Biography:

Jana Sawynok has a PhD in Pharmacology, and has been particularly interested in developing novel analgesics (adenosine-based therapeutics, topical analgesics). Since 2000, she has also been interested in Complementary and Alternative Medicine, with applications in chronic pain. She has published 180 papers in reputed journals, including 8 publications on qigong. She currently supervises (in collaboration with Mary Lynch, MD) medical students conducting pragmatic observational trials of qigong in the context of self-care at a tertiary pain care setting.

Abstract:

Qigong, which has a long history in China as a health and wellness practice, is currently considered as “meditative movement”. In Halifax, we have conducted several trials with Chaoyi Fanhuan Qigong for fibromyalgia: a randomized-controlled trial (RCT) (N=100) and an extension trial (N=20) (with standardized regimens for 8 weeks, follow-up 6 months), and reported individual cases (N=2) who undertook extended community-based practice (1-3 years). In the RCT, subjects were randomly assigned to immediate practice, or wait list/delayed practice groups. Training consisted of 3 half-day sessions, with weekly review and practice sessions for 8 weeks; participants were expected to practice daily for 45 mins during this time. Pain, sleep, impact, and physical and mental function were determined at baseline, at 8 weeks, and at 3 and 6 months. In the immediate practice group, there were significant benefits in all outcomes at 8 weeks compared to the wait-list group, and benefits were maintained at follow-up. In the delayed practice group, similar results were observed, demonstrating reproducibility between two cohorts. Benefits in all areas were related to amount of practice. Qualitative data recapitulated quantitative results, and revealed some further health benefits. In the extension trial, further benefit occurred and health gains were consolidated (e.g. improvements in asthma, food and chemical sensitivities, vision). In individuals who practiced 1-3 years, pain, sleep, and physical and mental function were vastly improved, and there were additional health gains in other areas. Qigong, when practiced diligently, produces marked health benefits in those with fibromyalgia.

Biography:

Abstract:

Fibromyalgia is a painful, non-articular condition predominantly involving muscles. Typically it is associated with fatigue, non-refreshing sleep, and activity intolerance influencing everyday life.

Fibromyalgia is based on a distinctive clinical appearance. Many studies have tried unsuccessfully to find an objective diagnostic test using muscle biopsies and single fiber examination, probably due to the change of the Copenhagen Declaration 1992 regarding classification criteria from 1990.

The fibromyalgia patient’s complain of fatigue ability has been verified by a reduced isokinetic muscle strength, and the true muscle strength has also been found to be lower than in a healthy control group. Furthermore, a shorter exhaustion time during exercise with shoulder abduction compared with healthy individuals has been measured.

Limitations in the ability to perform activities of daily living (ADL) in fibromyalgia patients have been documented using the Assessment of Motor and Process Skills (AMPS) test indicating ADL motor and process skills similar to early aging.

With the more advanced cuff algometry, we are now able to assess pressure pain thresholds and temporal and spatial summation indicating pain hypersensitization, which is believed to be the main cause for this condition staying chronic pain.

An in-depth description of these mentioned subjects will be given.

Biography:

Abstract:

The majority of patients with fibromyalgia have dyspepsia, irritable bowel Syndrome and other gastrointestinal problems.  Chronic infections of the gut have been shown to trigger the production of reactive oxygen species and reactive nitrogen species to eliminate the reservoir of pathogens in the gut. Dysfunction of the gut- brain axis has been shown to trigger neuropathic pain and other symptoms including insomnia, poor memory and concentration, mood swings, chronic fatigue syndrome and fibromyalgia. Other sources of infection include the mouth, sinus cavities and urogenital system.

The activation of reactive oxygen species and reactive nitrogen species in these systems activates immune and inflammatory pathways by initially switching on the cytokine, interleukin 1 beta and inhibiting its receptor antagonist. Interleukin 1 beta activation converts lysophosphatidylcholine(LPC) to lysophosphatidic acid (LPA) which is the critical initiator of neuropathic pain, demyelination and pain related protein expression. Other powerful neurotoxins include quinolinic acid and kyurenic acid.

