Fibromyalgia And Fatigue Center Of Boston

Welcome To Healing Choices Pc

Healing Choices, P.C. is a specialty medical practice founded by Keith W.L. Rafal, MD, MPH with a strong focus on interdisciplinary collaboration. The practice supports an integrative rehabilitation approach to patient care and is dedicated in partnership with patients to create opportunities in health and healing that serves to bridge conventional and alternative medicine.

We offer the Mind Heals ApproachSM.

The practice specializes in the consultation and treatment of a variety of chronic medical conditions. Keith W.L. Rafal, MD, MPH. has been the Medical Director of a large regional program for patients who have been diagnosed with Fibromyalgia, Myofascial Pain Syndrome and Chronic Fatigue Syndrome. We have access to a dedicated team of physical and occupational therapist and a therapeutic pool program through an interdisciplinary approach we also successfully treat other conditions such as chronic low back pain, neck pain, carpal tunnel syndrome, arthritis, chronic pain, stroke and neurological rehabilitation and women’s health concerns. Healing Choices empowers patients to make the necessary changes in their lives that will facilitate healing.

Dr. Rafal supports a health education model that includes close collaboration through a growing network of practitioners with expertise in the area of:

• Physical Medicine and Rehabilitation
• Medication Evaluation for Chronic Pain and Musculoskeletal Disorders
• Acupuncture

• Osteoarthritis

Myalgic Encephalomyelitis/chronic Fatigue Syndrome: Essentials Of Diagnosis And Management

• Alison C. BestedAffiliations
• Lily ChuCorrespondenceCorrespondence: Address to Lily Chu, MD, MSHS, Independent Consultant, 16 Lorton Ave, Unit 4, Burlingame, CA 94010.
• Nancy G. KlimasAffiliationsInstitute for Neuro Immune Medicine, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
• Jose G. MontoyaAffiliationsDr Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto Medical Foundation Research Institute, Palo Alto, CA
• Irma R. ReyAffiliationsInstitute for Neuro Immune Medicine, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL

Overlapping Symptoms: Fatigue Mood Pain

It is not clear that this updated definition for CFS will advance the understanding of the disorder or its acceptance as a diagnosable condition.22,25 There was little evidence that the new case definition was an improvement over prior CFS case definitions given continued diagnostic uncertainty.28 The new diagnostic criteria do not offer clinicians the ability to distinguish CFS from overlapping functional somatic syndromes, and in particular FM.

Most studies have found a significant clinical overlap of FM and CFS symptoms, with the majority of individuals meeting criteria for both syndromes.29,30 In 1 report, 50 patients with primary FM who had been followed in an academic rheumatology practice frequently reported symptoms thought to be typical of chronic Epstein-Barr virus infection , but not of FM. These included recurrent sore throat , recurrent rash , chronic cough , recurrent adenopathy , and recurrent low-grade fevers .29 In 55% of the patients, the illness had begun suddenly, with what seemed to be a viral syndrome.30 However, antibody titers to Epstein-Barr virus in the patients were not significantly different from those in age- and sex-matched healthy and unhealthy control subjects.30 This overlap is not surprising since fatigue is the second most prominent symptom in FM, right after chronic widespread pain.

Pain Catastrophizing

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Mgh Researchers Make Major Discovery About Fibromyalgia And Ibs

BOSTON Researchers at Mass. General Hospital have made a groundbreaking discovery that could ease symptoms for millions of people suffering from conditions such as chronic fatigue, fibromyalgia and irritable bowel syndrom.

Dr. Anne Louise Oaklander says a good proportion of patients diagnosed with those health issues may actually have a disease called small fiber polyneuropathy, SFPN.

This is a disorder in which nerve cells found under the skin are attacked by the body’s immune system.

The resulting damage can cause numerous symptoms including gastrointestinal discomfort and feeling like the skin is on fire.

The problem is their skin looks perfectly normal, and there’s no evidence that anything’s wrong, Oaklander said.

Along with others, Oaklander recently published a study in which they found that drugs called immunomodulators can be effectively used to treat SFPN, though these drugs may not work in every patient because every presentation of the disorder is different.

She said patients who learn they have SFPN often feel liberated.

