APA Daily Bulletin - Day 4, 2008 - (Page 3) May 7-8, 2008 The Daily BULLETIN 3 Wednesday/Thursday FRONTIERS OF SCIENCE Lecture offers practical approaches to diagnosis, treatment of fibromyalgia Educator and researcher I. Jon Russell, M.D., Ph.D., would challenge anyone who believes that a fibromyaglia diagnosis can only be made by excluding all other possibilities. In fact, he clearly reviewed the steps for positively diagnosing this malady during his Frontiers of Science lecture, “Fibromyalgia Syndrome: Diagnosis, Pathogenesis, and Management.” Dr. Russell, who is associate clinical professor of medicine and director of the University Clinical Research Center at the University of Texas Health Science Center in San Antonio, began by reviewing the complaints fibromyalgia patients present with, including widespread pain, severe headache, fatigue, neck and shoulder pain, syncope, and more. These symptoms raise many fl ags for clinicians, who end up running many diagnostic tests. However, if a patient presents with these symptoms, Dr. Russell said clinicians can quickly and simply rule out or diagnose fibromyalgia by checking the body’s tender points. If a patient has had widespread pain for three or more months and has severe pain reaction at 11 or more of the 18 tender points with four kilograms of pressure (about the amount of pressure it takes to blanch the blood flow from tip of the thumbnail), you can make a positive diagnosis for fibromyalgia. “That last component of the diagnostic ev a lu at ion add r e s s e s t he not ion t h at fibromyalgia is a wastebasket diagnosis or is a diagnosis of exclusion,” Dr. Russell said. “I don’t agree with that. I’ve just given you criteria on the basis of which you can make a diagnosis of fibromyalgia in a positive way.” After reviewing the diagnostic process, Dr. Russell shared imaging studies and other research regarding the epidemiology and pathogenesis of fibromyalgia syndrome. He showed how t h i s cond it ion i s not rheumatologic, as is often thought, but is very much a neurological or psychiatric issue. He then reviewed the various treatment options available and the studies done on the efficacy and safety these medications. There are exciting new developments in this area, Dr. Russell said. He reviewed the safety and efficacy of multiple drugs and drug classes, including tricyclic antidepressant drugs; pain relievers (such as tramadol and acetaminophen); SNRIs (duloxetine or milnaciprin); and sodium oxybate and pregablin. Dr. Russell showed results from several studies that show the outcome measures for fibromyalgia patients who tried these medications. Many of these drugs offer improved sleep and/or pain reduction for patients, but Dr. Russell recommended an off-label, combination approach he believes offers optimum benefit for the treatment of fibromyalgia. If you look at the syndrome as a triangle consisting of insomnia, pain, and depression, Dr. Russell said clinicians can prescribe duloxetine or milnaciprine to treat the pain/ depression side while using pregablin or sodium oxybate to treat the pain/insomnia side. This combination approach treats all three aspects of the disease. I. Jon Russell, M.D., Ph.D. 2008 APPI Bookstore The 2008 APPI Bookstore has over 400 titles that can help you grow professionally and increase your knowledge of psychiatric issues. APPI’s wide variety of topics allows you to select titles you’ve always wanted and add to your series collections. Update your Membership Profile The Online APA Membership Directory, located in the secure Member’s Corner section of the APA website, has been expanded to better serve your needs. The contact, biographical, and practice data that you supply when you update your membership profile will make it easier for other members to get in touch with you (and you with them). Making dependable patient referrals — using the most current and up-to-date member information — is now possible. If you haven’t yet updated your membership profile, please make sure to stop by the Membership Booth in the Member Center — all members who update their membership profile during the meeting will have their names entered in a drawing for a free year of national membership dues! APPI Bookstore Hours Wednesday 10:00am–3:00pm New Resources Added to DSM-IV-TR® at PsychiatryOnline.com Visit the APPI Bookstore for a demo of PsychiatryOnline.com, our powerful website that features DSM-IV-TR® as the cornerstone of an unsurpassed collection of psychiatric references, including books, journals, and self-assessment tools. The site includes more of our best-selling references! Plus much more ■ References including Institute, continued from page 1 DSM-IV-TR®, DSM-IV-TR® Casebook and its Treatment Companion, the American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders in both comprehensive and quick reference formats ■ Primary journal literature including The American Journal of Psychiatry, Psychiatric Services, and three other APPI peer-reviewed journals ■ Textbooks including The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition and Gabbard’s Treatment of Psychiatric Disorders, Fourth Edition ■ Self-Assessment tools for board certification and recertification review and lifelong learning ■ Clinical & research news from Psychiatric News The Institute on Pychiatric Services Scientific Program Committee: Back row, standing from left: Donna McNelis, Ph.D.; Kate Rye, D.O.; Altha Stewart, M.D.; Wesley Sowers, M.D.; Joan Anzia, M.D.; David Pollack, M.D. Front row, seated from left: Stephen Goldfinger, M.D.; Program Chair Jacqueline Feldman, M.D.; Nada L. Stotland, M.D., M.P.H.; James H. Scully, Jr., M.D. Subscribe during the APA Annual Meeting and receive a 10% DISCOUNT. Visit www.PsychiatryOnline.com and use APA2008 in the Discount Code and Priority Code boxes during checkout. Services Research Track. The track highlights the contributions of health services research to the delivery of effective psychiatric services and sound policy. These sessions take place on Friday, October 3. Saturday morning, October 4, there will be a “Career Counseling and Career Develop- ment Forum” for members in training, or even established members looking to change career directions. The forum will offer one-on-one time with national experts. Early registration for IPS ends September 12. The registration brochure is available online at www.psych.org/ips. http://www.PsychiatryOnline.com http://www.PsychiatryOnline.com http://www.PsychiatryOnline.com http://www.psych.org/ips
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