Wednesday, March 26, 2014

2014 IACFS/ME Conference -- Bateman on Fibro

fibromyalgia = amplified pain
American College of Rheumatologists 1990 defined it around pain exclusively
the criteria miss 12% of patients, conversely 19% are told they have fibro but are misdiagnosed
we have learned the limitations of the diagnostic criteria, so they must change
other central sensitivity symptoms: migraine, restless leg syndrome, IBS, etc.
women are 11x more likely than men to have fibro
2-3% prevalence
3-5% of women, 1/2 to 1.6% of men
6-10 million Americans
if a fibro patient has to decrease their activity by 50%, it's CFS -- clinicians generally pick one, whichever is their favorite
Bateman diagnoses FM vs. CFS/FM vs. CFS depending on pain level
Neurontin got a $430M fine for marketing it off-label for migraine and chronic pain, but that did lead to the development of fibro specific drugs
address all other medical conditions
address pain, sleep, mental health, fitness/exercise -- pain is affected by the others
history and exam
preventive screening -- exclude other diagnoses
sleep study
non-fibro pain (e.g., arthritis) will respond to different prescriptions than fibro pain
small fiber peripheral neuropathy (SFPN) is a distinct disease
does not show up on neuro exams -- must be biopsied
CLUES: activity tolerance, sleep problems
response to treatment can be an important diagnostic tool
13 of 20 patients benefited from Lyrica in a study by Alan and Kathy Light
gene expression in responders looks like controls
in non-responders it looks less like controls
Needs work: cause and prevention

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