Fibromyalgia Syndrome Case Studies 2 CEUs

Center for Complementary and Integrative Medicine CEU Provider #: 50-2682 1120 NW 14th St, Suites 1472 1475 Miami, FL 33136 Phone: 305-243-4751 Fax: 305-243-3648 E-mail: icamp@med.miami.edu

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External Diseases Matthew S. Enright 2011

Fibromyalgia Syndrome
From acupuncture to chiropractic, from massage to meditation, alternative and integrative treatments are in great demand. That's especially true for people with pain-related illnesses such as fibromyalgia. Alternative medicine, including herbal therapy and homeopathy are used in place of or in conjunction with conventional medicine. These systems are based on the belief that the body has the power to heal itself with multiple techniques including those that involve the mind, body and spirit. Study findings show that standard acupuncture may be effective in treating some people with fibromyalgia. Both biofeedback and electroacupuncture have also been used for relief of fibromyalgia symptoms. However, before you try alternative treatments, talk with your doctor. Check to see what limitations might apply to you. Working with your doctor, you can find an acceptable way to blend conventional medicine with alternative treatments or natural remedies. When you do, you may be able to increase restful sleep and reduce your fibromyalgia pain.

What is pain?

Pain or musculoskeletal complaints account for seven of the top ten conditions for which individuals use acupuncture, according to the 2007 National Health Interview Survey. Acute and chronic pain syndromes, as some of societys most costly health problems, have an enormous impact on individual, national, and global levels. In the United States, chronic pain is the third most common health-care problem, behind heart disease and cancer, with the combined annual costs of lost work days, doctor visits, hospital stays, pain-reducing drugs and disability totaling an estimated $100 billion. Acupuncture is best known for its ability to successfully manage and treat pain. Although pain itself is not a diagnosis rather an indication or forewarning that a problem exists somewhere in the body. More often the exact location of pain points to where the problem is, as in the case of lower back pain above a herniated disk. But in other situations, the site of pain may be related to problems distally, as in leg pain resulting from the same herniated disk pushing on a nerve in the back. The intensity of the pain can usually indicate the severity of the problem and although each individual has a different pain threshold, pain levels that increase or do not lessen over time can point to a condition or problem that requires medical attention. It is also important to understand the circumstances surrounding the onset of the pain. Was there an accident or incident, did the pain gradually develop over a course of time or during a certain period of life, is the pain better or worse during a particular time of day? The characteristics of pain give important information about what is causing the body to send this signal. Once noticed, it is important to address the underlying problem not just turn down the discomfort. Otherwise the body will continue to send out other warning signals until the core problem is corrected. According to Traditional Chinese Medicine (TCM), nothing within the human body can function independently. Pain is the bodys warning signal or alarm. It tells you something is wrong. If you ignore your bodys alarm, similarly to the fire alarm in your house, severe problems can form soon.

External Diseases Matthew S. Enright 2011

What is fibromyalgia?

Fibromyalgia is a chronic disorder that causes significant physical pain and debilitating fatigue. Classified as a syndrome, fibromyalgia is not a disease. Instead it is a condition that causes many different symptoms. These symptoms affect all systems in the body. Fibromyalgia plagues up to 5% of the population, with 6 million sufferers in the United States alone. The term fibromyalgia comes from Latin and Greek words: Fibra (Latin) means fibrous tissue and has to do with painful tendons and ligaments Myos (Greek) means muscles Algos (Greek) means pain

While not all affected patients experience all associated symptoms, the following symptoms commonly occur together: abdominal pain chronic pain debilitating fatigue insomnia / difficulty sleeping anxiety and depression joint stiffness chronic headaches and jaw pain difficulty swallowing dryness in mouth, nose, and eyes hypersensitivity to odors, bright lights, loud noises and cold and/or heat inability to concentrate (called "fibro fog") incontinence irritable bowel syndrome numbness or tingling in the extremities (fingers and feet) painful menstrual cramps poor circulation in hands and feet (called Raynaud's phenomenon) restless legs syndrome Fibromyalgia can cause signs and feelings similar to osteoarthritis, bursitis, and tendinitis. Some experts include it in this group of arthritis and related disorders. But the pain of bursitis or tendinitis is localized to a specific area. The feelings of pain and stiffness with fibromyalgia are widespread.

External Diseases Matthew S. Enright 2011

Tender Points in Fibromyalgia

In order to get a formal diagnosis of Fibromyalgia, you must find at least 11 of the following 18 points tender. (Please note, each point is bilateral.) However, what is tender on one day may not be on another day. Therefore, if you have a number that is less than 11, but meet the other criteria for Fibromyalgia (widespread pain, muscular stiffness and difficulty sleeping, etc.) you could treat the patient accordingly.

A - Suboccipital m. Insertion (the base of the skull) B - Trapezius m. (the bas of the neck) C - Supraspinatus m. (top of the shoulder) D - Anterior Cervical (breastbone) E - 2 cm distal to the lateral epicondyles (elbows) F - Approximately T 4-5 level (shoulder blades) G - Greater Trochanter (top of the hip) H - Gluteal m. region (small of the back) I - Fat pad over the knee

External Diseases Matthew S. Enright 2011

Case 1: A 46 year old female presented with signs and symptoms of irritability, mental-emotional depression, constipation with thin, ribbon-like or small round stools or diarrhea alternating with constipation, belching, rib side distention and abdominal distention and pain in the lumbar region, painful mensces, fatigue, loss of strength in the extremities, reduced food intake, stomach and epigastric distention and fullness after eating, superficial edema, cold hands and feet, easy bruising, profuse menstruation or abnormal uterine bleeding, dizziness upon standing up, a pale facial complexion, a fat, pale yet dark tongue with thin white fur and a wiry pulse.

