Dr James Schaller
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THE FAILURE OF FIBROMYALGIA TREATMENTS:
WHERE ARE THE REAL CURES?

Over the last 20 years I have watched as FM and Chronic fatigue syndrome have gained acceptance. But what has that meant in terms of cure and full recovery to patients? All I currently see are Band-Aid treatments which help take the edge off some aspect of the patientÕs suffering and watch folks over sell their treatments and protocols to the point of being sad. Cure seems unreal. Medicines seem to help 5-20% at best. And do not help at all in some cases.

One has the strong sense that the leaders in this research are looking under the wrong rocks and not being very effective.

On my web sites I talk about many causes of fatigue. There are approximately 1100 causes of fatigue, but most causes of fatigue that are not addressed by sincere FM physicians or the ones treating chronic fatigue are discussed on this web site or my other web sites or in my books.



Sexual dysfunction in fibromyalgia patients.

Orellana C, Casado E, Masip M, Galisteo C, Gratac—s J, Larrosa M.

Rheumatology Unit, Hospital de Sabadell, Barcelona, Spain; *ICS, ABS Manso, Spain.

OBJECTIVE:To investigate the prevalence of sexual dysfunction in female patients with fibromyalgia (FM), the impact of FM on sexual activity and the factors associated with sexual dysfunction in these patients.METHODS:Thirty-one consecutive women with FM were enrolled; two groups of 20 aged-matched healthy women and 26 patients with rheumatoid arth-ritis (RA) were used as controls. Demographic features were recorded in all patients. A cross-sectional analysis of pain (100-mm VAS scale), anxiety and depression (as determined by the STAI and Beck Depression Inventory scales, respectively) was performed. Sexual function was assessed by the Changes in Sexual Functioning Questionnaire (CSFQ).RESULTS:FM and RA patients showed a significantly higher rate of sexual dysfunction compared to healthy controls. Sexual dysfunction was more frequent among FM patients (97%) than in RA patients (84%) but without statistical differences. A univariate analysis showed that age (p=0.0002), marital (p=0.036) and work status (p=0.048), pain intensity (p=0.007), level of anxiety (p=0.002), level of depression (p=0.0005), were significantly associated with sexual dysfunction in FM. However, only the intensity of depression was associated with the sexual dysfunction in patients with FM in the multivariate analysis (p=0.012).CONCLUSIONS:Sexual function was very frequently and severely affected in patients with FM and this impairment appeared to be particularly associated with the degree of depression. The recognition of this dysfunction and its inclusion for the multidisciplanary management of FM may contribute to improve quality of life of these patients.

PMID: 18799102 [PubMed - in process]


Prevalence and impact of fibromyalgia on function and quality of life in individuals from the general population: results from a nationwide study in Spain.

Mas AJ, Carmona L, Valverde M, Ribas B.

Rheumatology Department, Hospital "Son Llˆtzer", Palma de Mallorca, Spain.

OBJECTIVE:To estimate the prevalence of fibromyalgia (FM) and to compare some descriptive epidemiological and quality of life data between persons with and without FM criteria in a representative sample of the general Spanish population.METHODS:Cross sectional study of 2,192 Spaniards aged 20 or above, selected by cluster sampling. Subjects were invited to a structured interview carried out by trained rheumatologists to ascertain various musculoskeletal disorders. The visit included screening and examination, validated instruments for measuring function (HAQ) and quality of life (SF-12) and questions about socio-demographic characteristics and musculoskeletal, mental, and other general symptoms. FM was suspected in subjects with widespread pain for more than three months. FM was defined by theAmerican College of Rheumatology classification criteria. All estimates are adjusted to sampling scheme.RESULTS:The prevalence of FM in Spain is 2.4% (95% CI: 1.5-3.2). FM is significantly more frequent in women (4.2%) than in men (0.2%), with an OR for women of 22.5 (95%CI: 7.2- 69.9), mainly in the 40-49 years age interval. It is more frequent in rural (4.1%) than in urban settings (1.7%), with an OR for rural settings of 2.5 (95%CI: 1.03-5.9). FM is associated with a low educational level, to a low social class, and to self-reported depression. The scores in the HAQ and in the SF-12 were significantly lower in FM subjects, despite adjustment by covariates.CONCLUSION:FM has a high prevalence in the general population. FM is associated to female gender, comorbidities, age between 40 and 59 years, and a rural setting. Persons fulfilling FM criteria show impaired functioning and quality of life.

PMID: 18799079 [PubMed - in process]

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Status of immune mediators in fibromyalgia.

Gur A, Oktayoglu P.

Department of Physical Medicine and Rehabilitation, Medical Faculty, Dicle University, Diyarbakir, Turkey. alig@dicle.edu.tr

Fibromyalgia (FM) is a form of nonarticular rheumatism characterized by long-term (> 3 months) and widespread musculoskeletal pain. However, the biophysiology of FM has remained elusive, and the treatment remains mainly empirical. There are numerous hypotheses about the pathophysiology of chronic widespread pain and FM; one includes a possible role of cytokines. Cytokines play a role in diverse clinical processes and phenomena such as fatigue, fever, sleep, pain, stress, and aching. Cytokines related to acute or repetitive tissue injuries may be responsible for long-term activation of spinal cord glia and dorsal horn neurons, thus resulting in central sensitization. Pain, stiffness, and depression in FM could be associated with some signs of inflammatory response system activation. Illumination of the pathophysiologic secrets of FM will result in more effective treatment regimens. We review the role of immune mediators in the pathophysiology of FM.

PMID: 18796266 [PubMed - in process]

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Systematic Review of Discriminating Power of Outcome Measures Used in Clinical Trials of Fibromyalgia.

Carville SF, Choy EH.

From the Sir Alfred Baring Garrod Clinical Trials Unit, Department of Academic Rheumatology, King's College London, London, UK.

OBJECTIVE: Fibromyalgia (FM) comprises many symptoms and features. Consequently, studies on the condition have used a wide variety of outcome measures and assessment instruments. We investigated those outcome measures and instruments in association with the OMERACT (Outcome measures in Rheumatoid Arthritis Clinical Trials) FM Workshop initiative to define core outcome measures that should be used to assess FM. METHODS: A systematic literature review up to December 2007 was carried out using the keywords "fibromyalgia," "treatment" or "management," and "trial." Data were extracted on outcome measures and assessment instruments used and the pre and post mean and standard deviation to calculate effect sizes (ES). Further sensitivity analysis was carried out according to treatment type, blinding status, and study outcome. RESULTS: The outcome domains identified fell largely within those defined by OMERACT. Morning stiffness was frequently assessed and therefore has been included here. The number of assessment instruments used was wide-ranging, so sensitivity analysis was only carried out on the top 5 within each domain. ES ranged from 0.54 to 3.77 for the key OMERACT domains. Health-related quality of life (HRQOL) was the only exception that had no instrument with moderate sensitivity. Of the secondary domains, dyscognition was lacking any sensitive instrument, as were fatigue and anxiety in pharmacological trials. CONCLUSION: Each of the key OMERACT domains has an instrument that appears to be sensitive to change, with the exception of HRQOL, which requires further research. Dyscognition, fatigue, and anxiety would all benefit from more research into their assessment instruments.

PMID: 18792996 [PubMed - as supplied by publisher]

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Response to: Long-term trials of pregabalin and duloxetine for fibromyalgia symptoms: How study designs can affect placebo factors.

Moore RA, Derry S, McQuay HJ.

Nuffield Department of Anaesthetics, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK.

Publication Types:
PMID: 18790568 [PubMed - as supplied by publisher]

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Fibromyalgia: Diagnosis and Management for the Primary Healthcare Provider.

Huynh CN, Yanni LM, Morgan LA.

Division of General Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.

Abstract Fibromyalgia is a disorder of chronic generalized musculoskeletal pain affecting 2% of the general population, with an increased frequency in women. Clinical diagnosis relies on history and research-supported tender point criteria. As in other chronic pain syndromes, a multidimensional approach optimizes treatment response. Empirical data and consensus support the use of nonpharmacological modalities, such as education, aerobic exercise, and cognitive behavioral therapy, in the management of fibromyalgia. Evidence-supported pharmacological interventions include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, alpha-2-delta ligands, and other serotonergic-noradrenergic analgesic agents, such as tramadol. This paper offers the primary healthcare provider a systematic approach to the diagnosis of fibromyalgia and management strategies based on available evidence, consensus, and empirical data.

PMID: 18788986 [PubMed - as supplied by publisher]

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Characteristics of electronic visual analogue and numerical scales for ratings of experimental pain in healthy subjects and fibromyalgia patients.

Price DD, Patel R, Robinson ME, Staud R.

Department of Neuroscience, University of Florida, College of Medicine, Gainesville, FL 32610-0221, USA; Department of Oral Surgery, University of Florida, College of Medicine, Gainesville, FL 32610-0221, USA.

Comparisons of measurement characteristics were made for three types of electronic pain scales: (a) visual analogue scale (VAS), (b) VAS combined with an electronic number box (VAS-N; 0-100), and (c) electronic number box scale (NUM). The three scales were capable of discriminating pain sensations from very small (0.5 degrees C) temperature steps in 13 healthy males, 26 healthy females, and 16 female fibromyalgia (FM) patients. All scales provided monotonic functions when used by subjects to rate pain from 5s nociceptive temperatures (45-49 degrees C), thereby demonstrating the generality of these results across different demographic groups. As expected, FM patients rated heat pain sensations higher on all scales in comparison to healthy females, demonstrating the capacity of these scales to detect well-established group differences in pain sensitivity that exist across these two groups. However, in comparison to male subjects, healthy females gave higher NUM but not VAS or VAS-N ratings to the range of nociceptive presented temperatures. We interpret this difference as a selective scaling bias of female subjects for NUM. Finally, all three groups (total of 55 subjects) found the scales easy to use after brief instructions, though subjects strongly preferred the use of VAS-N or VAS in comparison to NUM scale.

PMID: 18786761 [PubMed - as supplied by publisher]

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Influence of comorbidities on improvement of fibromyalgia symptoms when treated with acupuncture: a short report.

Singh BB, Khorsan R, Vinjamury SP.

Medicus Research LLC, Midlothian, Virginia, USA.

BACKGROUND: Fibromyalgia syndrome (FMS) is associated with chronic widespread pain, mood alteration, and disability. A definitive treatment plan has not been identified. The genesis of FMS is unclear and generally occurs in women. PURPOSE: To determine whether patient-identified most disruptive comorbidity (MDC) secondary to FMS may have mediated recovery for individual patients. This is a probative analysis of data from an effectiveness study published in the March 2006 issue of Alternative Therapies in Health and Medicine. (2006;12(2):34-41.) METHODS: The American College ofRheumatology (ACR) criteria for FMS was used in participant selection; 21 participants completed the study. RESULTS: The original outcome study indicated significant changes on standardized measures using specific points and numbers of treatment within an 8-week period. The preliminary data on influence ofMDC on improvement were differential related to self-report MDC by patients. CONCLUSIONS: For all MDCs combined, participants experienced significant improvement at 8 weeks of treatment. Participants with irritable bowel syndrome as their MDC generally had a lower percentage of improvement than other MDC cohort groups. This finding has implications for treatment.

PMID: 18780581 [PubMed - in process]

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Participation in online patient support groups endorses patients' empowerment.

van Uden-Kraan CF, Drossaert CH, Taal E, Seydel ER, van de Laar MA.

Institute for Behavioural Research, University of Twente, The Netherlands.

OBJECTIVE: Although much has been expected of the empowering effect of taking part in online patient support groups, there is no direct evidence thus far for the effects of participation on patient empowerment. Hence our exploring to what extent patients feel empowered by their participation in online support groups, and which processes that occur in these groups are related to the empowering outcomes. METHODS: An online questionnaire was completed by 528 individuals who were active in online groups for patients with breast cancer, fibromyalgia and arthritis. RESULTS: The respondents felt empowered in several ways by their participation. The empowering outcomes that were experienced to the strongest degree were 'being better informed' and 'enhanced social well-being'. No significant differences in empowering outcomes between diagnostic groups were found. The empowering outcomes could only be predicted in a modest way by the processes that took place in the online support groups. CONCLUSION: This study indicates that participation in online support groups can make a valuable contribution to the empowerment of patients. PRACTICE IMPLICATIONS: Health care providers should acquaint their patients with the existence of online support groups and with the benefits that participation in these groups can offer.

PMID: 18778909 [PubMed - as supplied by publisher]

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Hippocampal Metabolite Abnormalities in Fibromyalgia: Correlation With Clinical Features.

Wood PB, Ledbetter CR, Glabus Deceased MF, Broadwell LK, Patterson JC 2nd.

Departments of Family Medicine, Anesthesiology, and Psychiatry.

Although the pathology of fibromyalgia is poorly understood, a growing body of evidence suggests involvement of the central nervous system. The hippocampus is a brain center that is sensitive to the effects of stress exposure and has been demonstrated to be affected in a variety of disorders whose onset, like fibromyalgia, are associated with stressful experience. We therefore interrogated the bilateral hippocampus of 16 female fibromyalgia patients in comparison to 8 age- and gender-matched healthy control subjects using single voxel proton magnetic resonance spectroscopy. Our results demonstrate a significant reduction in the ratio of N-acetylaspartate to creatine (NAA/Cr) in fibromyalgia patients versus matched control subjects specifically in the right temporal lobe from a voxel centered on the right hippocampus (patient vs control, mean +/- standard deviation: 1.20 +/- 0.13 vs 1.34 +/- 0.10, P = .03). Moreover, correlation analysis demonstrated a significant negative correlation between patient scores on the Fibromyalgia Impact Questionnaire and NAA/Cr ratio within the right hippocampus (Spearman rank correlation, rho = -0.681, P = .018). Our results indicate that fibromyalgia is associated with brain metabolite abnormalities within the right hippocampus that correlate with patient symptoms. PERSPECTIVE: We have demonstrated an abnormality in hippocampal brain metabolites in premenopausal female fibromyalgia patients with no psychiatric comorbidity. A significant negative correlation between patient subjective experience of symptoms and a reduced NAA/Cr ratio suggests a role for hippocampal pathology in fibromyalgia.

PMID: 18771960 [PubMed - as supplied by publisher]

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Biology and therapy of fibromyalgia. Evidence-based biomarkers for fibromyalgia syndrome.

Dadabhoy D, Crofford LJ, Spaeth M, Russell IJ, Clauw DJ.

Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA. dclauw@med.umich.edu.

ABSTRACT: Researchers studying fibromyalgia strive to identify objective, measurable biomarkers that may identify susceptible individuals, may facilitate diagnosis, or that parallel activity of the disease. Candidate objective measures range from sophisticated functional neuroimaging to office-ready measures of the pressure pain threshold. A systematic literature review was completed to assess highly investigated, objective measures used in fibromyalgia studies. To date, only experimental pain testing has been shown to coincide with improvements in clinical status in a longitudinal study. Concerted efforts to systematically evaluate additional objective measures in research trials will be vital for ongoing progress in outcome research and translation into clinical practice.

PMID: 18768089 [PubMed - as supplied by publisher]

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Central mechanisms in the maintenance of chronic widespread noninflammatory muscle pain.

DeSantana JM, Sluka KA.

Physical Therapy and Rehabilitation Science, 1-242 MEB, University of Iowa, Iowa City, IA 52252, USA.

Chronic widespread pain (CWP) conditions such as fibromyalgia and myofascial syndromes are characterized by generalized pain, tenderness, morning stiffness, disturbed sleep, and pronounced fatigue. However, CWP pathophysiology is still unclear. A number of hypotheses have been proposed as the underlying pathophysiology of CWP: muscular dysfunction/ischemia, central sensitization, and a deficit in endogenous pain-modulating systems. This article reviews the current and emerging literature about the pathophysiology and neurobiology of chronic widespread -musculoskeletal pain. Widespread musculoskeletal pain results in changes in the central nervous system in human subjects and animal models. These changes likely reflect alterations in supraspinal modulation of nociception, and include increases in excitatory and decreases in inhibitory modulation pathways. These alterations in excitation and inhibition likely drive changes observed in the spinal cord to result in central sensitization, and the consequent pain and hyperalgesia.

