4 months [with only minor adverse effects, in cancer and noncancer pain sufferers who had not benefitted adequately from conventional medications]. Importantly, more than 85% of patients remained on the therapy for the course of the study.
"Monitoring of medical cannabis use is essential and will influence the future decision about this scientifically controversial issue," the investigators noted… In Israel, medical marijuana is approved for both cancer and noncancer pain, as well as for nausea and lack of appetite in cancer patients, multiple sclerosis, epilepsy, and inflammatory bowel disease, among other conditions.
There are now 23,000 licensed users of medical marijuana in Israel. "Although medical cannabis has been legal for a decade and is licensed to patients to relieve pain and other symptoms, there has been no information about the users themselves," Dr Shvartzman noted in a release...
“Recognizing Elder Abuse: Types, Clues, and What to Do” for healthcare professionals and concerned family, caregivers, and the public. A Medscape slide-show+transcript https://reference.medscape.com/features/slideshow/elder-abuse
“Chronic Back Pain May Be Arachnoiditis” https://www.medscape.com/viewarticle/851427
..."Every pain specialist should be aware that if they see a back pain patient who claims to have severe, constant back pain with the hallmark signs of not being able to stand for very long without having to sit or even lay down on the floor, then they could be dealing with arachnoiditis," said lead author Forest Tennant, MD, a chronic pain specialist with the Veract Intractable Pain Clinic in West Covina, California [speaking at the American Academy of Pain Management (AAPM) 2015 Annual Meeting].
INFLAMMATORY PROCESS
While most back pain is degenerative, arachnoiditis involves an inflammatory process of the
arachnoid surrounding spinal cord nerves, which can lead to a host of serious issues…
The article includes an 18-item questionnaire —compiled by Dr Tennant from literature review, clinical observations, and a survey of 26 patients with chronic pain in whom arachnoiditis was confirmed by MRIclinical observations— that can be useful in identifying potential arachnoiditis patients.
“Postexertion 'Crash' —not Fatigue per se— Marks [ME/CFS] Syndrome” https://www.medscape.com/viewarticle/871482
...research focused on the phenomenon of postexertional malaise (PEM) is shedding light on the etiology of the illness that has been known as chronic fatigue syndrome, but is now increasingly termed myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
A growing body of evidence … suggests ME/CFS arises from a complex neuroinflammatory process affecting the brain, autonomic nervous system, and energy metabolism, involving oxidative and nitrosative stress.
The name "chronic fatigue syndrome" is being phased out, not just because it is viewed as trivializing a condition that renders many patients completely or nearly bedbound, but also because it gives the misleading impression that the illness is characterized simply by prolonged unexplained fatigue. In fact, ME/CFS is characterized by multiple heterogeneous symptoms, with PEM, often described as a "crash" or a significant worsening of already-present symptoms, being a near-universal experience.
"Many studies show that physical exertion can help with insomnia in healthy people, and even people with other medical conditions such as depression, anxiety, or even heart failure. But in ME/CFS patients, physical exertion exacerbates their symptoms," [said] Lily Chu, MD, from Stanford University, Palo Alto, California, [conference co-chair of the 12th International IACFS/ME Research and Clinical Conference — Emerging Science and Clinical Care in 2016]...
Studies Document Biological Correlates of PEM...
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Jose Montoya, MD, professor of medicine at Stanford University, reported identifying a set of 15 cytokines and growth factors that changed significantly 24 hours after maximal ergo cycle exercise testing in 25 patients with ME/CFS compared with 25 healthy volunteers … matched for baseline sedentary behavior, age, and body mass index. The cytokines that most differed between the patients and controls were interleukin 1-beta, platelet activator inhibitor 1, CD-40 ligand, MIP-1alpha, and interferon-gamma.
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Dane B. Cook, PhD, professor of kinesiology at the University of Wisconsin in Madison, compared functional brain imaging performed during fatiguing and nonfatiguing cognitive and motor tasks in 15 patients with ME/CFS and 15 sedentary matched control participants … "These converging results, linking symptom exacerbation with brain function, illustrate some of the potential detrimental effects of PEM for ME/CFS patients," Dr Cook said.
