Global Health Asia-Pacific May 2022 May 2022 - Page 54

Fibromyalgia
Appropriate exercise is crucial to manage both ME / CFS and fibromyalgia
Stress might contribute to the development of both conditions , potentially putting women at higher risk since they ’ re more likely to work in subservient positions , e . g ., at overnight or in entry-level jobs . fibromyalgia prevalence among women since they ’ re also more likely to suffer from autoimmune diseases where the immune system mistakenly attacks healthy cells .
Both biological and social components are also believed to make ME / CFS more prevalent among women .
That ’ s because the sex ratio is pretty similar before puberty , said Dr Bateman , but , after that , sex differences , such as hormone levels , become more apparent , and women get diagnosed more often , leading to the assumption that “ hormonal differences play an important role .”
She also believes that stress might contribute to the development of both conditions , potentially putting women at higher risk since they ’ re more likely to work in subservient positions , e . g ., at overnight or in entrylevel jobs .
“ I do believe stress plays a role because it may alter your immune surveillance and changes how your immune system handles an infection ,” said Dr Bateman . “ We all know that if we ’ re more sleep deprived or stressed we ’ re more likely to get the flu . I think that ’ s a risk factor for ME / CFS , but we don ’ t know for sure .”
Diagnosis is doable with appropriate testing Despite the lack of clear-cut biomarkers , diagnosing ME / CFS and fibromyalgia is a fairly straightforward exercise if physicians know what to look for .
“ It ’ s easy to diagnose ME / CFS ,” said Dr Bateman . “ The problem is that some doctors don ’ t understand how to diagnose it .”
For instance , orthostatic intolerance is a common ME / CFS symptom that can be measured objectively by looking at how blood pressure and heart rate respond to changes from lying to upright positions .
The not-for-profit clinic she founded , the Bateman Horne Center , has developed a protocol for quickly carrying out the examination . Using the NASA lean test , it can be done in about 30 minutes by having patients lie down for 10-15 minutes and then stand up and lean against a wall for 10 minutes to measure whether supine to standing changes in blood pressure and heart rate point to orthostatic intolerance .
“ Our emphasis is on improving medical education and research as well as providing clinical care , and we ’ ve been trying to teach doctors how to do the NASA lean test ,” she said . “ This is really important because long COVID also causes orthostatic intolerance .”
Professor Kosek agrees that diagnosing fibromyalgia is relatively easy based on standard diagnostic criteria . The first step is to make sure patients don ’ t have conditions requiring other specific treatments , such as joint inflammation or cancer . This is followed by a clinical examination to confirm chronic pain and , if the older criteria are used , also tenderness across several body parts by palpating them and asking patients how painful they are .
While the approach is subjective given that what is considered painful differs among different people , “ it ’ s a good screening method for pain sensitivity and fibromyalgia , something that has been lost when using one of the newer sets of fibromyalgia criteria ” she said .
Treatment can help but only manages symptoms No cures are currently available for ME / CFS and fibromyalgia , but there are treatments that aim to prevent symptoms and provide some relief at best .
The first therapeutic goal in ME / CFS is to teach patients how to pace their activities in order to avoid flare-ups as much as possible .
“ You can ’ t exercise the illness away , you can make it only worse by doing too much activity , cognitively and physically ,” cautioned Dr Bateman .
This type of pacing is done by helping patients selfmonitor themselves and understand how much energy they have and which activities make the illness worse . Good practices include short activities throughout the day and rest between activities .
Patients can also benefit from diets high in fluids and salty foods to increase blood volume as these facilitate circulation to the heart and brain , thus relieving orthostatic intolerance . Medications can also help regulate blood volume , reduce heart rate , and induce the narrowing of blood vessels .
In terms of physical activity , people with ME / CFS tolerate anaerobic exercise better than cardio , which is largely aerobic . In addition , activities that are not upright are recommended as these allow patients to work slowly on flexibility , core body strength , and leg and upper body strength . If they can tolerate it , they should also do minimal aerobic exercise to develop the ability to walk for 10-15 minutes , explained Dr Bateman . “ My guidance to people is you can do
52 MAY 2022 GlobalHealthAsiaPacific . com