PMID: 18765138 [PubMed - in process]

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Neuromodulators for the treatment of headache disorders and fibromyalgia.

Krymchantowski AV, Bryson J, Lipton RB, Bigal ME.

Merck Research Laboratories, 1 Merck Drive, Whitehouse Station, NJ 08889, USA.

Migraine and fibromyalgia are prevalent and disabling disorders with few preventive medications approved by the US Food and Drug Administration (FDA). Neuromodulators (or antiepileptic drugs; AEDs) are often effective in the treatment of these conditions. Divalproex sodium and topiramate are FDA-approved AEDs for migraine. For fibromyalgia, pregabalin has recently been approved in the United States. We review the use of AEDs in the preventive treatment of these highly prevalent disorders.

PMID: 18765137 [PubMed - in process]

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Religiousness and spirituality in fibromyalgia and chronic pain patients.

Moreira-Almeida A, Koenig HG.

Federal University of Juiz de Fora School of Medicine, Rua da Laguna 485/104, Juiz de Fora, MG, 36015-230, Brazil. alex.ma@ufjf.edu.br

The influence of psychosocial factors on pain experience and patient response has received increasing interest and recognition. Patients with chronic pain from several sources (eg, musculoskeletal, cancer, or sickle cell) usually report that religiousness and spirituality are important in their lives. Prayer is the most used complementary therapy; religious coping is among the most common strategies used to deal with pain. Religious variables are not usually associated with pain measures, except in some studies indicating that petitionary prayer is related to higher pain levels, possibly suggesting a turning to religion due to increasing pain. The best available evidence supports a positive association between religiousness and spirituality, with higher well-being and positive affect, and a negative association with depressive and anxiety symptoms. We discuss the importance of addressing spiritual issues in clinical practice, and increasing and improving research on religiousness/spirituality in chronic pain patients.

PMID: 18765136 [PubMed - in process]

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Fibromyalgia: an update and immunological aspects.

Paiva ES, da Costa ED, Scheinberg M.

Hospital Israelita, Albert Einstein and Research Institute, Av. Albert Einstein 627, Sao Paulo, Brazil.

Fibromyalgia syndrome (FMS) is now understood as a chronic pain syndrome, and recent evidence indicates it is not a pure psychosomatic disorder. We review the current knowledge in FMS pain pathways, focusing on the central system sensitization phenomenon and the abnormalities in the inhibitory pain systems. Chronic headache is one of the most common symptoms in FMS, and better knowledge of their common pathophysiologic features can help us understand both conditions better. These features include the nerve growth factor actions and failure of the endocannabinoid system. In addition, we review new immunological aspects of FMS, both in their humoral (autoantibodies, antipolymer antibodies) and cytokine (interleukin-2) aspects.

PMID: 18765135 [PubMed - in process]

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Is pregabalin a safe and effective treatment for patients with fibromyalgia?

Spaeth M.

M Spaeth is an Internist and Rheumatologist in private practice in Graefelfing, Germany.

The concept of fibromyalgia being one of several 'central sensitivity syndromes' has led to the use of centrally acting drugs in the treatment of this disorder. One such drug, pregabalin, has recently been approved by the US FDA for the treatment of fibromyalgia. In a study by Mease and colleagues, significant relief from symptomatic pain was achieved in patients treated with pregabalin 300 mg/day, 450 mg/day and 600 mg/day compared with placebo. In addition, Patient Global Impression of Change and sleep scale scores were significantly improved in all treatment groups at the 13-week end point. Dizziness and somnolence were the two most common dose-related adverse events, but led to few withdrawals from the study. The results support the use of pregabalin as a mechanism-based treatment for pain and sleep disturbances in patients with fibromyalgia. Further studies with a longer observation period and randomized trials comparing different medications are needed.

PMID: 18762786 [PubMed - as supplied by publisher]

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Understanding, embracing, rejecting: Women's negotiations of disability constructions and categorizations after becoming chronically ill.

Crooks VA, Chouinard V, Wilton RD.

Department of Geography, Simon Fraser University, RCB 7123, 8888 University Drive, Burnaby, British Columbia, Canada V5A 1S6.

The purpose of this article is to elucidate the various responses women have to being, or not being, categorized as disabled within specific spheres (e.g., medical, state) or places (e.g., doctor's office, work) after developing a contested chronic illness. Drawing on interviews conducted with 55 women living with fibromyalgia syndrome in Ontario, Canada, we examine how they come to understand various constructions of disability and whether or not they reflect their sense of self, and how and why they either embrace or reject external categorizations of themselves as disabled by the state or medical professionals. In doing so we contribute to the limited geographic literature which stresses the importance of spatiality and ways of being in place to ill and impaired persons' negotiations of the self and relationships with others. We find that negotiating disability was, for many, an emotionally charged and complex process, drawing on one or more strategies: reluctantly employing some meanings associated with 'being disabled' to achieve material ends, creating an understanding of disability that is most in keeping with one's sense of self, embracing other meanings to the extent that they offer a legitimate basis for identity, and/or rejecting disability in the interests of sustaining an existing identity. For those women in need of forms of state assistance such as income support and health care, state institutions exert powerful pressures to come to terms with what disability means in one's life - particularly as medical and state authorities classify people as 'disabled enough' or 'not disabled enough' for entitlement to state resources.

PMID: 18760870 [PubMed - as supplied by publisher]

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Laser-evoked potentials in primary headaches and cranial neuralgias.

de Tommaso M.

Clinica Neurologica, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy. m.detommaso@neurol.uniba.it

Using neurophysiological methods to explore nociceptive pathways may improve knowledge of the functional changes subtending pain processing in the different forms of headache and facial pain. Laser-evoked potentials (LEPs) are a reliable neurophysiological assay for the clinical assessment of pain syndromes. Reduced amplitude of LEPs seems to characterize trigeminal neuralgia and painful temporomandibular disorders, suggesting the neuropathic origin of pain. In tension-type headache, as well as in fibromyalgia, enhanced pericranial LEP amplitude suggests the psychogenic origin of pain. In migraine, a normal amplitude of basal LEPs with reduced habituation and altered attentive modulation seems to express a general dysfunction of cortical pain processing, which may also contribute, other than to predispose, to the persistence of migraine. LEPs may be employed in the clinical evaluation of the neurophysiological and psychophysiological aspects of pain in the different forms of headaches and facial pain to improve the therapeutic approach and provide an objective measure of treatment efficacy.

PMID: 18759546 [PubMed - in process]

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Substitution of specialized rheumatology nurses for rheumatologists in the diagnostic process of fibromyalgia: A randomized controlled trial.

Kroese ME, Schulpen GJ, Bessems MC, Severens JL, Nijhuis FJ, Geusens PP, LandewŽ RB.

University Hospital Maastricht, Maastricht, The Netherlands.

OBJECTIVE: To evaluate the substitution of specialized rheumatology nurses for rheumatologists in diagnosing fibromyalgia (FM). METHODS: Referred patients with FM symptoms (n = 193) were randomized to a study group diagnosed by a specialized rheumatology nurse (SRN group, n = 97) or to a control group diagnosed by a rheumatologist (RMT group, n = 96). SRN patients were seen within 3 weeks by a nurse who took structured history and initiated routine laboratory tests. During a 5-minute supervision session, the rheumatologist was informed by the nurse about medical history, performed a brief physical examination, and confirmed or rejected the nurse's diagnosis. RMT patients were seen by a rheumatologist after a regular waiting period of 3 months. Outcome measures were initial agreement between the nurse and rheumatologist in the SRN group, final diagnosis after 12-24 months of followup, patient satisfaction, and diagnostic costs. RESULTS: The mean waiting time after randomization was 2.8 and 12.1 weeks in the SRN and RMT groups, respectively. Eight RMT patients cancelled their appointments because of the waiting time. Excellent agreement (kappa = 0.91) between rheumatologists and nurses was found. After 12-24 months of followup, none of the initial diagnoses were recalled in either group. SRN patients were significantly more satisfied than RMT patients. Mean diagnostic costs were lower in the SRN group (euro219) than in the RMT group (euro281) (95% uncertainty interval euro-103, euro-20). CONCLUSION: Substituting specialized nurses for rheumatologists in the diagnostic process of FM is a trustworthy and successful approach that saves waiting time, provides greater patient satisfaction, and is cost-effective.

PMID: 18759317 [PubMed - in process]

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A systematic review on the effectiveness of treatment with antidepressants in fibromyalgia syndrome.

Ueyler N, HŠuser W, Sommer C.

University of WŸrzburg, WŸrzburg, Germany.

OBJECTIVE: To systematically review the efficacy of treatment of fibromyalgia syndrome (FMS) with antidepressants. METHODS: We screened Medline, PsychINFO, SCOPUS, and the Cochrane Library databases (through October 2007) and the reference sections of original studies, meta-analyses, and evidence-based guidelines and recommendations on antidepressants in FMS. Randomized controlled trials (RCTs) on the treatment of FMS with antidepressants were analyzed. Inclusion criteria, study characteristics, quality, and all outcome measures were investigated. RESULTS: Twenty-six of 167 studies were included. The main outcome variables reviewed were pain, fatigue, sleep, depressiveness, and quality of life. Amitriptyline, studied in 13 RCTs, was efficient in reducing pain with a moderate magnitude of benefit (pain reduction by a mean of 26%, improvement in quality of life by 30%). Selective serotonin reuptake inhibitors (SSRIs) were studied in 12 RCTs, which also showed positive results, except for 2 studies on citalopram and 1 on paroxetine. Three RCTs on the dual serotonin and noradrenaline reuptake inhibitors (SNRIs) duloxetine and milnacipran and 1 of the 2 RCTs using the monoamine oxidase inhibitor moclobemide reported a positive result. The longest study duration was 12 weeks. CONCLUSION: Amitriptyline 25-50 mg/day reduces pain, fatigue, and depressiveness in patients with FMS and improves sleep and quality of life. Most SSRIs and the SNRIs duloxetine and milnacipran are probably also effective. Short-term treatment of patients with FMS using amitriptyline or another of the antidepressants that were effective in RCTs can be recommended. Data on long-term efficacy are lacking.

PMID: 18759260 [PubMed - in process]

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A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia.

Targino RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT, Furlan AD, Imamura ST, Azevedo Neto RS.

Departamento de Patologia, Avenida Doutor Arnaldo 455, Sao Paulo, Brazil. targino@usp.br

OBJECTIVE: To evaluate the effectiveness of acupuncture for fibromyalgia. METHODS: Fifty-eight women with fibromyalgia were allocated randomly to receive either acupuncture together with tricyclic antidepressants and exercise (n=34), or tricyclic antidepressants and exercise only (n=24). Patients rated their pain on a visual analogue scale. A blinded assessor evaluated both the mean pressure pain threshold value over all 18 fibromyalgia points and quality of life using SF-36. RESULTS: At the end of 20 sessions, patients who received acupuncture were significantly better than the control group in all measures of pain and in 5 of the SF-36 subscales. After 6 months, the acupuncture group was significantly better than the control group in numbers of tender points, mean pressure pain threshold at the 18 tender points and 3 subscales of SF-36. After one year, the acupuncture group showed significance in one subscale of the SF-36; at 2 years there were no significant differences in any outcome measures. CONCLUSION: Addition of acupuncture to usual treatments for fibromyalgia may be beneficial for pain and quality of life for 3 months after the end of treatment. Future research is needed to evaluate the specific effects of acupuncture for fibromyalgia.

Publication Types:
PMID: 18758677 [PubMed - indexed for MEDLINE]

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Development and validation of a direct enantiomeric separation of pregabalin to support isolated perfused rat kidney studies.

Zhang Y, Holliman C, Tang D, Fast D, Michael S.

Pharmacokinetics, Dynamics & Metabolism, Pfizer Global Research and Development, Pfizer Inc., Ann Arbor, MI 48105, United States.

Pregabalin (Lyricatrade mark) is the first compound approved to treat the neural pain associated with fibromyalgia. Pregabalin is the S-enantiomer of a gamma-amino acid analogue and chiral separation from its R-enantiomer must be achieved to support metabolic studies. The direct chiral separation of pregabalin from its R-enantiomer has been developed and HPLC/MS/MS assays have been validated to support isolated perfused rat kidney studies. The separation was developed through serial coupling of various macrocyclic glycopeptide stationary phases until partial separation of the enantiomers was achieved. Identification of the resolving stationary phase followed by optimization of the mobile phase enabled the baseline resolution of the enantiomers using mass spectrometry compatible solvents and modifiers. Assays were developed and validated for quantitation of the enantiomers from rat urine, isolated rat kidney perfusate, and isolated rat kidney perfusate ultrafiltrate to support pregabalin metabolic studies.

PMID: 18755638 [PubMed - as supplied by publisher]

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The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review.

McVeigh JG, McGaughey H, Hall M, Kane P.

School of Health Sciences, Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, BT37 0QB, Northern Ireland, UK, j.mcveigh@ulster.ac.uk.

Hydrotherapy is often used in the treatment of fibromyalgia syndrome (FMS), however there has been limited evaluation of its effectiveness. The aim of this systematic review was therefore to examine the effectiveness of hydrotherapy in the management of FMS. AMED, BNI, CINAHL, The Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, Science Direct and Web of Science were searched (1990-July 2006). Key words used 'fibromyalgia' and 'hydrotherapy', 'balneotherapy', 'aqua therapy', 'pool therapy', 'water therapy', 'swimming', 'hydrogalvanic', 'spa therapy', 'physiotherapy', 'physical therapy' and 'rehabilitation'. Searches were supplemented with hand searches of selected journals. Randomised controlled trials (RCTs) were assessed for methodological quality using the van Tulder scale. Ten RCTs met the inclusion criteria. Mean methodological quality was 4.5/9 on the van Tulder scale. Positive outcomes were reported for pain, health-status and tender point count. There is strong evidence for the use of hydrotherapy in the management of FMS.

PMID: 18751709 [PubMed - as supplied by publisher]

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Association Between Fibromyalgia and Coronary Heart Disease and Coronary Catheterization.

Ablin JN, Beilinson N, Aloush V, Elkayam O, Finkelstein A.

Department of Internal Medicine 6.

BACKGROUND: Fibromyalgia (FM) has been associated with physical and emotional trauma including invasive medical procedures. Both FM and ischemic heart disease have been linked with depression. The purpose of this study was to retrospectively investigate the frequency of FM symptoms and physical findings among patients undergoing coronary catheterization. METHODS: Consecutive patients who underwent coronary angiography during the previous 6 mo were recruited. Patients with major depression, bi-polar disorder, schizophrenia, or malignancy were excluded. Patients underwent dolorimetry for tender-point assessment and completed the fibromyalgia impact questionnaire (FIQ). Group A included patients with significant coronary pathology (n = 43), group B included patients with normal coronary arteries (n = 50), and group C included patients with normal controls (n = 51). A cardiological score incorporated the number of coronary arteries with significant pathology and left ventricular function. Chi-square or Fisher's exact test was used for categorical data and a one-way analysis of variance for continuous variables; a multivariate linear regression was performed to compare groups. RESULTS: Significantly increased levels of tenderness were discovered among patients with coronary pathology compared with healthy controls. Significantly increased levels of depression were also found, as well as higher scores on the FIQ scale. On multivariate analysis, a positive correlation was demonstrated between tenderness/FIQ scores and a composite cardiological score. CONCLUSION: Coronary angiography is associated with a significantly increased frequency of pain, tenderness, and depression after 6 mo, apparent in both patients undergoing coronary procedures and patients with normal coronaries. This association may impact the outcome of patients with significant coronary disease. Copyright (c) 2008 Wiley Periodicals, Inc.

PMID: 18727109 [PubMed - as supplied by publisher]

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Chronic fatigue syndrome with autoantibodies - The result of an augmented adjuvant effect of hepatitis-B vaccine and silicone implant.

