UPFRONT | Roundup CLINICAL Pain scientist explains fibromyalgia origins Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, though still widely misunderstood, is now considered to be a lifelong central nervous system disorder, which is responsible for amplified pain that shoots through the body in those who suffer from it. Daniel Clauw, a medical doctor and professor of anesthesiology, University of Michigan, analyzed the neurological basis for fibromyalgia in a plenary session address at the recent American Pain Society Annual Scientific Meeting. “Fibromyalgia can be thought of both as a discreet disease and also as a final common pathway of pain centralization and chronification. Most people with this condition have lifelong histories of chronic pain throughout their bodies,” said Clauw. “The condition can be hard to diagnose if one isn’t familiar with classic symptoms because there isn’t a single cause and no outward signs.” Clauw explained that fibromyal-gia pain comes more from the brain and spinal cord than from areas of the body in which someone may experience peripheral pain. The condition is believed to be associated with disturbances in how the brain processes pain and other sensory information. He said physicians should suspect fibromyalgia in patients with multifocal (mostly musculoskeletal) pain that is not fully explained by injury or inflammation. “Because pain pathways throughout the body are amplified in fibromyalgia patients, pain can occur anywhere, so chronic headaches, visceral pain and sensory hyper-responsiveness are common in people with this painful condition,” said Clauw. “This does not imply that periph-eral nociceptive input does not contribute to pain experienced by fibromyalgia patients, but they do feel more pain than normally would be expected from the degree of peripheral input. Persons with fibromyalgia and other pain states characterized by sensitization will experience pain from what those without the condition would describe as touch,” Clauw added. Due to the central nervous system origins of fibromyalgia pain, Clauw said treatments with opioids or other narcotic analgesics usually are not effective because they do not reduce the activity of neurotransmitters in the brain. “These drugs have never been shown to be effective in fibromyal-gia patients, and there is evidence that opioids might even worsen fibromyalgia and other centralized pain states,” he said. Clauw advises clinicians to integrate pharmacological treatments with nonpharmacological approaches like cognitive behavioral therapy, exercise and stress reduction. “Sometimes the magnitude of treatment response for simple and inexpensive non-drug therapies exceeds that for pharmaceuticals,” said Clauw. “The greatest benefit is improved function, which should be the main treatment goal for any chronic pain condition. The majority of patients with fibromyal-gia can see improvement in their symptoms and lead normal lives with the right medications and extensive use of non-drug therapies.” Based in Chicago, the American Pain Society is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. PATIENT CARE Ontario seeks higher fines for health-care data breaches ontario’s liberal govern-ment will propose legislation this fall to double the fines and enhance prosecution for security breaches involving patients’ medical records. “The government has an incredibly important role to play in securing and ensur-ing privacy is upheld,” said He a l t h M inist e r E r i c Hoskins.” Hoskins said the new legislation will double fines for violations of patients’ privacy to $50,000 for indi-viduals and $500,000 for the hospital or organization. It would also scrap a rule re-quiring that prosecutions start within six months of the alleged privacy breach, which Hoskins called “a serious barrier” to prosecut-ing offenders. Only three cases of breaching private medical records have ever been re-ferred for prosecution, and there has never been a suc-cessful prosecution under the Personal Health Infor-mation Protection Act since it was introduced in 2004. One case was unsuccessful and the two others are still under consideration by the Attorney General’s office. The proposed bill would make it mandatory to report privacy breaches to Ontar-io’s Information and Privacy Commissioner and to the relevant regulatory colleges that govern health-care pro-fessionals. The privacy commissioner can’t launch prosecutions, and can only refer cases to the Attorney General. “We are proposing in this legislation changes that will require mandatory reporting from a health-care custodian in a hospital, for example, if any human resource action takes place as a result of a breach,” said Hoskins. Potential privacy breaches increase with the growing use of electronic medical records, although security protocols are much more stringent than under the old paper files, added Hoskins, who said it’s not just a hos-pital problem. “I think that is part of the advantage of mandatory reporting of all breaches, is we are going to have a better understanding where these breaches occur,” he said. The Progressive Conserv-atives said the proposed legislation should make it mandatory to report serious breaches of patients’ privacy to police. “The government is fi-nally taking steps to better protect the privacy of the people, though it comes only after months of headlines exposing breaches of patient information and does not guarantee police involve-ment for serious cases,” said PC attorney general critic Sylvia Jones. -Keith Leslie The Canadian Press www.canadianchiropractor.ca 10 Canadian Chiropractor July/August 2015
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