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Katarina Lien, MD, PhD, a research fellow at the University of Oslo in Norway, presented data for 18 female patients with ME/CFS and 15 healthy sedentary control participants, all aged 18 to 50 years, who performed two cardiopulmonary exercise testing sessions 24 hours apart. Arterial blood lactate levels per work rate were higher in the patients than in the controls [and accumulated earlier in the patients] …
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J. Mark Van Ness, PhD, a scientific advisory committee member at the Workwell Foundation in Ripon, California, presented a study of 39 patients with ME/CFS and 39 control participants who performed a graded exercise test to volitional fatigue on a cycle ergometer. A subset of 17 patients and 18 control participants performed a second exercise test 24 hours later. Heart rate, measured continuously throughout both tests, did not differ between the two groups after the first test, or between the first and second tests in the control group. However, peak heart rate was significantly lower on test 2 compared with on test 1 in the ME/CFS group (P < .05). "Patients with ME/CFS appear to display postexertional reductions in the peak heart rate response to exercise, which could contribute to exercise intolerance and observed reductions in oxygen consumption during [PEM]. The combination of elevation in heart rate and reduction in peak exercise heart rate may contribute to impaired quality of life," Dr Van Ness concluded...
[25 comments at this article, some very illuminating.]
Possible Mechanism Identified for [myalgic encephalomyelitis/]'Chronic Fatigue Syndrome' https://www.medscape.com/viewarticle/874434
Blockage of a key metabolic enzyme could explain the profound … symptoms experienced by patients with ME/CFS [according to research findings] published December 22, 2016, in the Journal of Clinical Investigation Insight by Øystein Fluge, MD, from the Department of Oncology and Medical Physics at Haukeland University Hospital, Bergen, Norway, and colleagues.
The study included 200 patients with ME/CFS, as defined by the 2003 Canadian Consensus Criteria, which requires the hallmark symptom of postexertional malaise, among others … The authors compared serum concentrations of 20 standard amino acids from the 200 patients with ME/CFS and 102 healthy control patients.
In the patients with ME/CFS, there was a specific reduction of amino acids that fuel oxidative metabolism, pointing to functional impairment of pyruvate dehydrogenase (PDH), a key enzyme for the conversion of carbohydrates to energy. Impairment of PDH could result in … shortage of energy in the muscles and a buildup of lactate, experienced by patients as a burning sensation in their muscles after even minor exertion….
“CDC Grand Rounds: Chronic Fatigue Syndrome — Advancing Research and Clinical Education” https://www.medscape.com/viewarticle/873894_3 FULL TEXT OF Morbidity and Mortality Weekly Report. 2016;65(5051):1434-1438. Some very long-time, highly-respected researchers are co-authors on this article. Section 1 is Abstract & Introd. Section 2: ME/CFS Is a Significant Public Health Problem
Extrapolating from the three U.S. population-based studies, it is estimated that at least one million persons in the United States suffer from ME/CFS.[4-6] These studies indicate that ME/CFS is three to four times more common in women than in men. Persons of all racial and ethnic backgrounds are affected; however, the illness is more prevalent in minority and socioeconomically disadvantaged groups. The highest prevalence of illness is in persons aged 40–50 years, but the age range is broad and includes children and adolescents.
ME/CFS patients, their families, and society all bear significant costs associated with this illness. These include direct medical costs for provider visits and medications and indirect costs of lost productivity. In the United States, the estimated annual cost of lost productivity ranges from 9–37 billion dollars, and for direct medical costs, ranges from 9–14 billion dollars, with nearly one quarter of direct medical expenses paid directly by patients and their families.[7-9] When ME/CFS occurs in patients aged <25 years, these patients might not achieve their full educational potential, resulting in a life-long impact...