To assist in the management of fibromyalgia, tests may be conducted to identify metabolic imbalances. Hair and blood may be analyzed for the presence of heavy metals.  Urine and blood may be tested for total antioxidant capacity, superoxide dismutase and glutathione peroxidase and the levels of lipid peroxides. A separate organic acids test measures 76 different urine metabolites including yeast markers, bacterial markers, oxalate metabolites, glycolytic cycle metabolites, mitochondrial markers, neurotransmitter metabolites and nutritional markers.  Two additional tests involve the pentose-phosphate pathway which is the energy source for myelin repair. When this pathway is activated, it is associated with elevation of levels of Heat Shock Protein 27 and ATM Kinase.

Treatment initially involves a biomechanical approach focusing on spinal biomechanics that include the identification of spinal joint fixations and areas of facet hypermobility. Manual adjustment is used to correct these spinal joint fixations followed by exercises to strengthen the spinal muscular stabilizers to reduce facet hypermobility. Nutritional therapies are also implemented to address underlying metabolic errors identified through testing.     

Biography:

Dr. Samreen Ahmed has completed her MBBS at the age of 24 years from Dow Medical College, Pakistan, and currently volunteering as a Research Assistant at University of Illinois at chicago. Dr. Ahmed has written 3 case reports as a first author that were published in the IJBCP
 

Abstract:

Fibromyalgia, a condition in which there is stiffness and pain in soft tissues, such as muscles and tendons, has an unknown etiology. However, arterial spasm caused by stress hence hampering the oxygen supply can precipitate the pain. The pain in fibromyalgia is accompanied with fatigue, anxiety, and insomnia. The areas most affected comprises of cervical, and thoracic areas, however any part of the body can be affected.  Females are more commonly affected. Fibromyalgia, often present in depression patients, lack any pathognomonic laboratory findings. The purpose of this review is to elaborate the effects of different interventions for fibromyalgia, particularly with psychiatric symptoms. A literature review of various articles is conducted on MEDLINE, PSYCH Info, and PUBMED to evaluate the role of different treatment options in fibromyalgia patients, accompanying psychiatric symptoms. Literature review revealed aspirin and acetaminophen may be useful in treating pain, whereas, NSAIDS may also give effective response in some cases. Although, first -line of treatment, shown by evidence is cognitive-behavioral therapy, and exercise. However, amitriptyline, is the proven solid pharmacologic intervention, for short durational pain periods. Interestingly, Transcranial Magnetic Stimulation, also has potential in being helpful for chronic neuropathic pain syndromes, based on current data. tDCS, in combination with aerobic exercise is helpful significantly for anxiety, and pain.  In patients suffering from Fibromyalgia with depression, SSRI can be considered for managing depression, however, there is no fair evidence that SSRI are superior to placebo in intervening fibromyalgia’s key symptoms like fatigue, and sleep disturbance. Based on some evidence, amitriptyline should be considered when choosing for the first- line therapy. Different treatment options, such as aspirin and acetaminophen can help with the pain. Although stress reduction techniques, and message can also be helpful.  We suggest accessing patients with fibromyalgia thoroughly to look for psychiatric symptoms so that they could be addressed accordingly. TMS, CBT, and tDCS have potential in treating pain although there is insignificant data, hence we recommend more research in this field. 

Biography:

Christopher William Armstrong is pursuing his PhD at the University of Melbourne in the Department of Biochemistry and Molecular Biology. His focus has been on the development of metabolomic methods for studying the impact of the gut microbiome on health with a focus on ME/CFS. He has conducted two separate case-control studies and is now beginning a longitudinal study using personalized-omics methods to define ME/CFS as it pertains to the individual. He has 4 first-author publications to date.

Abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating long-term multisystem disorder that centres around fatigue that is inexplicably persistent in its severity and its inability to be relieved by rest. Gut dysbiosis, energy metabolism issues and oxidative stress are focal points of ME/CFS research. We have completed a metabolomic study that has enabled the observation of these issues through the metabolic analysis of blood serum, urine and feces with the quantitation of fecal microbes. We present a workflow for studying associations between gut bacteria and the host metabolism by using correlational analysis within the ME/CFS and healthy control cohorts. Samples were collected from a cohort of 34 females with ME/CFS (34.9±1.8 SE years old) and 25 healthy non-ME/CFS female participants (33.0±1.6 SE years old) and all samples underwent metabolic profiling via 1D ¹H NMR spectroscopy experiments. In the healthy control group we observed a strong association between fecal short chain fatty acids (SCFAs) and many metabolites in the blood and urine highlighting the potential impact of diet on host metabolism. In the ME/CFS cohort, blood glucose was elevated while blood lactate, urine pyruvate, and urine alanine were reduced indicating a glycolysis anomaly. The increase of blood aspartate and decrease of blood glutamate suggest an increase in gluconeogenesis. The increase of fecal SCFAs appears to be positively correlated with enhanced gluconeogenesis within the host, which suggests that gut bacteria may play a role in the fatigue phenotype of ME/CFS sufferers.

Biography:

I have completed my PhD Nursing in 2013 from University of Ulster. I have joined the American University of Madaba as assistant professor in nursing since Feb 2012. I have published  5 papers in reputed journals

Abstract:

The aim of this study was to examine predictors to fibromyalgia among refugees in Jordan. A cross sectional method was utilized.  A 384 refugees were recruited from four different cities in Jordan. In addition to fibromyalgia questionnaire, anxiety, stress, post traumatic stress disorder, insomnia, and refugees’ demographical details were collected. Logistic regression was used to examine predictors to fibromyalgia; all variables were included as a possible predictors.

The results of the current study showed that 23.7% (n=91) of refugees had moderate to severe fibromyalgia. Logistic model was statistically significant (P=0.001). The model explained 60% of the variance in fibromyalgia categories and correctly classified  84.9% of the cases. Refugees lives in Irbid city were 7.58 times more likely to exhibit fibromyalgia compared to refuges lives in Zarqa city. Increase age was associated with an increase likelihood of exhibit fibromyalgia. Increase post traumatic stress disorder, and anxiety scores were associated with higher fibromyalgia.

This study showed higher fibromyalgia prevalence among refugees in Jordan. In addition, refugees lives in Irbid city, older, anxious, and stressed after displacement were associated with higher fibromyalgia. The study recommend to assess fibromyalgia among all refugees in Jordan and consider these factors that showed to be associated to fibromyalgia when assess refugees. In addition, the study recommend health care worker to use non-pharmacological and pharmacological interventions to elevates fibromyalgia among refuges. Furthermore, the current study recommend further studies to explore other factors that were not included in the current study such as type of diseases associated with   fibromyalgia.

Biography:

Neil completed his PhD at the University of Sydney, Australia and is involved in university based studies at the Bio21 institute at the University of Melbourne. He is a consultant at Bioscreen Pty Ltd which is involved in the research and testing of the human gut microbiome. He has published more than 60 papers in peer reviewed journals and many as a coauthor with research groups in the US and Europe. He was a former co-editor of the Journal of Chronic Fatigue Syndrome, Philadelphia USA.        

