Abstract
Fibromyalgia is a multifaceted symptom complex difficult to define exactly and even mote problematic to give a long term prognosis. In June 1994, under the auspices of the Physical Medicine Research Foundation, a committee of fibromyalgia (FM) experts was convened at the University of British Columbia, Vancouver, Canada to address issues of diagnosis, testing, assessment, and prognosis. The consensus statement and the committee’s recommendations for the future research were published in 1996 in The Journal of Rheumatology(1). The American College of Rheumatology ( ACR) criteria for the classification of FM require generalized musculoskeletal pain and the presence of pain on palpation of 18 specified tender point sites. Other typical symptoms include fatigue, sleep disturbance, mood distirbance, headache, irritable bowel symptoms, among others. Tenderness at sites not specified by the ACR criteria does not exclude diagnosis. Although no specific laboratory testing in cunently available in FM, some abnormalities do exist These include high substance P (SP) content in CSF (2,3), abnormality in serum serotonin (4,5), a highly significant decrease in somatomedin C (6), and a reduced regional blood flow and a decrease in glucose metabolism in the hypothalamus and the caudate nucleus demonstrated by singlephoton-emission-computed tomography (SPECT) (7). Our study group at the University of Kuopio has been able to confirm these SPECT findings in FM. Alavi and his associates reported of changes in the regional cerebral blood flow in thalamus after superficial needling of acupuncture points which had been effective on previous treatments (8). We reported in the 1 st International on the Bi-Digital O-Ring Test in 1993 the benefits of the Bi-Digital O-Ring Test originally found and developed by Prof. Omura, Y. of New York in acute neck and shoulder pain (9). The defined technique using low dose laser irradiation (0.05-0.1 J/ point) to the abnormal area located by the Bi-Digital O-Ring Test and followed by finger pair and whole hand muscle force testing in the basis for functional diagnosis cervicobrachialgia. The common trigger areas in foe edge of upper trapezius muscle may compromise the functional state the intracranical circulation (10,11). In order to select the optimal wavelength and/or frequency for foe laser irradiation the test dose can be directed to the TPs in the upper trapezius. In our preliminary trial using low energy infrared irradiation (LEII) on typical trigger areas in upper trapezius and C7 region either a significant increase or decrease in rCBF was recently quantified with SPECT in three myofascial pain patients (12). According to Omura the functional state of patient’s representation immune response cam be checked by testing the thymus representation area (lower half of manubrium stemi)(13). Instead of ¡radiating foe thymus representation area we have given a test dose of 0.1-0.2 J transcutaneousty to radial artery and checked foe lower manubrium stemi again By checking foe response after irradiation with different laser parameters (wavelength, power density, frequency, etc.) it is possible to define the optimal parameters for foe treatment (total dose of 10-15 J). The other symptoms in FM should be tested at the corresponding organ representation areas.
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