Sec. 3: Clinical Approach
There is no "typical" case, but a patient history can be useful in educating physicians about ME/CFS [see Box 1 at article link]. This composite case history illustrates the key features of ME/CFS: significant reduction in ability to perform usual activities accompanied by profound fatigue; significant worsening of symptoms after minimal physical or mental exertion (termed postexertional malaise/PEM); unrefreshing sleep; cognitive difficulties; and orthostatic intolerance (such as dizziness and lightheadedness upon standing up). In addition, this patient experienced widespread muscle pain, joint pain, and unpredictable waxing and waning of symptoms. Persons with ME/CFS might be misunderstood because they appear healthy and often have no abnormalities on routine laboratory testing. Clinicians need to be alert to this difficulty and take the time to elicit a good history of the illness, which is critical in the differential diagnosis and can provide evidence of ME/CFS.
Clinical evaluation includes a thorough medical history, psychosocial history, complete physical examination, mental health assessment, and basic laboratory tests to screen for conditions that could cause symptoms similar to ME/CFS and that should be treated before attributing the illness to ME/CFS. The screening laboratory tests can include complete blood count with differential white blood cell count, sodium, potassium, glucose, blood urea nitrogen, creatinine, lactate dehydrogenase, aspartate transaminase, alanine transaminase, alkaline phosphatase, total protein, albumin, calcium, phosphorus, magnesium, thyroid stimulating hormone, free thyroxine, sedimentation rate, C-reactive protein, antinuclear antibodies, rheumatoid factor, and urinalysis.[11]
Patients might also have comorbid conditions such as fibromyalgia, irritable bowel and bladder, Sjögren's syndrome, chemical sensitivities, and allergies.[11] Additional tests might be clinically indicated...
Sec. 4 is Cause or Causes, Sec. 5 Treatment, Sec. 6 Addressing ME/CFS
...The Institute of Medicine (IOM) issued a 300-page report in which a panel of physicians and scientists reviewed nearly 9,000 published articles.[3] They concluded that ME/CFS is a biologically based [“serious, chronic, complex systemic disease that often can profoundly affect the lives of patients ... not primarily a psychological illness, although it might lead to a reactive depression...”] and proposed a new case definition and name (systemic exertion intolerance). The National Institutes of Health (NIH) [concurred on biology] and the Agency for Healthcare Research and Quality prepared a review of [diagnosis [see Box 2 on pg.6] and treatment literature].[16, 17] ...
“Senior [Pain Patients] With Access to Medical Marijuana Use Fewer Prescription Drugs” https://www.medscape.com/viewarticle/865791 Reuters via Medscape
“Managing Fatigue in Multiple Sclerosis” (2016) https://www.medscape.com/viewarticle/864874
...theories about why MS patients become fatigued ... include autonomic abnormalities MS patients may experience that might predispose them to such symptoms as orthostatic lightheadedness and other difficulties.
Another leading theory [concerns] the MS inflammatory process itself ... the inflammatory infiltrates and cytokines, such as gamma-interferon, that could also be involved in fatigue.
[And] functional MRI studies have shown that MS patients have to [reorganize and] activate larger areas of their cortex in order to perform tasks that normal individuals would be able to perform with much greater efficiency. [This] suggests that just the increased cognitive work ... might be involved in fatigue.
The first question ... is whether they awaken feeling tired—whether they have restorative sleep or not. … Most patients with MS ... usually wake up feeling well rested. They will have their maximum energy in the morning, and then later in the afternoon … use the description, "like somebody pulled a plug..." and all of a sudden they become very fatigued.
So [if] an MS patient [is] tired all the time and [wakes up that way], suspect a sleep disorder. ...a number of publications [show] a much higher incidence of sleep disorders than one would expect from that demographic.
[But before embarking on] pharmacologic therapies for MS fatigue that have variable evidence for their efficacy, ...[rule out] any sleep disorders that [might be suspected] on the basis of the history. ...then we talk a little bit more about both pharmacologic and nonpharmacologic therapy.
For nonpharmacologic therapy … a graded aerobic exercise program [can be valuable]. Also, many patients prefer to take a nap strategically in the afternoon, as opposed to taking a stimulant medication. Simple measures such as those can help a great deal with fatigue management.