Nancy AL, Yehuda S.

Center for Autoimmune Diseases, Department of Medicine 'B', Sheba Medical Center, Israel.

BACKGROUND: Chronic fatigue syndrome (CFS) that defines by prolonged fatigue and other manifestations, was recently integrated into a spectrum of central sensitivity syndromes including several diseases as fibromylagia. CFS etiology is multi-factorial commonly triggered by infectious agents. Vaccines, induce an immune response similarly to infections, and may trigger just like infections autoimmune diseases, CFS and fibromyalgia. Furthermore vaccines contain an adjuvant which enhances their immune stimulation. CASE PRESENTATION: A 56-year-old woman was diagnosed with CFS accompanied by fibromyalgia, demyelination and autoantibodies. Her illness begun following the 2nd dose of hepatitis-B vaccine, and was aggravated by the 3rd vaccination. She underwent silicone breast implantation 6 years before vaccination with no adverse events. However, between the 2nd and 3rd vaccination she suffered a breast injury with local inflammation. Upon explanation of her breast implants silicone leak was observed. DISCUSSION: Vaccines have been reported to precede CFS mainly following exposure to multiple vaccinations (e.g. the Gulf war syndrome), or as an adverse response to the vaccine adjuvant (e.g. the macrophagic myofasciitis syndrome). Silicone is considered an adjuvant to the immune system, and may induce "the adjuvant disease". Silicone implant, especially silicone leak relationship with autoimmunity and CFS has been the focus of considerable debates. CONCLUSION: Our patient illness started following hepatitis-B vaccine, suggesting that it was caused or accelerated by vaccination. In parallel to vaccination our patient suffered from breast injury, which might represent the time of silicone leak. The exposure to the adjuvant, silicone, might have augmented her immune response to the vaccine. To the best of our knowledge this is the first case of combined adverse effect to vaccine and silicone. Vaccine safety in individuals with silicone implants requires further studies.

PMID: 18725327 [PubMed - as supplied by publisher]

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Self-assessed physical function levels of women with fibromyalgia a national survey.

Jones J, Rutledge DN, Jones KD, Matallana L, Rooks DS.

Health Sciences, California State University, Fullerton, California.

OBJECTIVE: We sought to determine the self-reported physical function level of women with fibromyalgia (FM). METHODS: We performed a secondary analysis using data from an Internet-based survey posted on the National Fibromyalgia Association website. Data used for this study included women (n = 1,735) aged 31-78 years who reported being diagnosed with FM. RESULTS: More than 25% of women reported having difficulty taking care of personal needs and bathing, and >60% reported difficulty doing light household tasks, going up/down 1 flight of stairs, walking (1/2) mile, and lifting or carrying 10 lbs. More than 90% of women reported having difficulty doing heavy household tasks, lifting or carrying 25 lbs, and doing strenuous activities. Women with lower functional ability reported higher levels of fatigue, pain, spasticity, depression, restless legs, balance problems, dizziness, fear of falling, and bladder problems. CONCLUSIONS: The average woman in this sample reported having less functional ability related to activities of daily living and instrumental activities of daily living than the average community-dwelling woman in her 80s. Several symptoms/conditions were found to be associated with functional limitation in women with FM. Targeting these-singly or in clusters-may potentially be important in terms of future interventions.

PMID: 18723374 [PubMed - in process]

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Efficacy and tolerability of duloxetine in the treatment of patients with borderline personality disorder: a pilot study.

Bellino S, Paradiso E, Bozzatello P, Bogetto F.

Service for Personality Disorders, Unit of Psychiatry, Department of Neurosciences, University of Turin, Turin, Italy.

AbstractGuidelines of the American Psychiatric Association for borderline personality disorder (BPD) indicate selective serotonin reuptake inhibitors and the serotonin and noradrenaline reuptake inhibitor (SNRI) venlafaxine for treating affective dysregulation and impulsive behavioural dyscontrol symptoms. The SNRI duloxetine has been studied in patients with major depression, generalized anxiety disorder and fibromyalgia, showing particular efficacy on somatic complaints. This study investigates duloxetine in the treatment of patients with BPD. Eighteen outpatients with a DSM-IV-TR diagnosis of BPD were treated with open-label duloxetine, 60 mg/day, for 12 weeks. Patients were assessed at baseline, week 4 and 12 with the CGI Severity item, the BPRS, the HAM-D, the HAM-A, the SOFAS, the BPD Severity Index (BPDSI) and the HSCL-90-Somatization Subscale (HSCL-90 SOM). Adverse effects were evaluated using the Dosage Record Treatment Emergent Symptom Scale. Statistics were performed with the analysis of variance. Significant P values were </=0.05. Fourteen patients completed the study. Four patients (22.2%) discontinued treatment in the first 4 weeks because of non-compliance. A significant change was found for: BPRS, HAM-D, SOFAS, BPDSI total score and items 'impulsivity', 'outbursts of anger' and 'affective instability' and HSCL-90 SOM. Adverse effects were mild headache and nausea. Initial results suggest that duloxetine is an effective and well-tolerated treatment for BPD, with positive effects on somatic symptoms.

PMID: 18719047 [PubMed - as supplied by publisher]

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Anxiety, mood, and behavioral disorders among pediatric patients with juvenile fibromyalgia syndrome.

Kashikar-Zuck S, Parkins IS, Graham TB, Lynch AM, Passo M, Johnston M, Schikler KN, Hashkes PJ, Banez G, Richards MM.

Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA. Susmita.Kashikar-Zuck@cchmc.org

BACKGROUND: Mood and anxiety disorders are common psychiatric conditions among adult patients with fibromyalgia syndrome, but little is known about whether psychiatric disorders are prevalent among pediatric patients with fibromyalgia. OBJECTIVE: The primary objective of this study was to assess the prevalence of mood, anxiety, and behavioral disorders in a clinical sample of children and adolescents with juvenile primary fibromyalgia syndrome (JPFS) and assess the relationship between psychiatric disorders and JPFS symptom severity. METHODS: Standardized psychiatric interviews were conducted with children and their parents/primary caregivers, and measures of symptom severity including pain intensity and physician global ratings were obtained for 76 children and adolescents diagnosed with JPFS (ages 11 to 18 y) in pediatric rheumatology clinics at 4 hospitals in the Midwest. RESULTS: A total of 67.1% of patients had at least 1 current and 71.5% had at least 1 lifetime DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-fourth edition) psychiatric diagnosis. The most frequent psychiatric diagnosis was anxiety disorder (57.5% of JPFS patients). Although mood difficulties were also common, the presence of major depression was lower than has been reported for adults with fibromyalgia syndrome. Physicians' global assessment of functioning was significantly lower for patients with a current anxiety disorder. There were no significant differences in pain severity among patients with and without anxiety, mood, or behavioral disorders. DISCUSSION: There seems to be a high prevalence of anxiety disorders in patients with JPFS, and presence of anxiety disorder is associated with poorer physician-rated functioning. Future research should explore whether early anxiety symptoms are predictive of long-term functioning.

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PMID: 18716501 [PubMed - in process]

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Choosing a skeletal muscle relaxant.

See S, Ginzburg R.

St. John's University College of Pharmacy and Allied Health Professions, Jamaica, New York 11439, USA. sees@stjohns.edu

Skeletal muscle relaxants are widely used in treating musculoskeletal conditions. However, evidence of their effectiveness consists mainly of studies with poor methodologic design. In addition, these drugs have not been proven to be superior to acetaminophen or nonsteroidal anti-inflammatory drugs for low back pain. Systematic reviews and meta-analyses support using skeletal muscle relaxants for short-term relief of acute low back pain when nonsteroidal anti-inflammatory drugs or acetaminophen are not effective or tolerated. Comparison studies have not shown one skeletal muscle relaxant to be superior to another. Cyclobenzaprine is the most heavily studied and has been shown to be effective for various musculoskeletal conditions. The sedative properties of tizanidine and cyclobenzaprine may benefit patients with insomnia caused by severe muscle spasms. Methocarbamol and metaxalone are less sedating, although effectiveness evidence is limited. Adverse effects, particularly dizziness and drowsiness, are consistently reported with all skeletal muscle relaxants. The potential adverse effects should be communicated clearly to the patient. Because of limited comparable effectiveness data, choice of agent should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions.

Publication Types:
PMID: 18711953 [PubMed - indexed for MEDLINE]

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Etiology of fibromyalgia: The possible role of infection and vaccination.

Buskila D, Atzeni F, Sarzi-Puttini P.

Department of Internal Medicine H, Soroka Medical Center, Ben Gurion University, Beer Sheva, Israel.

Fibromyalgia syndrome (FMS), a condition characterized by widespread pain and diffuse tenderness, is considered a multifactorial disorder. FMS is now recognized as one of the "central" pain syndromes. Environmental and genetic factors play a role in the pathogenesis of FMS. Various triggers including trauma and stress as well as infections, may precipitate the development of FMS. Certain infections including hepatitis C virus, HIV and Lyme disease have been temporally associated with the development of FMS. There is some evidence for the possible role of vaccinations in triggering the development of FMS and related syndromes, however this association remains to be established.

PMID: 18706528 [PubMed - as supplied by publisher]

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POTS versus deconditioning: the same or different?

Joyner MJ, Masuki S.

Dept. of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA, joyner.michael@mayo.edu.

The 2007 Streeten Lecture focused on the idea that physical deconditioning plays a key role in the symptomology and pathophysiology of POTS. Parallels were drawn between the physiological responses to orthostatic stress seen in POTS patients and the physiological responses seen in "normal" humans after prolonged periods of bedrest, deconditioning, or space flight. Additionally, the idea that endurance exercise training might ameliorate some of these symptoms was also advanced. Finally, potential parallels between POTS, chronic fatigue syndrome, and fibromyalgia were also drawn and the potential role of exercise training as a "therapeutic intervention" in all three conditions was raised. The conceptual model for the lecture was that after some "initiating event" chronic deconditioning plays a significant role in the pathophysiology of these conditions, and these physiological changes in conjunction with "somatic hypervigilence" explain many of the complaints that this diverse group of patients have. Additionally, the idea that systematic endurance exercise training might be helpful was advanced, and data supportive of this idea was reviewed. The main conclusion is that the medical community must retain their empathy for patients with unusual conditions but at the same time send a firm but empowering message about physical activity. As always, we must also ask what do the ideas about physical activity and inactivity and the conditions mentioned above not explain?

PMID: 18704621 [PubMed - as supplied by publisher]

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Efficacy of Waon therapy for fibromyalgia.

Matsushita K, Masuda A, Tei C.

The First Department of Internal Medicine, Kagoshima University Hospital.

OBJECTIVE: Fibromyalgia syndrome (FMS) is a chronic syndrome characterized by widespread pain with tenderness in specific areas. We examined the applicability of Waon therapy (soothing warmth therapy) as a new method of pain treatment in patients with FMS. METHODS: Thirteen female FMS patients (mean age, 45.2+/-15.5 years old; range, 25-75) who fulfilled the criteria of the American College of Rheumatology participated in this study. Patients received Waon therapy once per day for 2 or 5 days/week. The patients were placed in the supine or sitting position in a far infrared-ray dry sauna maintained at an even temperature of 60 degrees C for 15 minutes, and then transferred to a room maintained at 26-27 degrees C where they were covered with a blanket from the neck down to keep them warm for 30 minutes. Reductions in subjective pain and symptoms were determined using the pain visual analog scale (VAS) and fibromyalgia impact questionnaire (FIQ). RESULTS: All patients experienced a significant reduction in pain by about half after the first session of Waon therapy (11-70%), and the effect of Waon therapy became stable (20-78%) after 10 treatments. Pain VAS and FIQ symptom scores were significantly (p<0.01) decreased after Waon therapy and remained low throughout the observation period. CONCLUSION: Waon therapy is effective for the treatment of fibromyalgia syndrome.

PMID: 18703857 [PubMed - in process]

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Iodine deficiency, more than cretinism and goiter.

Verheesen RH, Schweitzer CM.

Regionaal Reuma Centrum Z.O. Brabant, M‡xima Medisch Centrum, Ds. Th. Fliednerstraat 1, 5631 BM, Postbus 90052, 5600 PD Eindhoven, The Netherlands.

Recent reports of the World Health Organization show iodine deficiency to be a worldwide occurring health problem. As iodine status is based on median urinary iodine excretion, even in countries regarded as iodine sufficient, a considerable part of the population may be iodine deficient. Iodine is a key element in the synthesis of thyroid hormones and as a consequence, severe iodine deficiency results in hypothyroidism, goiter, and cretinism with the well known biochemical alterations. However, it is also known that iodine deficiency may give rise to clinical symptoms of hypothyroidism without abnormality of thyroid hormone values. This led us to the hypothesis that iodine deficiency may give rise to subtle impairment of thyroid function leading to clinical syndromes resembling hypothyroidism or diseases that have been associated with the occurrence of hypothyroidism. We describe several clinical conditions possibly linked to iodine deficiency, a connection that has not been made thus far. In this paper we will focus on the relationship between iodine deficiency and obesity, attention deficit hyperactivity disorder (ADHD), psychiatric disorders, fibromyalgia, and malignancies.

PMID: 18703293 [PubMed - as supplied by publisher]

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Fibromyalgia and chronic rhinosinusitis: outcomes after endoscopic sinus surgery.

Soler ZM, Mace J, Smith TL.

Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.

BACKGROUND: Limited clinical research exists concerning surgical outcomes for patients with chronic rhinosinusitis (CRS) and comorbid fibromyalgia. The aim of this study was to determine whether patients with CRS and concurrent fibromyalgia experience quality-of-life (QOL) improvement after endoscopic sinus surgery (ESS) and whether this improvement is similar to that seen in patients without fibromyalgia. METHODS: An adult (> or =18 years of age) population (n = 283) with medically refractory CRS was assessed using two disease-specific QOL instruments: the Rhinosinusitis Disability Index (RSDI) and the Chronic Sinusitis Survey (CSS). A nested case-control analysis of matched subjects (n = 18) with and without fibromyalgia was performed to compare pre- and postoperative QOL. RESULTS: Improvement in postoperative QOL was found in patients with CRS and comorbid fibromyalgia (p < or = 0.004). After controlling for age, gender, and disease severity, this improvement was similar to that seen in patients without fibromyalgia for all RSDI subscales as well as the CSS total and CSS symptom subscales. Patients with fibromyalgia reported significantly less improvement on the CSS medication subscale than patients without fibromyalgia (p = 0.027). CONCLUSION: Patients with CRS and comorbid fibromyalgia showed similar improvements in QOL after ESS when compared with patients without fibromyalgia when controlling for age, gender, and disease severity.

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PMID: 18702911 [PubMed - in process]

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The effects of endoscopic sinus surgery on level of fatigue in patients with chronic rhinosinusitis.

Sautter NB, Mace J, Chester AC, Smith TL.

Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.

BACKGROUND: Fatigue is a common symptom of chronic rhinosinusitis (CRS), but the response of fatigue to endoscopic sinus surgery (ESS) is rarely studied. METHODS: A prospective, open cohort of adult patients undergoing ESS for CRS was studied using 10-cm fatigue visual analog scales (VASs), Lund-MacKay computed tomography (CT), and Lund-Kennedy nasal endoscopy scoring. RESULTS: Two hundred seventy-two patients, followed for a mean (+/-SD) of 16.5 +/- 8.5 months after ESS, noted significant fatigue improvement with an effect size defined as large by Cohen (0.8 [95% CI, 0.5-1.3]). Neither preoperative CT scores nor preoperative endoscopy scores correlated with preoperative fatigue severity. Compared with the mean preoperative fatigue score (6.1 +/- 2.9 cm), preoperative fatigue was more severe in women (6.9 +/- 2.6 cm; p < 0.001) patients with depression (7.7 +/- 2.4 cm; p < 0.001) and patients with fibromyalgia (7.9 +/- 2.2 cm; p = 0.013), but less severe in patients with nasal polyposis (5.4 +/- 3.2 cm; p = 0.009). Significantly greater postoperative reduction in fatigue was noted in patients with fibromyalgia when compared with study patients without fibromyalgia (effect size = 1.8 [95% CI, 1.6-2.2]; p > 0.001) with final fatigue severity scores similar to the entire study group. Similarly, patients with severe fatigue (n = 112; mean VAS score, 8.8 +/- 0.8 cm) showed a more pronounced improvement than patients less severely fatigued (n = 160; mean VAS score 4.2 +/- 2.4 cm; effect size = 2.2 [95% CI, 2.0-2.9]; p > 0.001). CONCLUSION: Fatigue improves after ESS, with significantly greater improvement in patients with fibromyalgia and in patients that are more severely fatigued at presentation.