Abstract:

Pain usually starts in a localized region and in the majority of chronic pain syndromes over time it can spread to encompass multiple body regions. The current hypothesis is that this wide spread pain is related to the development of central sensitization. In a series of reproduced studies the author has found that a different mechanism may be involved. An increased excretion of amino acids (a diuresis event) correlated with the exacerbation of pain (VAS scores) but the excretion declined with duration of the pain syndrome suggesting a whole body amino acid depletion event. These events were associated with changes in serum sodium, osmolality and the presence of widespread pain. The fall in serum amino acids correlated with a fall in urea in both serum and urine which appeared to be associated with the change in the renal function. Assessment of eGFR revealed that few patients had evidence of kidney disease. These changes seem to mimick, at a lower level, those seen with Diabetes Insipidus or a Syndrome of Inapproriate Antidiuretic Hormone excretion (SIADH). No patients could be classified as SIADH as the osmolality and sodium levels were not outside the normal two standard deviation limits. It appears that an inflammatory mediated change in protein synthesis occur via the EIF2 and mTORC1 gene pathways. An hypothesis based upon epigenetic influences on EIF2 associate protein synthesis inhibition will be presented including the potential roles of posture, malabsorption, exercise, viral dsRNA and bacterial toxins in the development of pain syndromes.

Biography:

Abstract:

Back-ground: The international association for the study of pain (IASP) in its classification of chronic pain defines as pain perceived anywhere in the posterior region of cervical spine from the superior nuchal line to the first thoracic spinous process. Another type of classification proposed by IASP is based on duration of neck pain according to which chronic neck pain has duration of 3 months or more. Spinal mobilization is commonly used in the treatment of chronic neck pain. Various methods are used to treat patient with neck pain. In chronic neck pain patients have impaired neck proprioception. There is limited study found in spinal manipulative therapies on neck proprioception.

Method: Total 121 subjects of neck pain in Charotar region, Gujarat, India were screened by taking inclusion and exclusion criteria in consideration. The study was then performed on 28 subjects who meet the inclusion criteria. All the subjects who were ready to participate and fit for the study were informed about the procedure and purpose of the study and written consent was taken from each subject prior to the study. The pre-treatment baseline assessment was done on 0^th day by the investigator other than primary investigator. The 2 groups are Mulligan (SNAGS) and control group. All the groups given different exercise and treatment given for 3 WEEKS (5 session / week) and they are statistically analysed by paired t-test.

Biography:

Abstract:

Cross-Sectional Study

Objective : To determine the correlation between SF-36( a measure for overall health status in patients) and Oswestry-Disability Index(ODI) or Rolland-Morris Disability Questionnaire(RMDQ) confined to spine according to the type of pain from the spine.

Summary of Background Data : Data showed moderate correlation between ODI and SF-36 Physical Component Score(PCS) Physical Functioning(PF)(r=-0.46), Physical Role Functioning(RP) (r=-0.284), Bodily Pain(BP)(r=-0.327), and Mental Component Score(MCS) Emotional Role Functioning(RE)(r=-0.250), Social Role functioning(SF)(r=0.254), Vitality(VT)(r=0.296).

Methods : Between 1 January 2008 to 31 December 2013, a total of 69 patients were enrolled in this study. They were diagnosed with lumbar spinal stenosis and underwent decompression surgery such as laminotomy in this hospital. The three standardized questionnaires(ODI, RMDQ, and SF-36) were given to these patients, at least one year after the surgery.

Results : ODI and SF-36 had a statistically significant(p=0.001) and moderate correlation. Small correlations were also seen between PF(r=-0.46), RP(r=-0.284), and BP(r=-0.327) of SF-36 PCS and ODI, and between RE(r=-0.250), SF(r=-0.254), and VT(r=-0.296) of SF-36 MCS and ODI. Items in ODI for the level of pain while standing and traveling were mostly related to axial back pain, while item of lifting was related to referred buttock pain. Sleeping disturbance section in the ODI was mainly caused by radiated leg pain. In addition, RMDQ was also associated to the three types of pain.

Conclusioins : Moderate correlation was found between ODI or RMDQ as a condition specific outcome and the SF-36, indicating overall health status. ODI was found to be a more adequate measure to evaluate axial back pain rather than referred pain or radiating pain. RMDQ was  adequate to measure the health status and to evaluate the three types of spine pain. These three instruments could therefore provide the clinician with complementary information about the patient’s status.