[Regarding] pharmacotherapy, we have several medications which are not US Food and Drug Administration (FDA)-approved for MS fatigue, but which nonetheless have evidence for efficacy [such as] amantadine [e.g., Symmetrel], modafinil [e.g., Alertec, Modavigil, Provigil], armodafinil [e.g., Nuvigil] … [methylphenidate, e.g., Ritalin] and things like that. But I'm also careful as I move up the ladder of escalating therapy with stimulants, because of the obvious potential risks…
Some patients will say during an MS exacerbation that they have much more fatigue, so at times that may be not only a symptom of exacerbation but part of the symptom complex. In that case, treating their exacerbation may be all that you need to do.
The other issue to question patients about is the effect of their therapies on fatigue. For example, some patients who are on injectable beta-interferon complain of fatigue as a result of their therapy. That's another wrinkle in that whole management question. And other medications, such as baclofen [e.g., Lioresal] and similar things that we commonly use, may cause fatigue and drowsiness...
“Managing Pain in Frail Elders” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5179031/ FULL TEXT, Am Nurs Today. 2016;11(4). This is the fairly readable PubMedCentral version which includes useful, clearly informative material cited yet not given at Medscape, but the two versions work well together, in slightly differing ways addressing misconceptions about pain in the elderly, disability and other related factors, risks of stoicism and of disregarding pain, a specialized communication approach most adult family members and caregivers would find helpful to know without having to be professionals, roles of high quality nutrition and sleep and other interdisciplinary therapies —
For frail elders with exhaustion, weakness, and fatigue, consider using the following complementary interventions to relieve pain:
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simple cognitive behavioral techniques, such as education, distraction, reminiscence therapy, [intellectual activity] and selected coping strategies
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relaxation techniques, such as music therapy, humor, and paced breathing
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pet visitations and animal-assisted therapy
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physical interventions, including heat or cold application, therapeutic massage, positioning changes, assistive devices, and pressure-relieving and redistribution devices
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[simple] movement [and physical] therapies, such as … passive range of motion, tai chi, [warm-water therapy, light-touch massage with gentle, topical pain gels or lotions, etc.]
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spiritual interventions, such as mindfulness[/mind-body] meditation or prayer
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nutritional supplements and herbal preparations
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yes it really says that, wikipedia’s derogatory article on integrative/complementary medicine notwithstanding: nurses live and work on the front lines and very often known practical, effective, safe, beneficial science to which some other professionals and hard-opinionators are unwarrantedly opposed, c.f., the MMJ debate in the U.S.]
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environmental modifications, such as noise and light reduction, aromatherapy [or, conversely, perfume/fragrance clear-out if odor sensitivity is a probem], rest, a sleep protocol, and meaningful interpersonal interactions.
— family and cultural/ethnic elements, drug/medication concerns particular to the elderly —
Because frail elders are more vulnerable to adverse effects of analgesics, healthcare providers must conduct a risk-benefit analysis before pharmacologic treatment begins. Age-related changes in pharmacokinetics and pharmacodynamics, the likelihood of multiple chronic conditions that increase the risk of adverse effects, polypharmacy, and misconceptions about pain medications can affect the success of drug therapy. Under-nourishment and sarcopenia (common in frail elders) also alter pharmacokinetics and make adverse effects more likely.
Pharmacokinetic and pharmacodynamic changes manifest as altered drug absorption, distribution, metabolism, and elimination. For example, age-related increases in fat-to-water ratio, decreased plasma protein (such as albumin), and impaired liver and kidney function can lead to unpredictable responses to drugs. Pharmacogenetics (genetic differences in drug metabolism) also can affect drug metabolism, response, and effectiveness. Therefore, elderly patients typically require lower dosages and careful monitoring for adverse effects.
Before therapy starts, obtain baseline laboratory values for renal and liver function. Drug therapy should be tailored to the individual patient, with frequent monitoring to evaluate effectiveness and check for adverse effects. The widely acknowledged principle of pharmacologic treatment in older adults—careful dosing (start low), titration (go slow), and therapeutic evaluation (get to goal)—is especially important for vulnerable frail elders. (See Drugs that may be unsafe or inappropriate for frail elders [in the PubMedCentral version])...
end-of-life considerations, not-end-of-life considerations (long-term concerns).