It’s pretty routine that I have patients who break down and cry when they get an answer for the first time to something that’s been disabling them for years or decades, Oaklander said.

One of those patients is MaryEllen Talbot, who had initially been diagnosed with fibromyalgia before learning she actually has SFPN.

This diagnosis is from a biopsy, so it’s not subjective, it’s objective. It’s something they see on the lab, she said.

How Is Fibromyalgia Treated

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

There is no known cure for fibromyalgia, but symptoms can be managed. Mild cases may get better with stress reduction or lifestyle changes. More severe cases may need to be treated with a healthcare team approach. This may include your primary healthcare provider, a specialist called a rheumatologist, a physical therapist, and a pain management clinic. Treatment may include:

• Anti-inflammatory medicines to ease pain and help you sleep

• Other pain medicines

• Medicines approved for treating fibromyalgia

• Medicines to ease depression

• Exercise and physical therapy to stretch muscles and improve cardiovascular fitness

• Relaxation methods or cognitive behavioral therapy

• Heat or cold treatments

• Alternative treatments such as acupuncture and chiropractic or massage therapy

Talk with your healthcare providers about the risks, benefits, and possible side effects of all medicines.

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Key Points About Fibromyalgia

• Fibromyalgia is a chronic condition that causes pain in muscles and soft tissues all over the body.

• Researchers think it may be linked to sleep problems, stress, or immune, endocrine, or biochemical problems.

• Symptoms may also include lack of energy , sleep problems, depression, headaches, and other problems.

• There is no known cure, but symptoms can be managed.

• Treatments may include medicine, exercise, relaxation, heat or cold, and massage.

Distinguishing Between Fatigue And Daytime Sleepiness

CFS, like FM, has been linked to sleep disturbances.42-45 To explore the impact of sleep in CFS, the sleep patterns of 14 CFS patients were assessed using electroencephalograms to measure slow wave sleep and sleep efficiency.42 Guilleminault et al found that SWS percentage and sleep efficiency were lower and there was a significant increase in delta 1 relative power in the chronic fatigue group when compared to controls.42 Poor sleep was evaluated by monitoring non-rapid eye movement sleep and calculating cyclic alternating pattern rate. Patient complaints of chronic fatigue and unrefreshing sleep were associated with an abnormal CAP rate . These specific patterns were related to subtle, undiagnosed sleep-disordered breathing as related to an abnormal CAP rate.

Neu and another research team explored the relationship between fatigue and sleepiness in a second study in which the patients underwent polysonography and psychometric assessments to differentiate fatigue, mood disorders, sleepiness, and sleep quality.44 Patients with CFS appeared to have a compromised sleep disregulation, which suggests that their state of unresolved fatigue cannot be resolved with improved sleep, and offers clinicians more insight regarding the distinction between fatigue and sleepiness.

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Pediatric Fibromyalgia And Musculoskeletal Pain

We may not like it, but we need pain: It acts as an early warning system that something is causing or may cause damage to the body. If your child has a chronic condition known as fibromyalgia, though, the pain alarm is continually being set off by things that feel painless to most people — getting a friendly pat on the back, for instance, or sitting in a chair for a few hours.

Hearing your child complain of hurting all over can be upsetting, especially given that fibromyalgia isnt a disease but a condition that may last for years, even a lifetime. There isnt a cure. However, fibromyalgia doesnt actually damage the body, the way arthritis does. And with education, treatment and lifestyle changes, the majority of children with fibromyalgia can bring their condition under control and lead a full, relatively normal life.

• Fibromyalgia is found in about 2 to 4 percent of the U.S. population, or as many as 12 million people.

• Although fibromyalgia primarily affects women ages 20-60, doctors are increasingly seeing it in pediatric patients as well, usually around early adolescence .

• Fibromyalgia is a chronic — meaning long-lasting — disorder that causes widespread pain and stiffness in the tissues that support and move the bones and joints.

• Many people with fibromyalgia also have severe fatigue and trouble sleeping.

• Treatment for fibromyalgia aims to control symptoms through things like exercise, relaxation techniques and, in some cases, medication.

Impact And Prognosis Of Me/cfs

• Nacul L.
• Lacerda E.M.

