Fibromyalgia & Chronic Pain LIFE Mar/Apr 2013, Issue 8 - Page 21

Research Update Table 2 - Dysautonomic Features Commonly Found with PC3 Thermoregulatory Cardiovascular Gastrointenstinal Urological Psychiatric Other Diaphoresis; perception of temperature fluctuation; peripheral edema Palpations; unexplained chest pain; orthostasis; POTS; Raynaud’s GERD, irritable bowel syndrome; bloating Increased urgency; frequency Increased panic; anxiety; bipolar disorder Insomnia; restless legs syndrome, bruxism (TMJD); fatigue GERD: gastroesophageal reflux disease; PC3: posititional cervical cord compression; POTS: postural orthostatic tachycardia syndrome; TMJD: temporomandibular joint disease fe e l s s i m i l a r to a n e l e c t r i cal shock), and if sufficiently forceful, can cause death. Traditionally, x-rays have been employed to identify this condition, but f lexion-extension MRI views also have been studied. Dedicated MRI positioning devices have been engineered for patients with RA , 10 as they have for patients with degenerative diseases, 11,12 and some authors suggest that this imaging technique should be the diagnostic “study of choice for the upper rheumatoid C-spine” for pre-surgical staging. 13 Positional Spinal Cord Compression Linked With FM I n 2002, neurosurgeon, Dr. Dan Heffez also advocated viewing the cervical cord more dynamically with MRI. His suggestion was presented in the context of sorting out another complex p re s e n t at i o n , f i b ro mya l g i a (FM), at a small meeting of the National Fibromyalgia Research Association, in Portland, Oregon. His analysis found that symptoms of FM and cervical myelopathy overlapped for many patients with FM. Further, he noted that when he surgically decompressed severe, overlapping myelopathy, FM symptoms (allodynia, fatigue, central sensitization, pain, dyscognition, sleep disturbance) often subsided. 14 Similar observations were made for FM combined with Arnold Chiari malformation (often simply known as Chiari malformation, is a downward displacement of the cerebellar tonsils [back, lower part of the brain] through the foramen magnum [the opening at the base of the skull]). 15 T o say that Heffez’s message was re ceive d w ith mixe d responses would be overly generous. A furor built quickly to relegate it to near oblivion. No clinicians wanted to consider the specter of surgical intervention for 6 to 10 million American patients with FM. n light of the above findings, beginning in 2003, radiologists working with the Pacific Rheumatolog y Associates began obtaining flexion-extension cer vical spine MRI routinely for patients without additional charge. Positional cervical cord compression (PC3) was defined as clear, visually-confirmed abutment of the cervical cord, with a canal diameter measured at 10 mm or less (Figure 2). (Of note, the typical cervical spinal canal can average 14 to 16 mm in men and 13 to 15 mm in I Mar/Apr 2013 Fibromyalgia & Chronic Pain Life 21