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PMID: 18702910 [PubMed - in process]

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Amitriptyline in the treatment of fibromyalgia: a systematic review of its efficacy.

Nishishinya B, Urrœtia G, Walitt B, Rodriguez A, Bonfill X, Alegre C, Darko G.

Iberoamerican Cochrane Center, Public Health and Clinical Epidemiology Service, Hospital de la Santa Creu i Sant Pau, Universitat Aut˜noma de Barcelona, Universitat Aut˜noma de Barcelona, Barcelona, Kovacs Foundation, Palma de Mallorca, CIBER Epidemiolog’a y Salud Pœblica (CIBERESP), Spain, Washington Hospital Center, WA, USA and Hospital de la Vall d'Hebron, Barcelona, Spain.

The objective of this study was to assess the efficacy and safety of amitriptyline as a treatment of FM. A comprehensive computerized search in Medline (Pubmed), EMBASE and The Cochrane Library was performed. Randomized controlled trials (RCTs) comparing amitriptyline vs placebo in adult patients suffering from FM were identified, the methodological quality was assessed and the results of the main outcomes were evaluated. Ten RCTs were identified. Large clinical variability and statistical heterogeneity precluded quantitative meta-analysis. Overall, the study quality was moderate to high. Amitriptyline 25 mg/day (six RCTs) demonstrated a therapeutic response compared with placebo in the domains of pain, sleep, fatigue and overall patient and investigator impression. This benefit was generally seen at 6-8 weeks of treatment but no effect was noted at 12 weeks. Amitriptyline 50 mg/day (four RCTs) did not demonstrate a therapeutic effect compared with placebo. Neither dose of amitriptyline had an effect on tender points count. No clear statements on adverse events with amitriptyline can be made due to inconsistencies in data among the studies. A definitive clinical recommendation regarding the efficacy of amitriptyline for FM symptoms cannot be made. There is some evidence to support the short-term efficacy of amitriptyline 25 mg/day in FM. There is no evidence to support the efficacy of amitriptyline at higher doses or for periods >8 weeks. More stringent RCTs with longer follow-up periods are required to determine the long-term efficacy and safety of the amitriptyline and define its role in the multidisciplinary management of FM.

PMID: 18697829 [PubMed - as supplied by publisher]

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Screening for pain-persistence and pain-avoidance patterns in fibromyalgia.

van Koulil S, Kraaimaat FW, van Lankveld W, van Helmond T, Vedder A, van Hoorn H, Cats H, van Riel PL, Evers AW.

Department of Medical Psychology, Nijmegen Medical Center, Radboud University, Nijmegen, The Netherlands. s.vankoulil@mps.umcn.nl

BACKGROUND: The heterogeneity of patients regarding pain-related cognitive-behavioral mechanisms, such as pain-avoidance and pain-persistence patterns, has been proposed to underlie varying treatment outcomes in patients with fibromyalgia (FM). PURPOSE: To investigate the validity of a screening instrument to discriminate between pain-persistence and pain-avoidance patterns in FM. METHOD: In a three-part study, a self-reported screening instrument that assesses pain-avoidance behavior was used to distinguish patients with pain-persistence and pain-avoidance patterns. The resultant groups were compared with regard to several pain-related cognitive-behavioral factors, performance on a physical fitness test, and with regard to the judgments of trained therapists based on a semi-structured interview. RESULTS: The validity of the screening instrument to distinguish between pain-avoidance and pain-persistence patterns was supported by other validated self-report questionnaires for pain-related cognitive-behavioral factors, physical exercise tests, as well as by a high correspondence with blinded therapist judgment after intake assessments. CONCLUSION: These findings suggest that a short self-report screening instrument can be used to distinguish between pain-avoidance and pain-persistence patterns within the heterogeneous population of FM patients, which offers promising possibilities to improve treatment efficacy by tailoring treatment to specific patient patterns.

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PMID: 18696315 [PubMed - in process]

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The brief resilience scale: assessing the ability to bounce back.

Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J.

Department of Psychology, University of New Mexico, Albuquerque, New Mexico 87131-1161, USA. bwsmith@unm.edu

BACKGROUND: While resilience has been defined as resistance to illness, adaptation, and thriving, the ability to bounce back or recover from stress is closest to its original meaning. Previous resilience measures assess resources that may promote resilience rather than recovery, resistance, adaptation, or thriving. PURPOSE: To test a new brief resilience scale. METHOD: The brief resilience scale (BRS) was created to assess the ability to bounce back or recover from stress. Its psychometric characteristics were examined in four samples, including two student samples and samples with cardiac and chronic pain patients. RESULTS: The BRS was reliable and measured as a unitary construct. It was predictably related to personal characteristics, social relations, coping, and health in all samples. It was negatively related to anxiety, depression, negative affect, and physical symptoms when other resilience measures and optimism, social support, and Type D personality (high negative affect and high social inhibition) were controlled. There were large differences in BRS scores between cardiac patients with and without Type D and women with and without fibromyalgia. CONCLUSION: The BRS is a reliable means of assessing resilience as the ability to bounce back or recover from stress and may provide unique and important information about people coping with health-related stressors.

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PMID: 18696313 [PubMed - in process]

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Disruption of cognitive function in Fibromyalgia Syndrome.

Dick BD, Verrier MJ, Harker KT, Rashiq S.

Department of Anesthesiology and Pain Medicine, 8-120 Clinical Sciences Building, University of Alberta, Edmonton, Alta., Canada T6G 2B7; Department of Psychiatry, University of Alberta, Canada; Multidisciplinary Pain Centre, University of Alberta Hospital, Canada.

Accumulating evidence points to significant cognitive disruption in individuals with Fibromyalgia Syndrome (FMS). This study was carried out in order to examine specific cognitive mechanisms involved in this disruption. Standardized experimental paradigms were used to examine attentional function and working memory capacity in 30 women with FMS and 30 matched controls. Cognitive function was examined using performance on these tests and between group results were analysed in the context of important psychological and behavioural measures. Performance of standardized everyday attentional tasks was impaired in the FMS group compared to controls. Working memory was also found to be impaired in this group. Stimulus interference was found to be significantly worse in the FMS group as the demands of the tasks increased. These effects were found to exist independent of the measures of mood and sleep disruption. However, when pain levels were accounted for statistically, no differences existed between groups on cognitive measures. These findings point to disrupted working memory as a specific mechanism that is disrupted in this population. The results of this study suggest that pain in FMS may play an important role in cognitive disruption. It is likely that many factors, including disrupted cognition, play a role in the reduced quality of life reported by individuals with FMS.

PMID: 18691816 [PubMed - as supplied by publisher]

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Fibromyalgia syndrome: a relevant recent construction of an ancient condition?

Perrot S.

Service de MŽdecine Interne et Centre de la Douleur, H™tel-Dieu, Paris, France. serge.perrot@htd.aphp.fr

PURPOSE OF REVIEW: Fibromyalgia is considered the most common chronic pain syndrome. This syndrome is poorly understood and not widely accepted as a distinct clinical entity but an increasing number of pharmacological and nonpharmacological treatments are being developed for its management. RECENT FINDINGS: The clinical description of fibromyalgia is now well established, but controversies on diagnostic criteria are increasing. Pathophysiological studies suggest that fibromyalgia is a painful rheumatic disorder in which pain primarily stems from central sensitization and from other neuronal changes, including alterations in peripheral neuronal systems. Central sensitization may also underlie associated symptoms, including anxiety, sleep disorders, fatigue, and other dysfunctions such as irritable bowel syndrome and bladder instability.Several agents, including serotonin-norepinephrine reuptake inhibitors (duloxetine and milnacipran), weak opioids (tramadol), and anticonvulsants (pregabalin), as well as nonpharmacological approaches, have been recently evaluated in clinical trials, demonstrating benefit in terms of pain reduction and improvement of core symptoms (i.e., fatigue and sleep disturbance). SUMMARY: Despite the fact that pathophysiology and diagnostic criteria remain unclear, the level of scientific data collected on this recently described condition should convince clinicians of the existence of this syndrome, allowing improved management of the many patients suffering from chronic pain.

PMID: 18685409 [PubMed - in process]

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Determining long-term efficacy for treatment of chronic pain in fibromyalgia patients.

Crofford LJ.

Publication Types:
PMID: 18684565 [PubMed - in process]

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Health-related quality of life in patients with common rheumatic diseases referred to a university clinic.

Laas K, Roine R, RŠsŠnen P, Sintonen H, Leirisalo-Repo M; HUS QoL Study Group.

Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, Kasarmikatu 11-13, HUS, P. O. Box 263, 00029, Helsinki, Finland, karin.laas@helsinki.fi.

The aim of the present study was to assess the health-related quality of life (HRQoL) in patients with common rheumatic diseases referred to a rheumatology clinic and to compare it to the HRQoL of the general population. All patients with a new referral to the Department of Rheumatology of the Helsinki University Central Hospital were asked to participate in the study during the period from May 2002 to April 2003. A total of 295 patients with various rheumatic diseases were included in the analysis: 99 patients with rheumatoid arthritis (RA), 47 with arthralgia and fibromyalgia, 43 with other chronic arthritis (spondyloarthritis, psoriatic arthritis, enteropathic arthritis), 44 with osteoarthritis (OA), 22 with active reactive arthritis (ReA), 17 with systemic rheumatic diseases, 9 adults with juvenile idiopathic arthritis (JIA) and 14 with other diagnoses. HRQoL was measured by a disease specific instrument, the Stanford health assessment questionnaire (HAQ) and by a generic instrument, 15D. The mean baseline 15D score of the 295 included patients (0.822, SD 0.114) was significantly lower than of the general population (0.903, SD 0.098). Patients with OA and chronic arthritis reported the poorest HRQoL scores (both 0.810 on a 0-1 scale). In patients with RA and ReA the 15D score improved in a statistically significant and clinically important manner during the 8-month follow-up. Discomfort and symptoms caused by the disease were alleviated in a statistically significant manner in patients with RA as well as in those with arthralgia and fibromyalgia, chronic arthritis, ReA and systemic rheumatic diseases. HAQ score improved significantly in patients with RA, arthralgia and fibromyalgia, and ReA. The HRQoL of patients with common rheumatic diseases at referral to rheumatology clinic is significantly lower than the HRQoL of age-standardized general population. The most affected patients are those with OA, chronic arthritis and RA. A significant improvement in HRQoL with conventional interventions was achieved in patients with RA and ReA.

PMID: 18682951 [PubMed - as supplied by publisher]

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Is there a relationship between Eagle Syndrome and cervicofacial painful soft tissue rheumatisms?

Zinnuroglu M, Ural A, GŸnendi Z, Meray J, Kšybasoglu A.

Department of Physical Medicine and Rehabilitation, Gazi University School of Medicine, Ankara, Turkey.

OBJECTIVES/HYPOTHESIS: To investigate the incidence of locomotor system pathologies such as myofacial pain syndrome (MPS), fibromyalgia syndrome (FMS), and temporomandibular dysfunction in patients with Eagle Syndrome. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: Fourteen patients with Eagle Syndrome, who were treated surgically, were enrolled in the study. Etiologic factors for cervicofacial pain were assessed, pain status was compared preoperatively and postoperatively using visual analogue scale. Palpation of tonsillar fossa, neck and shoulder examination, neurologic examination, evaluation of occlusion status, trigger points, and painful zones were done. Plain anteroposterior and lateral radiographs of the cervical spine were obtained and the lengths of the transverse processes of the seventh cervical vertebrae were measured bilaterally. RESULTS: MPS, FMS, and temporomandibular dysfunction were diagnosed in 9 (64.3%), 3 (21.4%), and 2 (14.3%) patients, respectively. Visual analogue scale scores decreased significantly after the surgical excision of elongated styloid processes (from 6.7 +/- 2.3 to 2.1 +/- 1.8), and all the complaints except for headache had diminished (P < .05). Lengths of transverse processes of seventh cervical vertebra were found to be correlated with the length of styloid process (right; r = 0.644, P = .024, left; r = 0.616, P = .033). CONCLUSIONS: Cervicofacial pain is a common complaint in patients with Eagle Syndrome. It frequently coexists with rheumatic disorders resulting in chronic pain such as MPS and FMS. Even though Eagle Syndrome is a rare condition, it should be kept in mind in patients suffering from chronic cervicofacial pain that is refractory to treatment. Clinicians should be alert to diagnose and treat coexisting locomotor system disorders.

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PMID: 18677284 [PubMed - indexed for MEDLINE]

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Effects of concurrent strength and endurance training on physical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial.

Valkeinen H, AlŽn M, HŠkkinen A, Hannonen P, Kukkonen-Harjula K, HŠkkinen K.

Department of Health Sciences, University of JyvŠskylŠ, JyvŠskylŠ, Finland. heli.valkeinen@sport.jyu.fi

OBJECTIVE: To examine the effectiveness of concurrent strength and endurance training on muscle strength, aerobic and functional performance, and symptoms in postmenopausal women with fibromyalgia (FM). DESIGN: Randomized controlled trial. SETTING: Local gym and university research laboratory. PARTICIPANTS: Twenty-six women with FM. INTERVENTION: Progressive and supervised 21-week concurrent strength and endurance training. MAIN OUTCOME MEASURES: Muscle strength of leg extensors, upper extremities, and trunk; peak oxygen uptake (Vo(2)peak), maximal workload (Wmax), and work time; 10-m walking and 10-step stair-climbing time and self-reported functional capacity (Health Assessment Questionnaire); and symptoms of FM. RESULTS: After concurrent strength and endurance training, the groups differed significantly in Wmax (P=.001), work time (P=.001), concentric leg extension force (P=.043), walking (P=.001) and stair-climbing (P<.001) time, and fatigue (P=.038). The training led to an increase of 10% (P=.004) in Wmax and 13% (P=.004) in work time on the bicycle but no change in Vo(2)peak. CONCLUSIONS: Concurrent strength and endurance training in low to moderate volume improves the muscle strength of leg extensors, Wmax, work time, and functional performance as well as perceived symptoms, fatigue in particular. Concurrent strength and endurance training is beneficial to postmenopausal women with FM without adversities, but more extensive studies are needed to confirm the results.

Publication Types:
PMID: 18675392 [PubMed - in process]

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[Neuropsychological performance in patients with fibromyalgia syndrome: relation to pain and anxiety]

[Article in Spanish]

Mungu’a-Izquierdo D, Legaz-Arrese A, Moliner-Urdiales D, Reverter-Mas’a J.

Facultad de Deporte, Universidad Pablo de Olavide, Sevilla, Spain. dmunizq@upo.es

Previous studies have revealed the presence of cognitive impairment in patients with fibromyalgia syndrome (FMS). However, they have not determined the possible influence of the diverse clinical variables in these disturbances. The first aim of the current study is to compare the cognitive function of 81 patients with FMS and 35 healthy controls by means of a neuropsychological battery. The second aim is to determine the influence of anxiety and pain in the cognitive impairment of patients with FMS. The results of our study show that patients with FMS display a significantly lower cognitive performance and a significantly higher anxiety level than the healthy controls in all the parameters assessed. The neuropsychological performance in patients with FMS is associated with pain, and this relation was independent of the anxiety level. The relationship between cognitive performance and anxiety level was also significant. Therefore, we conclude that cognitive performance is primarily affected by pain. The level of anxiety explains part of the variability in neuropsychological tests that is not explained by pain.

