East meets West

1. East meets West Robert Bennett, MD Professor of Medicine and Nursing OHSU

2. East meets West Integrative Medicine: A marriage of conventional Western medicine with other healing modalities, including complementary and alternative medicine (CAM), for which there is evidence of safety and effectiveness. Examples:Traditional Chinese medicine (herbs, acupuncture, gigong)Hands–on therapy (osteopathy, massage), Lifestyle(education, nutrition, exercise)Mind-body therapies (yoga, Tai Chi).

3. The Topics The Myofascial Web Mindful Movement Eastern Treatments Optimal Nutrition

4. The Topics The Myofascial Web Mindful Movement Eastern Treatments Optimal Nutrition

5. Myofascial Trigger Points Why is it important to eliminate myofascial trigger points ?

6. Anatomyof Pain Brain Centralsensitization Pain generators Spinal cord

7. Trigger Point Therapy

8. The Topics The Myofascial Web Mindful Movement Eastern Treatments Optimal Nutrition

9. Time Magazine, February 2, 2014 The raisins sitting in my sweaty palm are getting stickier by the minute. They don't look particularly appealing, but when instructed by my teacher, I take one in my fingers and examine it The ability to focus for a few minutes on a single raisin isn't silly if the skills it requires are the keys to surviving and succeeding in the 21st century

10. Science meets Meditation Epigenetics: Changes in gene expression related to environmental factors Conclusion: Eight weeks of daily yogic meditation reversed the pattern of increased expression of genes associated with inflammation

11. The Topics The Myofascial Web Mindful Movement Eastern Treatments Optimal Nutrition

12. Traditional Chinese Medicine Yin and yang symbol for balance. In Traditional Chinese Medicine, good health is believed to be achieved by a balance between yin and yang Main components:Herbal medications Acupuncture Massage (Tuina) Exercise (qigong)

13. Acupuncture A 5000-year old medical system based on the theory that“Qi” (the life force which flows throughout our body) is out of balance

14. Cochrane database review 2013 Deare, JC, et al. Acupuncture for treating fibromyalgia. Cochrane database review. 2013, May 31 Reviewed 9 randomized controlled studies (i.e. sham acupuncture) involving 321 subjects: There is low to moderate-level evidence that acupuncture improves pain and stiffness The effect lasts up to one month Electro acupuncture is probably more effective than manual acupuncture The effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue

15. The Topics The Myofascial Web Mindful Movement Eastern Treatments Optimal Nutrition

16. Probiotics WHO definition: micro-organisms which, when administered in adequate amounts, confer a health benefit on the host Kefir Elie Metchnikoff first suggested the possibility of colonizing the gut with beneficial flora in the early 20th century. 1845 - 1916

17. Recent Review Quigley, EM. Prebiotics and probiotics; modifying and mining the microbiota. Pharmacology Research. March 2010 A new era in medical science has dawned with the realization of the critical role of the "forgotten organ", in generating a variety of functions which sustain health and, when disrupted, leads to disease. Your gut harbors 100 trillion organisms Prevotellacopri – rheumatoid arthritis Bacteroidesprevotella – obesity Clostridium perfringens – multiple sclerosis Lactobacilli & Bifidobacteria– irritable bowel

18. Coprophagy ? • Patients with recurrent Clostridium difficileinfection underwent therapy with donor feces that were infused, through a naso-duodenal tube. • This treatment was compared to a a group of patients treated with a conventional 14 day vancomycin regime.

19. Results of fecal transplantation study After 2 fecal transplantations there was a 94% cure rate

20. Are you a chocolate lover? A prebiotic? The good microbes, such as Bifidobacterium and lactic acid bacteria, feast on chocolate When you eat dark chocolate, they grow and ferment it, producing compounds that are anti-inflammatory

21. What about the descending inhibitory pain system ?

22. Descending Inhibition Remember Activate your descending inhibitory system every day

24. Myofascial Web and Fibromyalgia Ginevra Liptan, MD Fibromyalgia Information Foundation 2014 Annual Conference

25. Fibromyalgia (FM) pain • Hyper-reactive spinal cord and brain called “central sensitization” • Pain generated from muscle tissue

26. 18 tender points used to diagnose FM

27. Fascia –connective tissue around muscle Myofascial trigger points Fibromyalgia muscle pain sources

28. What is fascia? • Connective tissue network • Surrounds both individual and groups of muscles • Highly sensitive to pain • Contracts to give muscles extra strength

29. Myofascial “web”

30. Connective tissue that envelopes muscles

31. Connective tissue that’s left after muscle cells dissolved

32. Fascia in FM • Increased tension • Inflammation • Prone to “ knotting up”( myofascial trigger points)

33. Myofascial trigger points • Hyper-irritable or taut band of muscle • Painful on compression • Refers pain • Can occur in any muscle under strain

34. Myofascial trigger point

35. Myofascialrelease (MFR) Trigger point injections Self-care Treatments for fascia/trigger points

36. Myofascial release therapy • Manual traction and prolonged assisted stretching • Breaks up painful adhesions in the connective tissue surrounding muscle

37. MFR is not massage

38. Myofascial release for FM

39. Castro-Sanchez et al . 2011 • 20 weeks myofascial release therapy • Compared to sham ultrasound • Significant improvement in pain and tender points • Pain reduction persisted at 1 and 6 months post-intervention

40. Our study- MFR vs. massage • Women between the ages of 21 and 50 with a confirmed FM diagnosis • Randomized to myofascial release or Swedish massage • Therapists had advanced training using the John F. Barnes MFR approach • 90 minutes weekly for 4 weeks

41. FIQ-R Percentage Change in Myofascial Release Subjects A change of 14% or more is considered significant Percentage change in FIQ-R Myofascial release subjects 1–8

42. FIQ-R Percentage Change in Massage Subjects A change of 14% or more is considered significant Percentage change in FIQ-R Massage subjects 1–4

43. Trigger point injections • Injection of lidocaine • “Dry needling”

44. Trigger point self-treatment

45. Resources Web sites: • www.theracane.com • www.myofascialrelease.com • Book: • The Trigger Point Therapy Workbook: Your Self- Treatment Guide for Pain Relief by Clair Davies

47. Mindful Movement & Meditation How & Why Yoga Helps those with Fibromyalgia E.B. Ferdig E-RYT500, certified yoga therapist

48. OHSU Study Shows Yoga Effectiveness • Result:Pain reduced an average of 24% • Fatigue reduced an average of 30% • Depression reduced by 42% Participants attended weekly classes of gentle stretching, meditation, breathing exercises & group discussion They were also given a DVD video and encouraged to do yoga regularly at home

49. How & why does yoga help? • Yoga is varied & can be adapted to the student • Primarily a mental practice, but also can be: • Physical • Emotional • Energetic • Spiritual • We can take what we need & leave the rest • For yoga to work, we need to do it. To do it, we need to have experienceof it being helpful, so we might build new habits.

50. Benefits of Breathing • If we can breathe, we can do yoga • The pain that comes with Fibromyalgia keeps many people in “fight or flight” mode • By breathing very slowly for just one minute, we can take brain from fight or flight mode, to “executive functioning,” so we can make good decisions (or just relax)