1. Which of the following would best describe or diagnosis the above referenced symptoms: A - Liver / Spleen Disharmony B - Heart Fire C Wind Heat Invasion D Bi Syndrome

2. What would be the appropriate treatment principle: ABCDClear Heart Fire Resolve Exterior Tonify Liver/Spleen, supplement qi Open Channels and Collaterals and relieve pain

3. True or False, the follow Acupuncture point prescription would be effective in treating this syndrome: PC 6, SJ 5, LV 3, ST 36, SP 21, SP 6

4. Which of the following herbal formulas would be effective in treating this syndrome: A- Yu Ping Feng Wan B- Xiao Yao San C- Shen Tong Zhu Yu Wan

Case 2: A 19 year old female presented with signs and symptoms of loose stools or diarrhea, patient stated she can have dark, green colored stools or light yellow, mustard colored stools, a burning or acid feeling around the anus during and after defecation and foul-smelling stools, Patient also stated she had hot, painful limbs primarily in the elbow region and proximal to both knee caps with red, hot, wet skin lesions, frequent, hot, painful urination, red, hot, wet, vaginal discharge, red tongue with yellow fur and a slippery, rapid pulse.

5. Which of the following would best describe or diagnosis the above referenced symptoms: A Damp Cold B Damp Heat C Dryness D Pain Syndrome

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6. What would be the appropriate treatment principle: ABCDOpen Channels and Collaterals and relieve pain Drain damp heat Drain damp cold Nourish Yang

7. True or False, the follow Acupuncture point prescription would be effective in treating this syndrome: CV 12, ST 25, SP 9, ST 44, SP 21, GB 34, LI 4

8. Which of the following herbal formulas would be effective in treating this syndrome: A- Jiang Dan Gu Chun Wan B- Te Xiao Bi Ming Gan Wan C- Long Dan Xie Gan Wan

Case 3: A 21 year old female presented with signs and symptoms of fatigue, lack of strength, disinclination to speak and spontaneous sweating. Patient also complained of early morning diarrhea (3 times per weeks) but definitely a tendency to loose stools, low back pain (sacroiliac joint), pain in the mid thoracic back and knee soreness and limpness, decreased sexual desire along with frequent urination, nocturia, cold hands and feet (especially the feet), chest, abdominal, breast and rib-side oppression, distention, fullness and pain, menstrual irregularities, dysmenorrheal, irritability, emotional depression, a pale but dark, fat, swollen tongue with a thin white / slimy white fur with a wiry, fine, deep pulse.

9. Which of the following would best describe or diagnosis the above referenced symptoms: A Damp Cold Invasion B Kidney Yin Deficiency C Wind Heat Invasion D Spleen / Kidney Yang Vacuity with Liver Qi Stagnation

10. What would be the appropriate treatment principle: ABCDResolve Exterior Tonify Kidney Yin Drain damp cold Nourish Yang and Move Liver Qi

11. True or False: The use of Moxibustion would not be recommended with this syndrome:

12. Which of the following herbal formulas would be effective in treating this syndrome: A- Bu Zhong Yi Qi Tang

External Diseases Matthew S. Enright 2011

B- You Gui Wan C- None of the Above D- Both A and B

Case 4: A 33 year old female presented with fixed, sharp, stabbing pain in the lower abdomen and the lumbar spine which is worse in the evening and at night, engorged visible blood vessels from large varicosities to spider veins, engorged and distended sublingual veins, painful menstruation with clotting ranking 10 out of 10 on a VAS pain scale. Patient also presented with a dark, sooty facial complexion, a dark, purplish tongue with static spots (on the tongue) with a choppy pulse.

13. Which of the following would best describe or diagnosis the above referenced symptoms: A Qi Stagnation B Kidney Yang Deficieny C Blood Stasis D Damp Accumulation in the Upper Jiao

14. What would be the appropriate treatment principle: ABCDOpen Channels and Collaterals and relieve pain Tonify Kidney Yang Resolve Exterior Resolve Dampness

15. True or False: The use of local ashii points would be recommended with this syndrome:

16. Which of the following herbal formulas would be effective in treating this syndrome: ABCDBu Zhong Yi Qi Tang Shen Tong Zhu Yu Tang None of the Above Both A and B

Case 5: A 44 year old male presented with pain in the right shoulder (trapezius muscle) which radiated from the back of her head to the shoulder and pain in the mid to lower back along with swollen lymphnodes, fibrocystic lumps on the back (primarily concentrated in the thoracic region) and other hard, round, subcutaneous lumps and bumps along the medial aspect of the right leg and the lateral aspect of the left arm (just below the deltoid muscle), a purple, fat, swollen tongue with moderate white fur with a slippery, deep and weak pulse.

17. Which of the following would best describe or diagnosis the above referenced symptoms: A Wind Cold Invasion B Spleen Yang Deficieny C Phlegm Nodules

External Diseases Matthew S. Enright 2011

D Wind Heat Invasion

18. What would be the appropriate treatment principle:

19. True or False: The use of local ashii points would be recommended with this syndrome:

20. Which of the following herbal formulas would be effective in treating this syndrome: ABCDJia Wei Xiao Yao Wan Yin Qiao San None of the Above Both A and B

External Diseases Matthew S. Enright 2011

Examination Answers for Fibromyalgia Syndrome Case Studies: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______

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Center for Complementary and Integrative Medicine CEU Provider #: 50-2682 1120 NW 14th St, Suites 1472 1475 Miami, FL 33136 Phone: 305-243-4751 Fax: 305-243-3648 E-mail: icamp@med.miami.edu