Pharmacoecon Open.

• Campion P.
• et al.

BMC Public Health.J Chronic Fatigue Syndr.

• Cox D.L.
• Findley L.J.

Br J Occup Ther.

• Mild: mobile and self-caring may continue working but will have reduced other activities
• Moderate: reduced mobility, restricted in instrumental activities of daily living, needs frequent periods of rest usually not working
• Severe: mostly housebound limited to minimal activities of daily living severe cognitive difficulties may be wheelchair dependent
• Very severe: mostly bedridden unable to independently carry out most activities of daily living often experience extreme sensitivity to light, sound, and other sensory input

• Tian H.
• et al.

Am J Epidemiol.Chronic Illn.

Qual Life Res.Disabil Rehabil.Occup Med .

Rehabil Psychol.Front Pediatr.Fatigue.

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What Are The Symptoms Of Fibromyalgia

Each persons symptoms may vary. But chronic pain is the most common symptom. The pain most often affects the muscles and the points where muscles attach to bones. These are the ligaments and tendons.

Pain may start in 1 part of your body, such as your neck and shoulders. But any part of the body may be affected. The pain ranges from mild to severe, with “flare ups” and times of improvement. The discomfort from fibromyalgia may feel like burning, soreness, stiffness, aching, or gnawing pain, often times with sore spots in certain parts of your muscles. The pain may feel like arthritis. But it doesn’t damage muscles or bones.

Other common symptoms of fibromyalgia include:

• Medium to severe tiredness

• Less exercise endurance

• Irritable bowel symptoms, such as belly pain and bloating, diarrhea, and constipation

• Restless legs

• Painful menstrual periods

• Trouble thinking clearly

These symptoms can seem like other health conditions. Make sure to see your healthcare provider for a diagnosis.

What Causes Chronic Fatigue Syndrome

Chronic fatigue syndrome is a complex condition that often doesnt have an identifiable cause. Patients are usually diagnosed with chronic fatigue when they have extreme, persistent tiredness that does not improve with rest. This syndrome sometimes occurs alongside rheumatic diseases like fibromyalgia and may warrant the specialized care of a rheumatologist.

At Tufts Medical Center Community Care, our rheumatologists and primary care physicians work hand-in-hand to provide a full spectrum of coordinated, multidisciplinary treatment to patients with chronic fatigue. Well be here for you throughout your care journey, providing follow-up treatment as necessary to help reduce your symptoms and improve energy levels.

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Strengths And Limitations Of This Study

The strengths of this trial include the large and diverse sample of participants with fibromyalgia, including patients with associated comorbidities, poor quality of life, and heavy medication use. Such patients typically face limited options owing to the ineffectiveness of and contraindications to available treatments. Therefore, the overall positive findings among adults who were representative of those who are difficult to treat in routine practice strengthen the evidence that the effectiveness and durability of both tai chi and aerobic exercise extend to a diversity of patients with fibromyalgia.

We further expect that the mind-body therapy might in the future help to reduce the burden associated with long term opioid use for patients with fibromyalgia.

One finding that deserves further investigation is that both groups in this trial showed similar reduced use of analgesics over time. It is well documented that psychosocial variables play a pivotal role in the experience of pain and aberrant opioid taking behaviors.66 This may suggest that tai chi, which can address both the physical and the psychological symptoms in chronic pain, could be particularly effective in targeting opioid use and misuse. Future investigation of mind-body approaches should also focus on how these therapies can help reduce the burden associated with long term use of opioid analgesia.

Nih Research Center Directors To Speak

Hopefully, Nath will have some early results from the NIH intramural study.

All the NIH research center directors will be speaking. In the October NIH call, Koroshetz noted that the studies were just beginning and not much data was available. Since this conference was produced in large part to show off the NIH research centers, lets hope that six months later well get a peak at some early data.

Some other things we might hear from the speakers:

• Ron Davis results from continuing nano-needle work, the severely ill ME/CFS study, the metabolic hypothesis, and the blood work all funded by the Open Medicine Foundation.
• Nancy Klimas some results from her GWI illness and/or ME/CFS clinical trial underway using etanercept / mifepristone.
• Maureen Hanson exosome results from her NIH research grant study: will the cytokines everyone has been looking for for years finally show up in them?
• Betsy Keller the exercise subsets has she been able to tease them out?
• Ian Lipkin the continuing search for pathogens and, of course, the gut.
• Derya Unutmaz a gut-immune connection on the way to validation?