Publication Types:
PMID: 18674438 [PubMed - in process]

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Duloxetine for painful diabetic neuropathy and fibromyalgia pain: systematic review of randomised trials.

Sultan A, Gaskell H, Derry S, Moore RA.

Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, OX3 9DU, UK. asquadsultan@aol.com

BACKGROUND: Duloxetine hydrochloride is a reuptake inhibitor of 5-hydroxytryptamine and norepinephrine used to treat depression, generalized anxiety disorder, neuropathic pain, and stress incontinence in women. We investigated the efficacy of duloxetine in painful diabetic neuropathy and fibromyalgia to allow comparison with other antidepressants. METHODS: We searched PubMed, EMBASE (via Ovid), and Cochrane CENTRAL up to June 2008 for randomised controlled trials using duloxetine to treat neuropathic pain. RESULTS: We identified six trials with 1,696 patients: 1,510 were treated with duloxetine and 706 with placebo. All patients had established baseline pain of at least moderate severity. Trial duration was 12 to 13 weeks. Three trials enrolled patients with painful diabetic neuropathy (PDN) and three enrolled patients with fibromyalgia. The number needed to treat (NNT) for at least 50% pain relief at 12 to 13 weeks with duloxetine 60 mg versus placebo (1,211 patients in the total comparison) was 5.8 (95% CI 4.5 to 8.4), and for duloxetine 120 mg (1,410 patients) was 5.7 (4.5 to 5.7). There was no difference in NNTs between PDN and fibromyalgia. With all doses of duloxetine combined (20/60/120 mg) there were fewer withdrawals for lack of efficacy than with placebo (number needed to treat to prevent one withdrawal 20 (13 to 42)), but more withdrawals due to adverse events (number needed to harm (NNH) 15 (11 to 25)). Nausea, somnolence, constipation, and reduced appetite were all more common with duloxetine than placebo (NNH values 6.3, 11, 11, and 18 respectively). The results for duloxetine are compared with published data for other antidepressants in neuropathic pain. CONCLUSION: Duloxetine is equally effective for the treatment of PDN and fibromyalgia, judged by the outcome of at least 50% pain relief over 12 weeks, and is well tolerated. The NNT of 6 for 50% pain relief suggests that this is likely to be a useful drug in these difficult-to-treat conditions, where typically only a minority of patients respond. Comparing duloxetine with antidepressants for pain relief in DPN shows inadequacies in the evidence for efficacy of antidepressants, which are currently recommended in PDN care pathways.

Publication Types:
PMID: 18673529 [PubMed - in process]

PMCID: PMC2529342


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Chronic widespread pain in patients with occupational spinal disorders: prevalence, psychiatric comorbidity, and association with outcomes.

Mayer TG, Towns BL, Neblett R, Theodore BR, Gatchel RJ.

Department of Orthopedic Surgery, University of Texas, Southwestern Medical Center at Dallas, TX, USA. tgmayer@pridedallas.com

STUDY DESIGN: A prospective study assessing chronic widespread pain (CWP) and psychiatric comorbidities in patients with chronic disabling occupational spinal disorders (CDOSDs). OBJECTIVE: To assess the prevalence of CWP, demographic characteristics, and associated psychiatric comorbidity among CDOSD patients, as well as determine if CWP is a risk factor for less successful one-year postrehabilitation socioeconomic outcomes. SUMMARY OF BACKGROUND DATA: CWP is an essential criterion for diagnosing fibromyalgia. CWP is estimated to affect between 4.1% to 13.5% of the general population and it is associated with higher rates of psychiatric disorders and growing rates of disability. The prevalence of CWP, or its associations as a comorbidity, in patients with CDOSDs are unknown. METHODS: The socioeconomic outcomes, demographic characteristics, and psychiatric comorbidity of CDOSD patients with CWP were compared to non-CWP patients within a cohort of consecutive CDOSD patients (n = 2730), treated in an interdisciplinary functional restoration program. CWP was determined according to American College of Rheumatology criteria. Psychiatric comorbidity was assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-fourth Edition at the beginning of the rehabilitation program. RESULTS.: In the CDOSD cohort, 32% of the patients (N = 878) met American College of Rheumatology criteria for CWP, relative to 4.1% to 13.5% within the general population. CWP patients (82%) were much more likely than non-CWP patients (16%) to have multisite pain complaints, leading to the finding that CDOSD patients with multisite pain showed a CWP prevalence of 70%. CWP patients were 1.5 times more likely to be female, more likely to have multiple compensable injuries, and had slightly elevated rates of pre- and postinjury Axis I psychopathology. Nevertheless, CWP was not associated with less successful 1-year socioeconomic outcomes. CONCLUSION: A surprisingly high frequency of CDOSD patients participating in interdisciplinary rehabilitation met criteria for CWP, though the diagnosis was generally unknown to the patient. In this large workers' compensation cohort, CWP was not associated with longer periods of disability, more prerehabilitation surgery or higher pain self-report. With appropriate rehabilitation, CWP patients can have equally successful work return and health utilization outcomes compared to non-CWP patients, despite having significantly higher rates of certain psychiatric disorders.

PMID: 18670343 [PubMed - in process]

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Neuroendocrine dysfunction in Sjogren's syndrome.

Tzioufas AG, Tsonis J, Moutsopoulos HM.

Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece. agtzi@med.uoa.gr

Interactions among the immune, nervous and endocrine systems, which are mediated by hormones, neuropeptides, neurotransmitters, cytokines and their receptors, appear to play an important role in modulating host susceptibility and resistance to inflammatory disease. The neuroendocrine system has two main components: the central and the peripheral. The central compartment is located in the locus ceruleus, the brainstem centers of the autonomic system and the paraventricular nucleus; the peripheral mainly consists of the sympathetic/adrenomedullary system, the hypothalamic-pituitary-adrenal axis (HPA), the hypothalamic-pituitary-gonadal (HPG) axis, and the neuroendocrine tissue located in several organs throughout the body. Hormones and neuropeptides may influence the activities of lymphoid organs and cells via endocrine and local autocrine/paracrine pathways or alter the function of different cell types in target organs. Recent studies highlighted alterations of the neuroendocrine system in systemic autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus and Sjogren's syndrome (SS). SS, a prototype autoimmune disorder, has a wide clinical spectrum, extending from organ involvement (autoimmune exocrinopathy) to systemic disease and B cell lymphoma. In SS, several functions of the neuroendocrine system are impaired. First, the HPA axis appears to be disturbed, since significantly lower basal ACTH and cortisol levels were found in patients with SS and were associated with a blunted pituitary and adrenal response to ovine corticotropin-releasing factor compared to normal controls. Second, HPG axis is also involved, since lack of estrogens is associated with human disease and the development of autoimmune exocrinopathy in several experimental models. Finally, exocrine glands are enriched with neuroendocrine-related molecules, adjacent to local autoimmune lesions. Certain clinical manifestations of the disease, including the sicca manifestations, easy fatigue, fibromyalgia and psychological disturbances can be very well explained by mechanisms directly related to disturbances of the neuroendocrine axis. On the other hand, the molecular and biochemical effects of the inflammatory molecules or cell-to-cell interaction, observed during the local or systemic autoimmune injury with cells and mediators of the neuroendocrine system, are largely unexplored. Copyright 2008 S. Karger AG, Basel.

PMID: 18667798 [PubMed - in process]

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Characteristics and patterns of healthcare utilization of patients with fibromyalgia in general practitioner settings in Germany.

Berger A, Sadosky A, Dukes E, Martin S, Edelsberg J, Oster G.

OBJECTIVE: To examine characteristics and patterns of healthcare utilization of patients with fibromyalgia (FM) under the care of general practitioners (GPs) in Germany.RESEARCH DESIGN AND METHODS: Retrospective cohort study, using a large electronic database with information on GP encounters in Germany (IMS MediPlus). We identified all patients, aged >/= 18 years, with any encounters for FM (ICD-10 diagnosis code M79.7) between February 1, 2004 and January 31, 2007. We also constituted a comparison group consisting of randomly selected patients with one or more GP encounters - but none for FM - during this period, who we matched to FM patients based on age and sex. Characteristics and healthcare utilization of patients in the FM and comparison groups were then examined over the 1-year period, February 1, 2006-January 31, 2007.MAIN OUTCOME MEASURES: Prevalence of co-morbidities; use of pain-related pharmacotherapy; number of GP office visits; number of specialist referrals; and number of sick notes (physician-excused absences from work). RESULTS: The study sample consisted of 4983 FM patients and an identical number in the comparison group. Mean age was 58 years; 87% were women. The prevalence of various co-morbidities was greater among FM patients, including painful neuropathies (33% vs. 18% for comparison group) and depression (20% vs. 5%) (both p < 0.01); more FM patients also received pain-related pharmacotherapy (67% vs. 28%; p < 0.01). Compared with patients in the comparison group, FM patients averaged approximately twice as many GP visits (11.4 [SD = 10.1] vs. 5.8 [7.5]), referrals (4.5 [5.2] vs. 2.2 [3.6]), and sick notes (0.6 [1.8] vs. 0.3 [1.1]) (all p < 0.01).LIMITATIONS: Information in the study database is limited to GP encounters, and the sensitivity and specificity of our case-finding methods are unknown.CONCLUSIONS: Patients with FM under the care of GPs in Germany have comparatively more co-morbidities and higher levels of healthcare utilization.

PMID: 18664319 [PubMed - as supplied by publisher]

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Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals.

Thompson EA, Mathie RT, Baitson ES, Barron SJ, Berkovitz SR, Brands M, Fisher P, Kirby TM, Leckridge RW, Mercer SW, Nielsen HJ, Ratsey DH, Reilly D, Roniger H, Whitmarsh TE.

Bristol Homeopathic Hospital, Bristol, UK. elizabeth.thompson@ubht.nhs.uk

INTRODUCTION: We report findings from a pilot data collection study within a programme of quality assurance, improvement and development across all five homeopathic hospitals in the UK National Health Service (NHS). AIMS: (1) To pilot the collection of clinical data in the homeopathic hospital outpatient setting, recording patient-reported outcome since first appointment; (2) to sample the range of medical complaints that secondary-care doctors treat using homeopathy, and thus identify the nature and complexity of complaints most frequently treated nationally; (3) to present a cross section of outcome scores by appointment number, including that for the most frequently treated medical complaints; (4) to explore approaches to standard setting for homeopathic practice outcome in patients treated at the homeopathic hospitals. METHODS: A total of 51 medical practitioners took part in data collection over a 4-week period. Consecutive patient appointments were recorded under the headings: (1) date of first appointment in the current series; (2) appointment number; (3) age of patient; (4) sex of patient; (5) main medical complaint being treated; (6) whether other main medical complaint(s); (7) patient-reported change in health, using Outcome Related to Impact on Daily Living (ORIDL) and its derivative, the ORIDL Profile Score (ORIDL-PS; range, -4 to +4, where a score <or=-2 or >or=+2 indicates an effect on the quality of a patient's daily life); (8) receipt of other complementary medicine for their main medical complaint. RESULTS: The distribution of patient age was bimodal: main peak, 49 years; secondary peak, 6 years. Male:female ratio was 1:3.5. Data were recorded on a total of 1797 individual patients: 195 first appointments, 1602 follow-ups (FUs). Size of clinical service and proportion of patients who attended more than six visits varied between hospitals. A total of 235 different medical complaints were reported. The 30 most commonly treated complaints were (in decreasing order of frequency): eczema; chronic fatigue syndrome (CFS); menopausal disorder; osteoarthritis; depression; breast cancer; rheumatoid arthritis; asthma; anxiety; irritable bowel syndrome; multiple sclerosis; psoriasis; allergy (unspecified); fibromyalgia; migraine; premenstrual syndrome; chronic rhinitis; headache; vitiligo; seasonal allergic rhinitis; chronic intractable pain; insomnia; ulcerative colitis; acne; psoriatic arthropathy; urticaria; ovarian cancer; attention-deficit hyperactivity disorder (ADHD); epilepsy; sinusitis. The proportion of patients with important co-morbidity was higher in those seen after visit 6 (56.9%) compared with those seen up to and including that point (40.7%; P<0.001). The proportion of FU patients reporting ORIDL-PS>or=+2 (improvement affecting daily living) increased overall with appointment number: 34.5% of patients at visit 2 and 59.3% of patients at visit 6, for example. Amongst the four most frequently treated complaints, the proportion of patients that reported ORIDL-PS>or=+2 at visit numbers greater than 6 varied between 59.3% (CFS) and 73.3% (menopausal disorder). CONCLUSIONS: We have successfully piloted a process of national clinical data collection using patient-reported outcome in homeopathic hospital outpatients, identifying a wide range and complexity of medical complaints treated in that setting. After a series of homeopathy appointments, a high proportion of patients, often representing "effectiveness gaps" for conventional medical treatment, reported improvement in health affecting their daily living. These pilot findings are informing our developing programme of standard setting for homeopathic care in the hospital outpatient context.

Publication Types:
PMID: 18657769 [PubMed - in process]

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Duloxetine (cymbalta) for fibromyalgia.

[No authors listed]

PMID: 18654110 [PubMed - indexed for MEDLINE]

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Self-reported differences in empowerment between lurkers and posters in online patient support groups.

van Uden-Kraan CF, Drossaert CH, Taal E, Seydel ER, van de Laar MA.

Institute for Behavioural Research, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands. c.f.vanuden-kraan@utwente.nl

BACKGROUND: Patients who visit online support groups benefit in various ways. Results of our earlier study indicated that participation in online support groups had a profound effect on the participants' feelings of "being empowered." However, most studies of online patient support groups have focused on the members of these groups who actively contribute by sending postings (posters). Thus far, little is known about the impact for "lurkers" (ie, those who do not actively participate by sending postings). OBJECTIVE: In the present study, we explored if lurkers in online patient support groups profit to the same extent as posters do. METHODS: We searched the Internet with the search engine Google to identify all Dutch online support groups for patients with breast cancer, fibromyalgia, and arthritis. Invitations to complete an online survey were sent out by the owners of 19 groups. In the online questionnaire, we asked questions about demographic and health characteristics, use of and satisfaction with the online support group, empowering processes, and empowering outcomes. The online questionnaire was completed by 528 individuals, of which 109 (21%) identified themselves as lurkers. RESULTS: Lurkers (mean age 47 years) were slightly older than active participants (mean age 43 years, P = .002), had a shorter disease history (time since diagnosis 3.7 years vs 5.4 years, P = .001), and reported lower mental well-being (SF 12 subscore 37.7 vs 40.5, P = .004). No significant differences were found in other demographic variables. Posters indicated visiting the online support groups significantly more often for social reasons, such as curiosity about how other members were doing, to enjoy themselves, as a part of their daily routine (all P < .001), and because other members expected them to be there (P = .003). Lurkers and posters did not differ in their information-related reasons for visiting the online support group. Lurkers were significantly less satisfied with the online support group compared to posters (P < .001). With regard to empowering processes such as "exchanging information" and "finding recognition," lurkers scored significantly lower than posters. However, lurkers did not differ significantly from posters with regard to most empowering outcomes, such as "being better informed," "feeling more confident in the relationship with their physician," "improved acceptance of the disease," "feeling more confident about the treatment," "enhanced self-esteem," and "increased optimism and control." The exception was "enhanced social well-being," which scored significantly lower for lurkers compared to posters (P < .001). CONCLUSION: Our study revealed that participation in an online support group had the same profound effect on lurkers' self-reported feelings of being empowered in several areas as it had on posters. Apparently, reading in itself is sufficient to profit from participation in an online patient support group.

Publication Types:
PMID: 18653442 [PubMed - in process]

PMCID: PMC2483925


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Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: An fMRI analysis.

Derbyshire SW, Whalley MG, Oakley DA.

School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.

