Practitioners Only Education

What is the topic you are speaking about?

A BioRegulatory Systems Medicine (BrSM) approach to Fibromyalgia and Central Sensitivity Syndromes (CSS).

What makes you passionate about this topic?

Central sensitivity syndromes (CSS) are chronic and often disabling conditions with fibromyalgia being said to perhaps be one of the most challenging chronic pain conditions actively under investigation in the world pain community.

Fibromyalgia and other CSSs are also one of the most common groups of disorders seen by primary care physicians but because of their bewildering array of symptoms and a paucity of objective findings, they often frustrate the diagnostic and therapeutic efforts of health care providers. Furthermore the combination of symptoms not only complicates the recognition and treatment of these disorders, but also magnifies their disease burden.

I am passionate about this subject because sharing new insights in particular into the common underlying pathophysiological mechanisms that link these conditions, may facilitate their much-needed earlier recognition and diagnosis in addition to the expeditious commencement of more holistic therapeutic approaches.

What do you think is so important to discuss at this time?

The previous lack of a clear organic basis and the increased prevalence of affective disorders in central sensitivity syndromes in particular fibromyalgia, led many physicians to consider these as non-diseases or a psychosomatic illnesses. Recent research, however, has illuminated our understanding of the neurobiological basis of chronic pain syndromes and how pain dysregulation referred to as “central sensitisation” is suggested to underpin the pathophysiology of fibromyalgia and other overlapping CSSs i.e. “the common binding pathophysiological glue of CSS”.

It is important to discuss how central sensitisation can take place as a result of multiple proposed biological systems/network deregulations in particular the neuroendocrine network as a result of for example, chronic stress.

This will provide physicians with a better understanding of the CSS paradigm thinking that incorporates both biological/organic and psychosocial factors thus allowing them to more rapidly recognise, diagnose and timeously introduce a multidisciplinary therapeutic strategy.

Furthermore, it is important to explore the bioregulatory therapeutic approach of CSS in particular fibromyalgia and how this differs to the current treatment pathway. This will allow physicians to recognise the important role that BrSM can play in managing patients with these disorders in addition to how aligned this therapeutic approach is with the CSS paradigm thinking that embraces patient centered care.

What do you think practitioners will walk away with from having attended the seminar?

Practitioners who attend will be able:

  • To identify the group of diseases currently classified as CSS.
  • To understand the role of multiple systems/network impairment as a major part of the pathophysiology of CSS.
  • To recognise the fact that common networks are shared in CSS and are able to appreciate the implication it has on the therapeutic approach.
  • To have a better understanding of how a bioregulatory therapeutic approach including the use of a combination of medications with bioregulatory properties can be used in patients with CSS in particular fibromyalgia.

How much research has been done on the topic?  In your opinion, what are the most fascinating facts about this topic?

Interesting enough, concepts and descriptions of what we now know as CSS in particular fibromyalgia has been written about over the last 150 years.

Therefore, years of research has been done on this topic but prior to the understanding of some common underlying pathophysiological mechanisms such as central sensitisation. These disorders have been explored and studied as separate entities in different fields of medicine with each medical specialty having their own diagnostic label e.g. somatoform disorders in psychiatry, irritable bowel syndrome in gastroenterology, fibromyalgia in rheumatology.

There are now also numerous studies in the field of chronic pain as well as emerging data from the fields of nursing, rheumatology, dentistry, gastroenterology, gynecology, neurology, and orthopedics that is providing substantial evidence that these syndromes are not clearly distinct disease entities, but rather represent a common phenomenon with different subtypes. Furthermore the current fragmented approach to these disorders due to the various syndrome diagnoses is now seen as an obstacle for research and a hindrance for effective patient care.

In my opinion, some fascinating facts about this topic is the finding that both previous or the current presence of CSS in patients together with the number of CSS disorders is an important risk factor for the development of other CSS, especially fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome. This highlights the need for both early diagnosis and timeous therapeutic management that must not only be multidisciplinary but most importantly patient centered i.e. providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.


TOPIC: BioRegulatory Medicine approach to Fibromyalgia and Central Sensitivity Syndromes

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