A Clinician Session will also occur.

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Health Tech Startups Working To Address Chronic Pain Without Opioids

The origin story might sound familiar. It, too, had begun with a request from insurers, this one about objectively evaluating injuries attributed to toxic chemicals. So Gillis teamed up with University of Illinois colleagues and published a few papers. From those papers, the Cytokine Institute was born.

Its analyses cost between $6,250 and $12,500 a pop, according to a 2007 article in Business Insurance. Gillis told the journalist that the product could determine with 99.9% accuracy whether someone had been exposed to a substance and whether it had caused injury. Neal Jardine, an attorney who defends companies in these sorts of cases, told the publication about a tire retreader whod claimed his cancer was caused by chemical exposures on the job, but who dropped his lawsuit after Gillis tests showed no link. The technique, Jardine went on, was objective and had the potential to change workers comp claims forever. Gillis told the BBC it had already been used as evidence in 20 cases in California civil court.

Though his research led to legal strategies that are still being used today, he went on, the Cytokine Institute found a shallow market, which he said had to do with incentives driving toxic tort litigation. In short, uncertainty was advantageous to plaintiffs and defendants, thus definitive testing was unattractive.

Effect Of Tai Chi Versus Aerobic Exercise For Fibromyalgia: Comparative Effectiveness Randomized Controlled Trial

• Accepted 13 February 2018

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Dysfunction Of The Hypothalamic

Studies of the neuroendocrine aspects of fibromyalgia have found dysfunction of the HPA axis. The HPA axis is a critical component of the stress-adaptation response. The sequence of HPA action is that corticotropin-releasing hormone from the hypothalamus stimulates the anterior pituitary to release adrenocorticotropic hormone . In turn, ACTH stimulates the adrenal cortex to produce glucocorticoids .

Some authors have noted that 5 main measurable neuroendocrine abnormalities are associated with dysfunction of the HPA axis. These are as follows:

• Low free cortisol levels in 24-hour urine samples
• Loss of the normal circadian rhythm, with an elevated evening cortisol level
• Insulin-induced hypoglycemia associated with an overproduction of ACTH
• Low levels of growth hormone
• Stimulated ACTH secretion leading to insufficient adrenal release of glucocorticoids

Circadian regulation and the stress-induced stimulation of the HPA axis are, in part, regulated by serotonin. Perturbations in serotonin metabolism may explain the abnormalities of the HPA axis in fibromyalgia. Dysfunction of the HPA axis may exaggerate the effects of abnormal serotonin metabolism. Hypoactivity of the HPA axis may cause low central serotonin levels.

Fibromyalgia And Fatigue Centers

Last year, in a desperate attempt to find help with my severe CFS and FM, I did a search online and found out about the Fibromyalgia and Fatigue Centers . These centers, which I believe there are now 13 or 14 nationwide, deal specifically with CFIDS, Fibromyalgia, and hormonal issues.

I have finally found somewhere to go where the doctors and staff truly believe that I am sick and they dont just tell me, You just have to learn to live with it. The staff at F & F are extremely helpful, courteous, empathetic, and wonderful!

These doctors are trained in giving in depth blood work and I was with the doctor on my first visit for over an hour! Yes, that is correct. OVER ONE HOUR!!

The centers use conventional, along with some natural type approaches to treat which include supplements, IV therapy, compounded prescriptions, food allergy testing, etc.

The F & F Centers have found that the large majority of CFS and FM patients have hypothyroidism and other hormonal deficiencies. I know for me I was having severe hormonal issues, but when my family doctor and other specialists checked, my hormone panels were normal. I kept going back though because I knew they werent. But the F & F doctors are trained specifically to do TSH, T3 & T4 panels and they have found that CFIDS and FM patients do not adequately convert T4 to the active T3, which results in low levels of active thyroid hormone and will have low thyroid despite having a normal TSH.

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