The neuropsychological status of pain conditions such as fibromyalgia, commonly categorized as 'psychosomatic' or 'functional' disorders, remains controversial. Activation of brain structures dependent upon subjective alterations of fibromyalgia pain experience could provide an insight into the underlying neuropsychological processes. Suggestion following a hypnotic induction can readily modulate the subjective experience of pain. It is unclear whether suggestion without hypnosis is equally effective. To explore these and related questions, suggestions following a hypnotic induction and the same suggestions without a hypnotic induction were used during functional magnetic resonance imaging to increase and decrease the subjective experience of fibromyalgia pain. Suggestion in both conditions resulted in significant changes in reported pain experience, although patients claimed significantly more control over their pain and reported greater pain reduction when hypnotised. Activation of the midbrain, cerebellum, thalamus, and midcingulate, primary and secondary sensory, inferior parietal, insula and prefrontal cortices correlated with reported changes in pain with hypnotic and non-hypnotic suggestion. These activations were of greater magnitude, however, when suggestions followed a hypnotic induction in the cerebellum, anterior midcingulate cortex, anterior and posterior insula and the inferior parietal cortex. Our results thus provide evidence for the greater efficacy of suggestion following a hypnotic induction. They also indicate direct involvement of a network of areas widely associated with the pain 'neuromatrix' in fibromyalgia pain experience. These findings extend beyond the general proposal of a neural network for pain by providing direct evidence that regions involved in pain experience are actively involved in the generation of fibromyalgia pain.

PMID: 18653363 [PubMed - as supplied by publisher]

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Duloxetine: a new psychopharmacologic treatment option for fibromyalgia?

Pae CU, Masand P.

Publication Types:
PMID: 18652792 [PubMed - in process]

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Visceral sensory neurons that innervate both uterus and colon express nociceptive TRPv1 and P2X3 receptors in rats.

Chaban VV.

Department of Biomedical Sciences, Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA 90095, USA. victorchaban@cdrewu.edu

In women, clinical studies suggest that functional pain syndromes such as irritable bowel syndrome, interstitial cystitis, and fibromyalgia, are co-morbid with endometriosis, chronic pelvic pain, and others diseases. One of the possible explanations for this phenomenon is visceral cross-sensitization in which increased nociceptive input from inflamed reproductive system organs sensitize neurons that receive convergent input from an unaffected visceral organ to the same dorsal root ganglion (DRG). The purpose of this study was to determine whether primary sensory neurons that innervate both visceral organs--the uterus and the colon--express nociceptive ATP-sensitive purinergic (P2X3) and capsaicin-sensitive vanilloid (TRPV1) receptors. To test this hypothesis, cell bodies of colonic and uterine DRG were retrogradely labeled with fluorescent tracer dyes micro-injected into the colon/rectum and uterus of rats. Ganglia were harvested, cryo-protected, and cut in 20-microm slices for fluorescent microscopy to identify positively stained cells. Up to 5% neurons were colon-specific or uterus-specific, and 10%-15% of labeled DRG neurons innervate both viscera in the lumbosacral neurons (L1-S3 levels). We found that viscerally labeled DRGs express nociceptive P2X3 and TRPV1 receptors. Our results suggest a novel form of visceral sensory integration in the DRG that may underlie co-morbidity of many functional pain syndromes.

PMID: 18646315 [PubMed - in process]

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Conceptualizing and measuring illness self-concept: A comparison with self-esteem and optimism in predicting fibromyalgia adjustment.

Morea JM, Friend R, Bennett RM.

School of Nursing, Oregon Health & Science University, Portland, OR.

Illness self-concept (ISC), or the extent to which individuals are consumed by their illness, was theoretically described and evaluated with the Illness Self-Concept Scale (ISCS), a new 23-item scale, to predict adjustment in fibromyalgia. To establish convergent and discriminant validity, illness self-concept was compared to self-esteem and optimism in predicting health status, illness intrusiveness, depression, and life satisfaction. The ISCS demonstrated good reliability (alpha = .94; test-retest r = .80) and was a strong predictor of outcomes, even after controlling for optimism or self-esteem. The ISCS predicted unique variance in health-related outcomes; optimism and self-esteem did not, providing construct validation. Illness self-concept may play a significant role in coping with fibromyalgia and may prove useful in the evaluation of other chronic illnesses. (c) 2008 Wiley Periodicals, Inc.

PMID: 18646034 [PubMed - as supplied by publisher]

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Fibromyalgia: the role of sleep in affect and in negative event reactivity and recovery.

Hamilton NA, Affleck G, Tennen H, Karlson C, Luxton D, Preacher KJ, Templin JL.

Department of Psychology, University of Kansas, USA. nancyh@ku.edu

OBJECTIVE: Fibromyalgia (FM) syndrome is a chronic pain condition characterized by diffuse muscle pain, increased negative mood, and sleep disturbance. Until recently, sleep disturbance in persons with FM has been modeled as the result of the disease process or its associated pain. The current study examined sleep disturbance (i.e., sleep duration and sleep quality) as a predictor of daily affect, stress reactivity, and stress recovery. DESIGN AND MEASURES: A hybrid of daily diary and ecological momentary assessment methodology was used to evaluate the psychosocial functioning of 89 women with FM. Participants recorded numeric ratings of pain, fatigue, and positive and negative affect 3 times throughout the day for 30 consecutive days. At the end of each day, participants completed daily diary records of positive and negative life events. In addition, participants reported on their sleep duration and sleep quality each morning. RESULTS: After accounting for the effects of positive events, negative events, and pain on daily affect scores, it was found that sleep duration and quality were prospectively related to affect and fatigue. Furthermore, the effects of inadequate sleep on negative affect were cumulative. In addition, an inadequate amount of sleep prevented affective recovery from days with a high number of negative events. CONCLUSIONS: These results lend support to the hypothesis that sleep is a component of allostatic load and has an upstream role in daily functioning. PsycINFO Database Record (c) 2008 APA, all rights reserved.

PMID: 18643007 [PubMed - in process]

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Patient perspectives on the impact of fibromyalgia.

Arnold LM, Crofford LJ, Mease PJ, Burgess SM, Palmer SC, Abetz L, Martin SA.

University of Cincinnati Medical Center, 222 Piedmont Avenue, Suite 8200, Cincinnati, OH 45219, United States.

OBJECTIVE: The objective of this study was to elicit and assess important symptom domains and the impact of fibromyalgia on patients' quality of life and functioning from a patient's perspective. The intention was to collect this information as part of an overall effort to overcome shortcomings of existing outcome measures in fibromyalgia. METHODS: This was a qualitative study in which six focus group sessions with 48 women diagnosed with fibromyalgia were conducted to elicit concepts and ideas to assess the impact of fibromyalgia on their lives. RESULTS: The focus groups conducted with fibromyalgia patients identified symptom domains that had the greatest impact on their quality of life including pain, sleep disturbance, fatigue, depression, anxiety, and cognitive impairment. Fibromyalgia had a substantial negative impact on social and occupational function. Patients reported disrupted relationships with family and friends, social isolation, reduced activities of daily living and leisure activities, avoidance of physical activity, and loss of career or inability to advance in careers or education. CONCLUSION: The findings from the focus groups revealed that fibromyalgia has a substantial negative impact on patients' lives. PRACTICE IMPLICATIONS: A comprehensive assessment of the multiple symptoms domains associated with fibromyalgia and the impact of fibromyalgia on multidimensional aspects of function should be a routine part of the care of fibromyalgia patients.

PMID: 18640807 [PubMed - in process]

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Complementary treatments in rheumatic diseases.

Ernst E.

Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK.

Which complementary therapies are effective for reducing pain in which rheumatic conditions? This is the question this article addresses, with particular emphasis on treatments that are, according to the totality of the available trial data, likely to be effective, and with a focus on six conditions relevant to rheumatologists: back pain, fibromyalgia, myofascial pain, neck pain, osteoarthritis, and rheumatoid arthritis.

PMID: 18638686 [PubMed - in process]

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Antidepressant use in painful rheumatic conditions.

Perrot S, Javier RM, Marty M, Le Jeunne C, Laroche F.

Service de MŽdecine Interne et ThŽrapeutique, Consultation de la Douleur, H™tel Dieu, UniversitŽ Paris Descartes, 1 Place du Parvis Notre Dame, 75004 Paris, France.

This article reviews the pharmacologic and clinical evidence supporting the use of antidepressant drugs for treating painful rheumatologic conditions. Clinical studies have shown that tricyclic antidepressants, even at low doses, have analgesic effects in rheumatologic conditions equivalent to those of serotonin and noradrenalin reuptake inhibitors, but are less well tolerated. Selective serotonin reuptake inhibitors may also have analgesic effects, but higher doses are required to achieve analgesia in conditions such as fibromyalgia and low back pain. Antidepressant drugs may be useful in painful rheumatologic conditions, but in some studies the analgesic effects of antidepressants may be associated with functional impairment, sleep disorders, and fatigue. Further studies are required to determine antidepressants' analgesic mechanism of action and the specific role they should play in the management of chronic painful rheumatologic conditions.

PMID: 18638685 [PubMed - in process]

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The pharmacotherapy of chronic pain.

Lynch ME.

Pain Management Unit, Queen Elizabeth II Health Sciences Centre, Department of Anesthesiology, Psychiatry, and Pharmacology, Dalhousie University, 4th Floor Dickson Centre, Room 4086, Halifax, NS B3H 1V7, Canada.

Most patients with rheumatic diseases experience difficulties with chronic pain. To assist clinicians in directly addressing this pain, this article presents a treatment approach and algorithm based on best evidence. The usual approach for mild to moderate pain is to start with a nonopioid analgesic. If this is inadequate or poorly tolerated, and if there is an element of sleep loss, it is then reasonable to add an antidepressant with analgesic qualities. If there is a component of neuropathic pain or fibromyalgia, then a trial of one of the gabapentinoids is appropriate. If these steps are inadequate, then an opioid analgesic may be added. For moderate to severe pain, one would initiate a trial of chronic opioid earlier. Cannabinoids and topicals may also be appropriate as single agents or in combination.

PMID: 18638682 [PubMed - in process]

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Speed of mental operations in fibromyalgia: a selective naming speed deficit.

Leavitt F, Katz RS.

Department of Behavioral Sciences, Section of Rheumatology, Rush Medical College, Chicago, IL, USA. frankleavitt@sbcglobal.net

OBJECTIVE: Abnormal processing of information in fibromyalgia may hold clues to brain abnormalities in this illness. The purpose of this study is to examine the speed of mental operations in people with the fibromyalgia syndrome (FMS) under the pressure of time. The central question addresses whether FMS is associated with processing speed deficits across a spectrum of speeded tasks. METHODS: Sixty-seven patients with fibromyalgia with a history of memory complaints and 51 controls presenting with complaints of memory loss completed 10 timed cognitive measures of processing speed. Controls were patients with memory complaints who did not have FMS. RESULTS: The majority of FMS patients (>70%) performed within 1 standard deviation of the norm on 7 or more of 10 speeded measures. However, more than 49% of FMS patients tested as impaired (>1.67 SD below normative mean) on 2 specific validated speed tasks (reading words and naming colors). Compared with controls, the number of FMS patients showing impairment was 2.0 times greater for reading speed, and 1.6 times greater for color naming speed. A mean time delay of 203 milliseconds was recorded for reading words and 285 milliseconds for naming colors in the FMS impaired sample. A 203 milliseconds delay in reading words represents a 48% (203/417) time increase over the normal time for reading the same stimulus word. CONCLUSION: Abnormalities in naming speed are an unappreciated feature of FMS. Selective deficits in naming speed in association with otherwise well preserved global processing speed set patients with FMS apart from controls with memory complaints. Clinicians would be wise to specifically request adding a rapid naming test such as the Stroop Test to the cognitive battery; to document cognitive dysfunction in FMS patients who otherwise appear to test normally, despite often intense complaints of memory and concentration difficulties that can affect job performance and increase disability.

PMID: 18636019 [PubMed - in process]

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ATP, calcium and magnesium levels in platelets of patients with primary fibromyalgia.

Bazzichi L, Giannaccini G, Betti L, Fabbrini L, Schmid L, Palego L, Giacomelli C, Rossi A, Giusti L, De Feo F, Giuliano T, Mascia G, Bombardieri S, Lucacchini A.

Department of Internal Medicine, Division of Rheumatology, University of Pisa, Via Roma 67, 56126 Pisa, Italy.

OBJECTIVES: To evaluate the intracellular levels of the high energy adenosine triphosphate nucleotide ATP and essential divalent cations, calcium and magnesium, in platelets of patients affected by primary fibromyalgia syndrome (FMs). DESIGN AND METHOD: Platelet ATP and cation concentrations were measured in 25 patients affected by FMs and 25 healthy volunteers through a chemiluminescent and a fluorimetric assay, respectively. RESULTS: Significant lower ATP levels were observed inside platelets of FM patients (fmol ATP/plt: 0.0169+/-0.0012 vs. healthy controls, fmol ATP/plt: 0.0306+/-0.0023, mean+/-SEM) (*** P<0.0001). A trend towards higher calcium concentrations (P=0.06) together with significant increased magnesium levels were also reported in platelets of patients by comparison with controls (P=0.02). CONCLUSIONS: This preliminary study suggests that disturbances in the homeostasis of platelet ATP metabolism-signaling and calcium-magnesium flows might have a relevance in the pathogenesis of FMs.

PMID: 18634773 [PubMed - in process]

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Strengthening resilience capacity might light the way to a brighter future for patients with fibromyalgia.

Zautra AJ.

AJ Zautra is a Foundation Professor in the Department of Psychology at the Arizona State University, AZ, USA.

The difficulties in finding successful treatments for patients with fibromyalgia are well known within the field of rheumatology. Indeed, only one drug has been approved by the FDA for the treatment of patients with fibromyalgia, and must be used at high doses to elicit a response. A recent study by Rooks et al. evaluated physical exercise interventions in patients with fibromyalgia and found evidence of symptom improvement. Patients allocated to the exercise regimens showed significant reductions in pain that were sustained through a 6-month follow-up period. Improvements in functioning, depression and vitality, attributable to exercise, were also substantial. Random assignment to multiple treatments, the use of state-of-the-art methods and measures, and a close examination of effects in comparison to control conditions all add confidence in the findings of the Rooks et al. study. Despite some problems with the study, including its relatively short duration and the increased attrition rate in the control group, clinicians should be encouraged to incorporate a rigorous exercise program into their therapeutic strategies for patients with fibromyalgia. Several other behavioral interventions that focus on strengthening the resilience capacities of those suffering from chronic pain are also currently being tested.

PMID: 18628730 [PubMed - as supplied by publisher]

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A meta-analysis of the efficacy of fibromyalgia treatment according to level of care.

Garcia-Campayo J, Magdalena J, Magall—n R, Fern‡ndez-Garc’a E, Salas M, AndrŽs E.

Miguel Servet Hospital, University of Zaragoza, Zaragoza, Spain. jgarcamp@arrakis.es.

ABSTRACT: INTRODUCTION: The aim of this paper was to compare the efficacy of the treatments for fibromyalgia currently available in both primary care and specialised settings. METHODS: Published reports of randomised controlled trials (RCTs) researching pharmacological and non-pharmacological treatments in patients with fibromyalgia were found in the MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and PsychInfo databases. The most recent electronic search was undertaken in June 2006. RESULTS: We identified a total of 594 articles. Based on titles and abstracts, 102 full articles were retrieved, 33 of which met the inclusion criteria. These RCTs assessed 120 treatment interventions in 7789 patients diagnosed with primary fibromyalgia. Of them, 4505 (57.8%) were included in the primary care group of our study and 3284 (42.2%) in the specialised intervention group. The sample was mostly made up of middle-aged women, who have had fibromyalgia for a mean period of 6 to 10 years. The mean effect size of the efficacy of the 120 treatment interventions in patients with fibromyalgia compared with controls was 0.49 (95% confidence interval [CI] = 0.39 to 0.58; p < 0.001). In the primary care group it was 0.46 (95% CI = 0.33 to 0.58) while in specialised care it was 0.53 (95% CI = 0.38 to 0.69), with no statistical significance in the differences. We analysed the efficacy of treatments by comparing primary and specialised care in the different fibromyalgia groups and there were no significant differences. The variables of the studies that affected the improvements in the efficacy of fibromyalgia treatment were low quality of the studies and a shorter duration of treatment. However, both factors were biased by the heterogeneity of the studies. Other variables that also improved outcome and were not biased by the heterogeneity of the studies, were younger age of the patients and shorter duration of the disorder. On the contrary, gender and type of treatment (pharmacological vs. psychological) did not affect outcome. CONCLUSION: Based on this meta-analysis and despite the heterogeneity of specialised care studies and of the other limitations described in this article, treating fibromyalgia in specialised care offers no clear advantages.

