Speakers and topics

The rational management of fibromyalgia

Robert M. Bennett, MD, FRCP, FACP
Professor of Medicine
Oregon Health & Science University, Portland
Oregon, USA

Over the past few years there have been impressive advances in our understanding of basic mechanisms responsible for pain in fibromyalgia. There is now a consensus that fibromyalgia patients have a neurophysiological abnormality in pain processing which results in an amplification of sensory impulses; this is generally referred to as "central sensitization". This development of a scientific basis for fibromyalgia has stimulated clinical researchers and pharmaceutical companies in a quest to develop innovative new therapies for fibromyalgia patients. Prof. Bennett will discuss these latest findings in the context of a rational approach to the management of fibromyalgia.

Neuroendocrine mechanisms in fibromyalgia

Rinie Geenen, PhD
Assistant Professor in Health Psychology Department of Health Psychology, Utrecht University University Medical Centre, Department of Rheumatology and Immunology, Utrecht, The Netherlands

Fibromyalgia is considered a sensory processing disturbance with biopsychosocial co-morbidity. Using illustrations form the reallife of patients with fibromyalgia, this lecture addresses the question whether and how psychological processes may affect neuroendocrine functioning in fibromyalgia. It is still a question whether subtle neuroendocrine alterations are involved in the pathophysiology of fibromyalgia and contribute to its ongoing symptomatology or are a consequence of pain and its associated symptoms such as fatigue, low physical fitness, sleep disturbance and mood disorder, or both. Factors that improve neuroendocrine responses to stress possibly explain why exercise and stress management can be helpful in case of fibromyalgia.

Fibromyalgia – translating science into clinical practice

Karl G. Henriksson
Associate Professor in Neurology
Former head of The Pain Clinic and the
Neuromuscular Unit, University Hospital,
Linköping, Sweden

Today, science has taught us that fibromyalgia usually develops from chronic localized or regional musculoskeletal pain. A less common source of fibromyalgia is severe mental or physical stress. In both cases, the primary factor is a changed function of nerve cells in the central nervous system. If long-standing or permanent, such a change results in disease. Pain and increased pain sensitivity can give rise to many symptoms including sleep disturbance, fatigue, and symptoms related to chronic stress. Psychological and social factors influence especially the intensity of symptoms, quality of life, and the social consequences. Research has shown new ways to confirm the diagnosis. Several studies deal with treatment, and others investigate how fibromyalgia influences work capacity.
Unfortunately, many of the research findings have not found their way to the primary care settings in which most fibromyalgia patients present. Means of bridging the gap between science and clinical practice will be discussed.

The role of life stress in fibromyalgia

Boudewijn Van Houdenhove, PhD
Professor Extraordinary
Medical Faculty, Department of Neuroscience and
Psychiatry, Leuven, Belgium

Although fibromyalgia remains a controversial diagnosis, there is growing agreement about the etiopathogenetic role of life stress in the condition. First, evidence concerning the role of adverse life events, personality and lifestyle factors, posttraumatic stress, and early negative childhood experiences will be reviewed. Second, neurobiological links between stress and main fibromyalgia symptoms – notably chronic widespread pain and effort intolerance – will be highlighted. Finally, methodological issues with regard to stress research, the clinical relevance of the stress concept for fibromyalgia, and future research perspectives will be discussed.

Physical activity and exercise for patients with fibromyalgia

Kaisa Mannerkorpi, PhD
Associate Professor, PT, Salgrenska Academy,
Dept. Rheumatology, Göteborg University, Sweden

Physical exercise, aiming to improve or maintain physical fitness, is nowadays regarded as an important form of treatment for patients with fibromyalgia (FM) and other chronic pain disorders. Research shows that most patients with FM are able to manage low-to-moderate-intensity exercise, while high-intensity exercise should be undertaken with care. Studies examining the effects of exercise show that exercise is beneficial for most patients with FM, improving function and mood.

Cognitive and behavioral factors in musculoskeletal disorders: mood and stop-rules

Johan W.S. Vlaeyen, PhD
Professor of Behavioral Medicine
Department of Medical, Clinical and
Experimental Psychology
Maastricht University, The Netherlands

In patients with chronic pain, the lowered ability to accomplish tasks of daily living (pain disability) has long been conceptualized as merely the consequence of pain severity. In the last decade however, the intuitively appealing paincongruency idea has been refuted, and cognitive factors related to pain appeared more important than pain itself. The so-called Fear-Avoidance (FA) model has become influential as a valid explanation for the transition from acute to chronic pain disability. However, the FA model appears less applicable in pain disability associated with task persistence and overuse, also seen in patients with musculoskeletal pain. This presentation will briefly review the application of the FA model, but also discuss a novel model that is based on the interaction between current mood and so-called "stop-rules".

Central sensitivity syndromes (CSS): the concept and significance

Muhammed B. Yunus,
MD, FACP, FACR, FRCPE
Professor of Medicine, Section of Rheumatology
University of Illinois College of Medicine at Peoria
Peoria, USA

CSS comprises a number of conditions with similar and overlapping features, including absence of structural pathology, and are connected by a common pathophysiological mechanism of central sensitization. These conditions include fibromyalgia syndrome, chronic fatigue syndrome, irritable bowel syndrome, chronic headaches, temporomandibular disorder, restless legs syndrome, multiple chemical sensitivity and post-traumatic stress disorder.
The CSS model provides a new direction for future research and better management of these conditions.

Stelling