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बुधवार, 5 अक्तूबर 2011

A tough disease to treat: FIBROMYALGIA


"Fibromyalgia is a name in search of a meaning."
-Anonymous Canadian rheumatologist

Fibromyalgia syndrome (FMS) is a specific, chronic non-degenerative, non-progressive, noninflammatory, truly systemic pain condition. Diseases have known causes and well-understood mechanisms for producing symptoms. FMS is a syndrome, which means it is a specific set of signs and symptoms that occur together. This in no way means that fibromyalgia is any less serious or potentially disabling than a disease. Rheumatoid arthritis, lupus, and other serious afflictions are also classified as syndromes.

Sleep disorders. Inflammatory cell abnormalities. A small fiber neuropathy. There is evidence suggesting that these conditions, along with many others, are associated with what is often diagnosed as fibromyalgia. In particular, sleep apnea and chronic hypoxia to the brain's pain centers were frequently proposed by readers as potential inciters of fibromyalgia symptoms, and a number of commenters recommended ordering a sleep study in patients in whom the condition is suspected.

A family practice doctor of osteopathy wrote: "After finishing residency I was bombarded with patients who had tender points and the diagnosis of fibromyalgia. I started to screen [them] for sleep apnea and was flabbergasted at the number of patients who had hypoxic/apneic episodes at night. Now, after several years of screening patients, about 75% of my patients diagnosed with fibromyalgia have nocturnal oxygen or a CPAP [continuous positive airway pressure] machine."
And then there was inflammation. As one reader pointed out, a 2010 article from Clinical Rheumatology suggests that mast cells (MCs) may play a key role in the condition. The study reported significantly increased MC counts in the papillary dermis of patients with fibromyalgia. The authors wrote: "MCs are present in skin and mucosal surfaces throughout the human body, and are easily stimulated by a number of physical, psychological, and chemical triggers to degranulate, releasing several proinflammatory products which are able to generate nervous peripheral stimuli causing CNS [central nervous system] hypersensitivity, local, and systemic symptoms."
A recent abstract presented at the International Association for the Study of Pain's 2010 conference in Montreal, Quebec, Canada, reported that patients with fibromyalgia have more symptoms of depression and alterations in peripheral and central nervous pain pathways compared with healthy individuals. A neurologist commented, "[Fibromyalgia] symptoms are the same as in small fiber neuropathy, and amenable to the same treatments. [This] study reports that patients with fibromyalgia have decreased epidermal nerve fiber density, as in small fiber neuropathy." Another neurologist suggested "testing patients for small fiber neuropathy before telling them anything."
Fibromyalgia is considered as pain due to over stimulation, over sensitivity to pain.

(copied from emedicine artilcles (medscape.com), small portion of article)

Even though there is no definite criteria for diagnosis, eleven tender points out of 18 points, sleepless ness, extreme bodyache, anxiety, triggering of pain by infection, stress etc, spontaneous remission and exacerbation makes the diagnosis.

In Ukkinadkas Ayurveda:

We have treated number of fibromyalgia cases some with good results, some with temporary results, some with satisfactory results and some with no results. We have treated many patients in OP and in IP levels.
Shastikashali pindasweda gives imminent result but later usually pain reccurs after heavy work.
We have also tried with Pindasweda and Dhara, and shodhana treatments in many, the immediate response from patient was excellent in most of the patients, some patients had good recovery, there was no recurrence of pain and they could manage their routine without much pain, but some patients with all these medicines and follow up medicines, their pain aggravated when they started their routine works.

But recently surprisingly we got very good result with our new product developed for skin allergies, tablet Ukkinadkas Alaril. Accidentally we came to know that this works in fibromyalgia, we have treated more than six cases of FMS with this tablet with satisfactory result. None of the patients had undergone any of pre panchakarma or panchakarma procedures. But to conclude this result we need another 50 to 60 patients of Fibromyalgia. We have administered tablet Ukkinadkas Alaril aong with other vathahara combinations(usually we prescribe Maharasnadi, Rasnadi, Sahacharadi, Prasaranyadi, Erandadi gana kwatha, Vamshatwagadi kwatha, …….. depending up on the severity and symptoms, many times we also add herbal antipsychotic and tranquilisers with good result, guggulu preparations, sometimes rasa preparations, in case if we note mild inflammatory signs which is not a common sign in FMS)
Also it is very difficult to find a similar disease mentioned in Ayurveda. But we can well correlate with the Samanya lakshana of AMAVATHA for Fibromyalgia. I request all the doctors to share your experience and your view regarding Fibromyalgia.

Jayagovinda Ukkinadka
http://www.facebook.com/profile.php?id=1812422041

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