Thanks to Cort's report on the 2010 OFFER Conference, I watched Dr. Woods OFFER 2010 presentation for medical doctors (providers) on fibromyalgia research and treatment and was so taken by his presentation that I took notes in order to give them to my primary care physician - my only medical doctor -- in order to encourage them to maybe watch the video also. (I downloaded the video and put it into a format that he could watch even on a TV - trying hard to encourage him!). After I got done, I thought, "why don't I just post this at PR?, maybe it will help somebody else, or entice somebody else to watch his presentation. I am one of those ME w/FMS patients (don't you love the term, “comorbid”!!), so I followed the fibromyalgia/pain information out there. His presentation was by far the most enlightening presentation I have seen in a very long while. So for anybody that's interested -- here are my notes…………….Be warned -- I have to use voice dictation -- and although I spend quite a bit of time rereading my dictation -- a lot of times garbled words get spit out and I miss them. ______________________________________________________________________________ Notes on Dr. Wood’s FMS presentation at OFFER conference October 2010: Fibromyalgia: Advances in Theory and Practice" Patrick Wood, MD Pacific Rheumatology Associates, Chief Medical Officer for Angler Biomedical Technologies //////////////////////////////////////////////////////////////////////////////// Dr. Wood has a sense a humor. This is my sense of humor also. A couple examples from his presentation... I sometimes tell my patients that did doctors can do four things: 1. talk to you 2. refer you 3. cut you 4. poison you he then tells them, "I am a poisoner"………. this is how he refers to drug reps (pharmaceutical representatives that haunt doctors offices): "those pretty people who come into your office” ////////////////////////////////////////////////////////////////////////////// Simple Clinical Tests he performs: o secondary pain/windup pain test. Space space puts his thumb on the dorsal forearm with a steady gentle pressure and keeps it there for a minute or two. Many patients will not be able to stand this as the pain winds up. o He will very likely run his hands up and down a person's arms and shoulders etc. with a light stroke or touch -- and that drives some people crazy with pain symptoms. Sleep information: o FMS patients do not go into Delta sleep. Delta sleep is where growth hormone is produced and memories are made. o In fibromyalgia there are alpha wave bursts throughout the night. These are arousal waves -- so FMS patients are kept on a high alert pattern, instead of falling into deep sleep. Neurotransmitter/Dopamine information: o the drug companies have pushed the fact that there are is a serotonin and and norepinephrine deficiency in fibromyalgia, but if you look at the actual studies you will see that there is a more significant dopamine deficiency. o Fibromyalgia patients are making very high levels of endorphins, and thus the mu-opiod receptors are engaged and not available for imaging (why there are reports of mu-opioid receptor deficiencies). The dopamine synthesis system and dopamine delivery system needs to be functional in order for opioids to work, thus the native (endogenous) opioids are not working correctly and patients commonly need very high levels of exogenous (pharmaceutical) opioids for pain reduction. Many times even high levels of pharmaceutical opioids will not have much effect in pain reduction in fibromyalgia patients because of this dopamine dysfunction. These patients are not "drug seeking addicts”, they just have this dysfunction. FMS Androgen system: o mild cortisol deficiency o low growth hormone levels (due to sleep disturbances) FMS Functional MRI/brain picture information: o pictures show dysfunctions in the areas of the brain that control cognitive thinking (cortex -- brain fog) o pictures show dysfunctions in the areas that control dopamine synthesis (the hypothalamus) o pictures show high activity in the areas of the brain that control pain perception Cervical Spine Compression FMS Subgroup: o his partner, Dr. Andrew Holman, and some associates in Washington have come up with a subgroup of fibromyalgia patients whose symptoms seem to be caused by cervical compression of the spinal cord. They have come up with standards for MRI imaging and measurement that will indicate that this compression occurs upon extension of the patient's neck. Reduction of this compression via ??? Causes in the fibromyalgia symptoms to be reduced?? Eliminated?? o He showed studies that show cervical spine compression causes autonomic arousal -- and sleep disturbances. o When they look at the cervical spine compression they are not looking at/for any disc degenerative effects. Abnormal Iron (FE) Metabolism: o Dr. Wood/Holman have recently done studies looking at serum ferritin levels in fibromyalgia patients separated into two subgroups -- those with cervical compression and those without cervical compression. o FMS patients with no cervical compression show a very very strong correlation of symptoms with abnormal (increased?) Serum ferritin (FE) levels. This is new information to the medical profession. He did not indicate what he thinks it means -- but he and Dr. Holman R. going to publish on this somewhere in the next six months. o FMS patients with cervical compression do not show any increase serum ferritin (FE) levels. o Definitely -- two subgroups -- producing very similar symptoms. Pharmacology: o he has a rule of 30s -- for a drug to make it to FDA approval it needs to make 30% of the patients feel 30% better. 30% of the other patients will feel no effects, and 30% of the other patients will dislike the side effects?? o Gabapentin -- takes 12 weeks to have affect, and the pain score lowers from 7.5 to 5.5. Dr. Wood states -- "how many of you would like to spend your day with the pain level of 5.5?". He thinks this drug is relatively ineffective. Remember there will be responders and nonresponders. o Duloxetine (Cymbalta) -- the effects occur quickly, once again a reduction from a pain level of about 7.5 down to obtain level of about five in two weeks, but then the effects wear off. He wonders how the drug ever received approval. o Milnacipran (Savella). Once again the 30% rule applies… 7.5 down to 5 or so. -effects level off... Pharmaceuticals That Dr. Wood Finds Useful: Pramipexole -- generic. Dr. Wood/Holman?? Have done a study where they titrate up to 4.5 mg of Pramipexole (this is a huge amount of Pramipexole he says if you didn't titrate that it would cause hallucinations). o They do not use this drug on patients with cervical compression. o Symptom reduction over a multi-month period shows reductions from 7.5 down to 4.5, and the graph shows a continual reduction over the whole time period and continues to trend downwards at the end…. Sodium Oxybate -- date rape drug. Super physiological dosages. Schedule 3 substance. ???FDA just recently denied approval for….???. taken twice a day -- once at bedtime and once 3 to 4 hours later. Very effective drug. Downside -- the cost is $2400 a month. Insurance companies are very reluctant to cover the cost, even though it's a very effective drug. o Increases delta wave sleep o increases dopamine synthesis and production o increases growth hormone production Pyridostigmine (Mestinon). 60mg b.i.d . Currently, the pharmaceutical he most commonly prescribes, o increases growth hormone production via somatostatin reduction.. o increased vagal tone (the level of activity in the parasympathetic nervous system) o decreased anxiety o increase sleep o he says this drug is a good indication of how studies mix together responders and nonresponders due to improperly chosen cohorts, and then the results are mixed and hard to understand. He thinks in many of his patients this drug has significantly improved their lives, even though the medical research "studies" do not support a decrease in pain levels, etc, enuf!