...the term [‘frailty’] generally refers to a state of increased vulnerability to stressors (such as pain) and difficulty regaining homeostasis after an adverse health event. Frail elders show declines in muscle strength, balance, mobility, physical activity, cognition, endurance, nutrition, and weight. This puts them at risk for persistent pain, comorbidities, polypharmacy, falls, and delirium… cognitive or mental health impairment… frequent care transitions…
In many ways, the combined article[s] are also remarkably applicable for chronic illness and other debilitating conditions as well. Highly recommended.
“Fibromyalgia Brings High Societal and Personal Costs” https://www.medscape.com/viewarticle/863160
Average direct costs of fibromyalgia syndrome (FMS) add up to C$3804 per patient each year, [2016] data from Canada show. Overall, the data demonstrate the substantial societal burden of the disease.
A similar burden has been found in studies conducted in the United States, where the disorder affects nearly 5 million adults, according to the Centers for Disease Control and Prevention...
“Fibromyalgia: Management Strategies for Primary Care Providers” https://www.medscape.com/viewarticle/858197 FULL TEXT OF the International Journal of Clinical Practice article (so it’s findings may not be practicable in the U.S. for-profit medical environment). Int J Clin Pract. 2016;70(2):99-112. From the abstract:
Aims: Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation…
Methods: We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements.
Results: The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes.
Discussion: The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training.
Conclusion: Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting.
“COMMENTARY: The Evaluation and Management of Fatigue” 2015 https://www.medscape.com/viewarticle/852370 Distinguishing ME/CFS vs Over-Training Sydrome vs sleep disorders, daily-life management/changes, admittedly often problematic for career/responsibilities, uses of stimulants —
...there are appropriate medications for fatigue mitigation. Caffeine is the most frequently used stimulant worldwide. It has proven effects on cognitive function and is safe to use in moderate doses (100-400 mg/day).[20, 21]{Note: “caffeine” alone is not the same as coffee or tea or chocolate etc.}
Modafinil, armodafinil, and amphetamine-based medications also have proven wakefulness-promoting and cognitive effects.[21] It is important to note that none of these medications should be thought of as a substitute for sleep. They help with executive function and promote wakefulness, but do nothing to restore physiology otherwise. They can be used as mitigating agents, but none are considered a treatment per se...
“Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome – Prospective Clinical Trial” http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127012 PLOS [Public Library of Science-One] FULL TEXT. (N.B. Some of the co-authors are very long-time researchers in FM.) From the abstract:
...FMS is an important representative example of central nervous system sensitization and is associated with abnormal brain activity. Key symptoms include chronic widespread pain, allodynia and diffuse tenderness, along with fatigue and sleep disturbance. The syndrome is still elusive and refractory. The goal of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on symptoms and brain activity in FMS.
METHODS AND FINDINGS
A prospective, active control, crossover clinical trial. Patients were randomly assigned to treated and crossover groups: The treated group patients were evaluated at baseline and after HBOT. Patients in the crossover-control group were evaluated three times: baseline, after a control period of no treatment, and after HBOT. Evaluations consisted of physical examination, including tender point count and pain threshold, extensive evaluation of quality of life, and single photon emission computed tomography (SPECT) imaging for evaluation of brain activity. The HBOT protocol comprised 40 sessions, 5 days/week, 90 minutes, 100% oxygen at 2ATA. Sixty female patients were included, aged 21–67 years and diagnosed with FMS at least 2 years earlier. HBOT in both groups led to significant amelioration of all FMS symptoms, with significant improvement in life quality. Analysis of SPECT imaging revealed rectification of the abnormal brain activity: decrease of the hyperactivity mainly in the posterior region and elevation of the reduced activity mainly in frontal areas. No improvement in any of the parameters was observed following the control period.
CONCLUSIONS
The study provides evidence that HBOT can improve the symptoms and life quality of FMS patients. Moreover, it shows that HBOT can induce neuroplasticity and significantly rectify abnormal brain activity in pain related areas of FMS patients.
ClinicalTrials.gov NCT01827683