PMID: 18627602 [PubMed - as supplied by publisher]

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Medication-induced mitochondrial damage and disease.

Neustadt J, Pieczenik SR.

Montana Integrative Medicine, Bozeman, MT 59718, USA. drneustadt@gmail.com

Since the first mitochondrial dysfunction was described in the 1960s, the medicine has advanced in its understanding the role mitochondria play in health and disease. Damage to mitochondria is now understood to play a role in the pathogenesis of a wide range of seemingly unrelated disorders such as schizophrenia, bipolar disease, dementia, Alzheimer's disease, epilepsy, migraine headaches, strokes, neuropathic pain, Parkinson's disease, ataxia, transient ischemic attack, cardiomyopathy, coronary artery disease, chronic fatigue syndrome, fibromyalgia, retinitis pigmentosa, diabetes, hepatitis C, and primary biliary cirrhosis. Medications have now emerged as a major cause of mitochondrial damage, which may explain many adverse effects. All classes of psychotropic drugs have been documented to damage mitochondria, as have stain medications, analgesics such as acetaminophen, and many others. While targeted nutrient therapies using antioxidants or their precursors (e. g., N-acetylcysteine) hold promise for improving mitochondrial function, there are large gaps in our knowledge. The most rational approach is to understand the mechanisms underlying mitochondrial damage for specific medications and attempt to counteract their deleterious effects with nutritional therapies. This article reviews our basic understanding of how mitochondria function and how medications damage mitochondria to create their occasionally fatal adverse effects.

PMID: 18626887 [PubMed - in process]

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Association of comorbid mood disorders and chronic illness with disability and quality of life in Ontario, Canada.

Gadalla T.

Faculty of Social Work at the University of Toronto.

Mood disorders are more prevalent in individuals with chronic physical illness compared to individuals with no such illness. These disorders amplify the disability associated with the physical condition and adversely affect its course, thus contributing to occupational impairment, disruption in interpersonal and family relationships, poor health and suicide. This study used data collected in the Canadian Community Health Survey, cycle 3.1 (2005) to examine factors associated with comorbid mood disorders and to assess their association with the quality of life of individuals living in Ontario. Results indicate that individuals with chronic fatigue syndrome, fibromyalgia, bowel disorder or stomach or intestinal ulcers had the highest rates of mood disorders. The odds of having a comorbid mood disorder were higher among women, the single, those living in poverty, the Canadian born and those between 30 and 69 years of age. The presence of comorbid mood disorders was significantly associated with short-term disability, requiring help with instrumental daily activities and suicidal ideation. Health care providers are urged to proactively screen chronically ill patients for mood disorders, particularly among the subgroups found to have elevated risk for these disorders.

PMID: 18625088 [PubMed - in process]

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A cross-sectional study of the relationship between body mass index and clinical characteristics, tenderness measures, quality of life, and physical functioning in fibromyalgia patients.

Neumann L, Lerner E, Glazer Y, Bolotin A, Shefer A, Buskila D.

Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, 84105, Israel, lily@bgu.ac.il.

We examined the relationship between body mass index (BMI) and measures of tenderness, quality of life, and physical functioning in female fibromyalgia (FMS) patients. A random sample of 100 female FMS patients from a database of 550 FMS individuals was interviewed and assessed according to a structured questionnaire that included FMS-related symptoms, measures of tenderness (point count and dolorimetry), quality of life (SF-36), physical functioning, and BMI. Weight was defined as normal, overweight, and obesity according to BMI. Twenty-seven percent of the FMS patients had normal BMI, 28% were overweight, and 45% were obese. BMI was negatively correlated with quality of life (r = -0.205, P = 0.044) and tenderness threshold (r = -0.238, P = 0.021) and positively correlated with physical dysfunctioning (r = 0.202, P = 0.047) and point count (r = 0.261, P = 0.011). Obese FMS patients display higher pain sensitivity and lower levels of quality of life. In designing studies that explore factors affecting tenderness, BMI should be included in addition to sex, age, etc.

PMID: 18622575 [PubMed - as supplied by publisher]

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Fatigue and blood pressure in primary Sjogren's syndrome.

d'Elia HF, Rehnberg E, Kvist G, Ericsson A, Konttinen Y, Mannerkorpi K.

Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Gšteborg University, Sweden. helena.forsblad@vgregion.se

OBJECTIVE: Primary Sjogren's syndrome (SS) is an autoimmune disease characterized by fatigue. Little is known about the genesis of fatigue. Fatigue is thought to represent a multidimensional concept and it is important to be able to measure it confidently. The aims were to evaluate the reliability and validity of the 20-item Multidimensional Fatigue Inventory (MFI-20) in SS and to search for factors associated with this disabling symptom. METHODS: Forty-eight women with primary SS completed the MFI-20 questionnaire. The results were compared with age-matched women with fibromyalgia (FM) and healthy controls. Convergent construct validity was assessed by correlations to a Visual Analogue Scale (VAS) for global fatigue by Spearman's correlation (r(s)). Test-retest reliability was analysed by the intraclass correlation coefficient (ICC) in 28 women. Associations between clinical variables and subscales of the MFI-20 were analysed. RESULTS: The SS women scored significantly higher in all subscales of the MFI-20 compared to controls but similar to FM. The ICCs were satisfactory, ranging from 0.66 for general fatigue to 0.85 for the total score of MFI-20. All subscales correlated significantly to VAS for global fatigue, general fatigue showing the highest correlation (r(s) = 0.70). The estimated number of hours of sleep/day was significantly associated with many of the fatigue dimensions. All five subscales of the MFI-20 were inversely associated with diastolic blood pressure (BP) and two with systolic BP. CONCLUSIONS: The MFI-20 was found to be a reliable and valid tool for the measurement of fatigue in primary SS. High levels of fatigue were correlated with low BP, suggesting an associated involvement of the autonomic nervous system.

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PMID: 18612929 [PubMed - in process]

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Central nervous system abnormalities in fibromyalgia: assessment using proton magnetic resonance spectroscopy.

El-Gabalawy H, Ryner L.

Publication Types:
PMID: 18609732 [PubMed - in process]

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Teaching medical students about medically unexplained illnesses: a preliminary study.

Friedberg F, Sohl SJ, Halperin PJ.

Department of Psychiatry and Behavioral Science, Stony Brook University, New York 11794-8790, USA. Fred.Friedberg@stonybrook.edu

BACKGROUND: This study examined how an interactive seminar focusing on two medically unexplained illnesses, chronic fatigue syndrome (CFS) and fibromyalgia, influenced medical student attitudes toward CFS, a more strongly stigmatized illness. METHODS: Forty-five fourth year medical students attended a 90 minute interactive seminar on the management of medically unexplained illnesses that was exemplified with CFS and fibromyalgia. A modified version of the CFS attitudes test was administered immediately before and after the seminar. RESULTS: Pre-seminar assessment revealed neutral to slightly favorable toward CFS. At the end of the seminar, significantly more favorable attitudes were found toward CFS in general (t (42) = 2.77; P < 0.01) and for specific items that focused on (1) supporting more CFS research funding (t (42) = 4.32; P < 0.001; (2) employers providing flexible hours for people with CFS (t (42) = 3.52, P < 0.01); and (3) viewing CFS as not primarily a psychological disorder (t (42) = 2.87, P < 0.01). Thus, a relatively brief exposure to factual information on specific medically unexplained illnesses was associated with more favorable attitudes toward CFS in fourth year medical students. CONCLUSION: This type of instruction may lead to potentially more receptive professional attitudes toward providing care to these underserved patients.

PMID: 18608944 [PubMed - in process]

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The holistic effects of long-term exercise, health education, and resource assistance on one woman with multiple debilitating medical problems: a case report.

Karper WB.

Department of Exercise and Sport Science, School of Health and Human Performance, University of North Carolina at Greensboro, Greensboro, NC 27402, USA. wbkarper@uncg.edu

This interventional case study describes the effects of a 3-component program on one woman with multiple, serious medical problems. The program was anchored with exercise accompanied by health education and resource help, and it lasted from fall 1998 until spring 2007. The patient was diagnosed with fibromyalgia, multiple sclerosis, Crohn's disease, and depression. The program was conducted 3, and for a period of time, 5 days per week for approximately 60 minutes per session. Results from fitness testing, psychosocial measurements, and the subject's feedback suggest that the exercise, health education, and resource help combined to produce a positive effect on selected fitness variables, psychosocial factors, and everyday functioning. Most important, the program impact appears to have had a holistic effect on numerous symptoms related to this patient's medical problems as well as functional improvement.

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PMID: 18607233 [PubMed - indexed for MEDLINE]

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The relationship between fibromyalgia and major depressive disorder: a comprehensive review.

Pae CU, Luyten P, Marks DM, Han C, Park SH, Patkar AA, Masand PS, Van Houdenhove B.

Department of Psychiatry, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea. pae@catholic.ac.kr

OBJECTIVE: A large body of evidence suggests that the relationship between major depressive disorder (MDD) and fibromyalgia (FM) is complex. Improved understanding of this relationship promises to provide clinicians with better assessment and treatment options for both disorders. METHOD: This paper reviews research on the prevalence, etiology and pathogenesis, clinical characterization, and treatment of FM and MDD, as well as studies that examined the relationship between these disorders. Studies were identified via PubMed literature search. RESULTS: Our findings point to substantial similarities in neuroendocrine abnormalities, psychological characteristics, physical symptoms and treatments between FM and MDD. However, currently available findings do not support the assumption that MDD and FM refer to the same underlying construct or can be seen as subsidiaries of one disease concept. CONCLUSION: New methodological and theoretical approaches may lead to a better understanding of the link between FM and MDD, and to more effective psychological and psychopharmacological therapies for FM patients. In the meantime, clinicians should carefully screen for a history of MDD in patients with FM.

PMID: 18606054 [PubMed - in process]

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Reflex sympathetic dystrophy: reflections from a clinician.

Small E.

Department of Pediatrics, Mount Sinai School of Medicine, 666 Lexington Avenue, Mount Kisco, NY 10549, USA. sportsdr@yahoo.com

Reflex sympathetic dystrophy is defined as chronic musculoskeletal pain and autonomic dysfunction. It is a difficult diagnosis to make, and the adolescent often sees many specialists before arriving at the correct diagnosis. In this article I review reflex sympathetic dystrophy and reflect on the differential diagnosis, pertinent medical history, personal characteristics of patients with reflex sympathetic dystrophy, physical examination, and laboratory evaluation. Principles of management are considered, including physical therapy, pharmacology, psychological therapy, and alternative therapies. Accurate diagnosis and management are critical for not prolonging the adolescent's and the family's suffering. It is important to provide aggressive physical therapy, stress management, relaxation training, and close follow-up. It is also critical to avoid immobilization, surgery, or invasive procedures and unnecessary tests.

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PMID: 18605399 [PubMed - indexed for MEDLINE]

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[Pain caused by mental stress : An investigation in patients with fibromyalgia and chronic shoulder/neck pain.]

[Article in German]

Petzke F, Althaus E.

Schmerzambulanz, Klinik fŸr AnŠsthesiologie und operative Intensivmedizin, UnversitŠtsklinikum Kšln, 50924, Kšln, Deutschland, Frank.Petzke@uni-koeln.de.

PMID: 18604565 [PubMed - as supplied by publisher]

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Therapeutic touch with preterm infants: composing a treatment.

Hanley MA.

School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX, USA. maryanne.hanley@ttuhsc.edu

BACKGROUND: Therapeutic touch (TT), a complementary therapy, has been shown to decrease stress, anxiety, and pain in adults and children, as well as improve mobility in patients with arthritis and fibromyalgia. However, less has been reported about the effectiveness of this therapy with infants, particularly preterm infants. OBJECTIVES: The aims of this research study were to explore the nature of the use of TT with preterm infants and describe a TT treatment process for this vulnerable population. DESIGN: Narrative inquiry and qualitative descriptive methods were used to discover knowledge about how TT is used with preterm infants. DATA COLLECTION: Telephone/in-person interviews and written narratives provided the data describing nurses' use of TT with preterm infants. PARTICIPANTS: The participants were registered nurses who practiced TT with preterm infants for varying years of experience. RESULTS: The participants described the responses of infants, 25 to 37 weeks postgestational age, whom they treated with TT. The infants' responses to TT included reduced heart and respiratory rates, enhanced ability to rest, improved coordination in sucking, swallowing, and breathing, and a greater ability to engage with the environment. The practitioners described the phases and elements of TT for preterm infants, which revealed unique patterns, for example, the treatment phase included the elements of smoothing and containing. CONCLUSION: The description that emerged from the practitioners' narratives of the TT treatment process for preterm infants provides preliminary data for the systematic use and evaluation of TT as an adjunct to facilitating preterm infants' physiological, behavioral, energy field development, and well-being.

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PMID: 18602618 [PubMed - in process]

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[S3 guideline of AWMF--definition, pathophysiology, diagnosis and therapy of fibromyalgia syndrome]

[Article in German]

[No authors listed]

Publication Types:
PMID: 18600620 [PubMed - indexed for MEDLINE]

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Thalassotherapy for fibromyalgia: a randomized controlled trial comparing aquatic exercises in sea water and water pool.

de Andrade SC, de Carvalho RF, Soares AS, de Abreu Freitas RP, de Medeiros Guerra LM, Vilar MJ.

Division of Rheumatology, Department of Clinical Medicine, Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, RN, Brazil, sandra.andrade.fisio@gmail.com.

The aim of this study was to evaluate the effectiveness of aerobic exercise in water pool compared with aerobic exercise performed in sea by women with fibromyalgia (FM). A total of 46 patients were randomly allocated into two groups: pool group (23 patients) and sea group (23 patients) that performed the same aerobic exercise program. Patients were evaluated baseline and after 12 weeks using: VAS, number of tender points, FIQ, SF-36, PSQI, and BDI. Both groups improved significantly in post-treatment for all the evaluated variables. There were no significant differences between two groups, except for BDI (F = 2.418, P < 0.0001). Aerobic exercise program performed in water (pool or sea) was effective for patients with FM. However, sea water exercises have been shown to bring more advantages related to emotional aspects. Then, exercise performed sea water (thalassotherapy) is an option for effective treatment with low cost for patients with FM.

PMID: 18600327 [PubMed - as supplied by publisher]

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An evaluation of the effectiveness of a videotape programme on interobserver reliability in outcome assessment for fibromyalgia.

Bellamy N, Anjema C, Chhina T, Dudek N, Hurley B, Landesman B, Probyn L, Hill J, Campbell J.

Department of Medicine, The University of Queensland, Brisbane, Australia.

Aims. A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used observer dependent outcome measures in patients with fibromyalgia (FM). Methods. During a single day, six third-year medical students independently examined six patients with FM in predetermined order using a Latin Square design, before and after viewing a standardized videotape which demonstrated methods for performing doiorimelry and for delecting skinfold tenderness and reactive hyperaemia. Reliability coefficients were calculated based on the variance components of the Analysis of Variance (ANOVA) table. Results. Prestandardizalion reliability coefficients were <0.80 for 8 measures. Following standardization all reliability coefficients, but one, approximated or exceeded 0.80. Conclusions. An important and beneficial effect of the standardization procedure was noted for several outcome variables. Such improvements in observer agreement have important implications for training senior medical students to perform quantitative measurement in the longitudinal management of FM patients in clinical practice. The use of a videotape to achieve this goal has obvious cost and convenience advantages compared with personal onc-on-one or small group training procedures.

PMID: 18597153 [PubMed - in process]

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Fibromyalgia. A plan for the pain.

[No authors listed]

PMID: 18595160 [PubMed - indexed for MEDLINE]

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The meaning and process of pain acceptance. Perceptions of women living with arthritis and fibromyalgia.

Lachapelle DL, Lavoie S, Boudreau A.

University of New Brunswick, Fredericton, Canada. dlachape@unb.ca

BACKGROUND: Within the past 10 years, cognitive-behavioural pain management models have moved beyond the traditional focus on coping strategies and perceived control over pain, to incorporate mindfulness- and acceptance-based approaches. Pain acceptance is the process of giving up the struggle with pain and learning to live life despite pain. Acceptance is associated with lower levels of pain, disability and psychological distress. Relatively little is known, however, about how patients arrive at a state of acceptance without the aid of therapy. OBJECTIVES: To explore personal definitions of acceptance and the factors that facilitate or hinder acceptance. METHODS: Eleven focus groups, involving a total of 45 women with arthritis and fibromyalgia, were conducted. RESULTS: The qualitative analysis revealed that, while the women rejected the word 'acceptance', they did agree with the main components of existing research definitions. The women's responses revealed that acceptance was a process of realizations and acknowledgements, including realizing that the pain was not normal and help was needed, receiving a diagnosis, acknowledging that there was no cure and realizing that they needed to redefine 'normal'. Diagnosis, social support, educating self and others, and self-care were factors that promoted acceptance. Struggling to retain a prepain identity, negative impacts on relationships, others not accepting their pain and the unspoken message that the pain was 'all in their head' were barriers to acceptance. CONCLUSION: The implications of these findings, distinctions between the diagnostic groups and recommendations regarding how health professionals can facilitate the process of acceptance are discussed.

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PMID: 18592056 [PubMed - in process]

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[Juvenile primary fibromyalgia syndrome--review]

[Article in Icelandic]

Baldursd—ttir S.

Sjœkrathj‡lfun Styrkur ehf., Reykjavik. vefjagigt@vefjagigt.is

Fibromyalgia syndrome is known to cause significant morbidity among adults characterised by widespread musculoskeletal pain, stiffness, fatigue, non-restorative sleep, cognitive dysfunction and diminished physical function. Although well-recognised in adults, the impact of the syndrome in the paediatric population has only recently been addressed. The estimated prevalence of juvenile primary fibromyalgia syndrome (JPFS) is 1.2%-6.2%. Prevalence is higher in girls than boys, and peaks at the time of puberty. JPFS is of unknown aetiology, characterised by numerous symptoms that mimic the symptoms of adult fibromyalgia syndrome, the most prevalent being sleep disturbance, widespread persistent musculoskeletal pain and fatigue. JPFS has a major influence on health, physical function and quality of life. The diagnosis of JPFS is based on the criteria defined by Yunus and Masi (1985), which include generalised musculoskeletal aching at three or more regions for at least three months and at least five of eighteen typical tender points. The precise cause of JPFS is unknown, but there is an emerging understanding that the development of this syndrome is related to many factors, such as genetic and anatomic factors, disordered sleep and psychological distress. According to emerging studies, a multidisciplinary treatment may be helpful in treating JPFS. Multicomponent treatment that includes attendance by patient and parents, sleep hygiene with or without medication, physical training and cognitive behavioural therapy, is advocated.

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PMID: 18591723 [PubMed - indexed for MEDLINE]

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Update on fibromyalgia therapy.

Abeles M, Solitar BM, Pillinger MH, Abeles AM.

Division of Rheumatology, Department of Medicine, The University of Connecticut School of Medicine, Farmington, USA. aabeles@uchc.edu

Primary fibromyalgia, a poorly-understood chronic pain syndrome, is characterized by widespread musculoskeletal pain, nonrestorative sleep, fatigue, psychological distress, and specific regions of localized tenderness, all in the absence of otherwise apparent organic disease. While the etiology of fibromyalgia is unclear, accumulating data suggest that disordered central pain processing likely plays a role in the pathogenesis of symptoms. Although various pharmacological treatments have been studied and espoused for treating fibromyalgia, no single drug or group of drugs has proved to be particularly useful in treating fibromyalgia patients as a whole, and only one drug to date has earned U.S. Food and Drug Administration approval for treating the syndrome in the United States. This review critically and systematically evaluates clinical investigations of medicinal and nonmedicinal treatments for fibromyalgia dating from 1970 to 2007.

Publication Types:
PMID: 18589048 [PubMed - indexed for MEDLINE]

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Autoimmune diseases and infections: controversial issues.

Baio P, Brucato A, Buskila D, Gershwin ME, Giacomazzi D, Lopez LR, Luzzati R, Matsuura E, Selmi C, Sarzi-Puttini P, Atzeni F.

Internal Medicine, Ospedali Riuniti di Bergamo, Bergamo, Italy.

The etiology and pathogenesis of certain types of disease remain controversial and stand like a bridge that crosses infectious, autoimmune and autoinflammatory pathways. Infection, for example, may initiate a disease, although it is the genetic regulation in the host, the interplay between virus or bacteria persistence and autoimmunity that produces the later phases of disease, the antigenic determinants responsible for inducing autoimmune disease, and the pathogenetic effector mechanisms. Infections agents cause pericarditis, but in 85% of cases it is "idiopathic". It has also been shown that persistent Clamydia pneumoniae, Porphyromonas gingivalis, and Helicobacter pylori infections cause host immunity and promote atherogenesis. A number of infectious agents have been suggested as potential triggers for primary biliary cirrhosis. Infections and vaccinations have also been linked to the pathogenesis of fibromyalgia syndrome, a common, chronic syndrome of widespread pain. Many factors are also responsible for fever of unknown origin such as: infections, autoimmunity disease, etc. However, it is difficult to determine a direct correlation between the infections agents in such a large group of diseases. The aim of this review is to analyze some of the controversies about the role of infections in autoimmune diseases.

Publication Types:
PMID: 18570758 [PubMed - indexed for MEDLINE]

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Determinants of health care use in chronic fatigue syndrome patients: a cross-sectional study.

Scheeres K, Wensing M, Severens H, Adang E, Bleijenberg G.

Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. k.scheeres@nkcv.umcn.nl

BACKGROUND: Chronic fatigue syndrome (CFS) is associated with a high use of health care services. To reduce the related costs for patients and society, it will be useful to know which factors determine CFS patients' amount of health care use. Little is known, however, about these factors. METHOD: The present study retrospectively performed a cross-sectional analysis to investigate the possible factors determining CFS patients' health care use. A total of 263 CFS patients, derived from two subgroups (149 from tertiary care and 114 from primary/secondary care), participated. Health care use was measured with a questionnaire asking details on consumption over the past 6 months. Fatigue severity and physical functioning were measured with the subscale Experienced Fatigue of the Checklist Individual Strength (CIS-20) and the subscale Physical Functioning of the SF-36, respectively. Multiple regression analysis, T-tests, and chi(2) tests were performed. RESULTS: The regression analysis revealed that, after controlling for patient characteristics (explaining 13%), fatigue factors added 4% predictive value and certain perpetuating factors of fatigue, including focus on bodily symptoms and attributions of fatigue, added another 5%. The analysis of subgroups revealed that, compared to the tertiary care population, fewer patients from primary/secondary care had visited a medical specialist (50% vs. 71%), used antidepressants (16% vs. 25%) and tranquilizers (3% vs. 18%), and had spent a night in hospital (7% vs. 10%). However, overall costs of health care between these subgroups did not differ. CONCLUSIONS: This study showed that illness duration, physical impairment due to fatigue, and psychological perpetuating factors of fatigue do determine the variance in CFS patients' health care use. These results give clear directions for treating CFS patients and managing health care for CFS.

Publication Types:
PMID: 18582610 [PubMed - indexed for MEDLINE]

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Multidisciplinary modalities in the treatment of fibromyalgia.

Goldenberg DL.

Department of Medicine, Newton-Wellesley Hospital, Newton, Mass., USA. dgoldenb@massmed.org

Fibromyalgia is a common musculoskeletal pain condition associated with chronic widespread pain, tenderness at various points on the body, fatigue, and sleep abnormalities. Individuals with fibromyalgia often have comorbid anxiety, depression, and/or other pain syndromes. Research into pharmacologic remedies for fibromyalgia has demonstrated efficacy for a variety of agents, but pharmacology is only one piece of the puzzle when it comes to successful management of fibromyalgia. Sensitive and appropriate methods of diagnosis and an integrated treatment plan including proper patient education, aerobic exercise, and cognitive-behavioral therapy have been shown to be effective in alleviating fibromyalgic symptoms.

Publication Types:
PMID: 18537461 [PubMed - indexed for MEDLINE]

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Pharmacotherapy for patients with fibromyalgia.

Clauw DJ.

Division of Rheumatology, Department of Internal Medicine, and Michigan Institute for Clinical and Health Research, University of Michigan Medical School, Ann Arbor, USA. dclauw@umich.edu

Fibromyalgia is a common and disabling syndrome. Despite research detailing the efficacy of a variety of medicinal treatments, most notably, tricyclic antidepressants, serotonin-norepinephrine re-uptake inhibitors, and alpha(2)delta ligands, there is still widespread, routine use of agents that are mostly ineffective in treating the central nature of fibromyalgic pain. This article discusses pharmacotherapeutic options for fibromyalgia, including those with high-level evidence for efficacy, moderate-level evidence, and little or no evidence for efficacy. The importance of an integrated treatment approach that includes pharmacotherapy and at least one, but preferably more, of the most effective nonmedicinal treatment options available (e.g., education, aerobic exercise, and cognitive-behavioral therapy) is also discussed.

Publication Types:
PMID: 18537460 [PubMed - indexed for MEDLINE]

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Fibromyalgia and cognition.

Glass JM.

Substance Abuse Section, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA. jglass@umich.edu

Patients with fibromyalgia frequently complain of cognitive problems or "fibrofog." The existence of these symptoms has been confirmed by studies of the incidence of cognitive problems in fibromyalgia patients and by the results of objective tests of metamemory, working memory, semantic memory, everyday attention, task switching, and selective attention. The results of these tests show that fibromyalgia patients have impairments in working, episodic, and semantic memory that mimic about 20 years of aging. These patients have particular difficulty with memory when tasks are complex and their attention is divided. Cognitive symptoms in these patients may be exacerbated by the presence of depression, anxiety, sleep problems, endocrine disturbances, and pain, but the relationship of these factors to cognitive problems in fibromyalgia patients is unclear. Standardized tests and treatment have not yet been established for cognitive problems in fibromyalgia patients.

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PMID: 18537459 [PubMed - indexed for MEDLINE]

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Management of fibromyalgia and comorbid psychiatric disorders.

Arnold LM.

Division of Women's Health Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. Lesley.Arnold@uc.edu

According to the American College of Rheumatology, fibromyalgia is widespread pain of at least 3 months' duration in combination with pain at 11 or more of 18 specific tender point sites on the body. Many individuals with fibromyalgia also have comorbid psychiatric disorders, which can present diagnostic dilemmas and require additional treatment considerations to optimize patient outcomes. Fibromyalgia has been found to be strongly associated with depressive and anxiety symptoms, a personal or family history of depression, and accompanying antidepressant treatment. Psychiatric comorbidities negatively impact the severity and course of fibromyalgia. Pharmacotherapy can be employed to control fibromyalgia and comorbid mood and anxiety disorders. Additionally, nonpharmacologic therapies for fibromyalgia and comorbid psychiatric disorders include cognitive-behavioral therapy and aerobic exercise. The efficacy of pharmacologic and nonpharmacologic treatments is examined in this article, as well as the diagnostic difficulties that comorbid disorders present.

Publication Types:
PMID: 18537458 [PubMed - indexed for MEDLINE]

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Pathophysiologic mechanisms of fibromyalgia and its related disorders.

Bradley LA.

Division of Clinical Immunology and Rheumatology, Department of Medicine, and Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama, Birmingham, USA. larry.bradley@ccc.uab.edu

This article reviews current findings regarding the pathophysiologic abnormalities that contribute to the enhanced pain responses of individuals with fibromyalgia as well as the relationships between fibromyalgia and commonly co-occurring disorders. Risk factors for fibromyalgia or enhanced pain responses include genetic and family influences, environmental triggers, and abnormal neuroendocrine and autonomic nervous system function. These risk factors also are associated with several disorders that frequently co-occur with fibromyalgia, such as major depressive disorder, migraine, and irritable bowel syndrome. Indeed, fibromyalgia and these co-occurring conditions may be part of a group of affective spectrum disorders that share important common, and perhaps heritable, causal factors. Recent research strongly suggests that alterations in central processing of sensory input also contribute to the cardinal symptoms of fibromyalgia, persistent widespread pain and enhanced pain sensitivity. Exposure to psychosocial and environmental stressors, as well as altered autonomic nervous system and neuroendocrine responses, also may contribute to alterations in pain perception or pain inhibition. Understanding the pathophysiology of fibromyalgia and co-occurring disorders may help clinicians provide the most appropriate treatment to their patients.

Publication Types:
PMID: 18537457 [PubMed - indexed for MEDLINE]

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Introduction: fibromyalgia and its related disorders.

Goldenberg DL.

Department of Medicine, Newton-Wellesley Hospital, Newton, Mass., USA. dgoldenb@massmed.org

Publication Types:
PMID: 18537456 [PubMed - indexed for MEDLINE]

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The internet-based arthritis self-management program: a one-year randomized trial for patients with arthritis or fibromyalgia.

Lorig KR, Ritter PL, Laurent DD, Plant K.

Stanford University School of Medicine, Stanford, California, USA.

OBJECTIVE: To determine the efficacy of an Internet-based Arthritis Self-Management Program (ASMP) as a resource for arthritis patients unable or unwilling to attend small-group ASMPs, which have proven effective in changing health-related behaviors and improving health status measures. METHODS: Randomized intervention participants were compared with usual care controls at 6 months and 1 year using repeated-measures analyses of variance. Patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia and Internet and e-mail access (n = 855) were randomized to an intervention (n = 433) or usual care control (n = 422) group. Measures included 6 health status variables (pain, fatigue, activity limitation, health distress, disability, and self-reported global health), 4 health behaviors (aerobic exercise, stretching and strengthening exercise, practice of stress management, and communication with physicians), 5 utilization variables (physician visits, emergency room visits, chiropractic visits, physical therapist visits, and nights in hospital), and self-efficacy. RESULTS: At 1 year, the intervention group significantly improved in 4 of 6 health status measures and self-efficacy. No significant differences in health behaviors or health care utilization were found. CONCLUSION: The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP.

Publication Types:
PMID: 18576310 [PubMed - indexed for MEDLINE]

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Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression.

Bigatti SM, Hernandez AM, Cronan TA, Rand KL.

Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA. sbigatti@iupui.edu

OBJECTIVE: This study is an examination of sleep, pain, depression, and physical functioning at baseline and 1-year followup among patients with fibromyalgia syndrome (FMS). Although it is clear that these symptoms are prevalent among FMS patients and that they are related, the direction of the relationship is unclear. We sought to identify and report sleep problems in this population and to examine their relationship to pain, depression, and physical functioning. METHODS: Patients diagnosed with fibromyalgia were recruited from a Southern California health maintenance organization and evaluated according to American College of Rheumatology criteria in the research laboratory. Six hundred patients completed the baseline assessment and 492 completed the 1-year assessment. Measures included the Center for Epidemiologic Studies Depression Scale, the McGill Pain Questionnaire, the Pittsburgh Sleep Quality Index, and the Fibromyalgia Impact Questionnaire. RESULTS: The majority of the sample (96% at baseline and 94.7% at 1 year) scored within the range of problem sleepers. Path analyses examined the impact of baseline values on 1-year values for each of the 4 variables. No variable of interest predicted sleep, sleep predicted pain (beta = 0.13), pain predicted physical functioning (beta = -0.13), and physical functioning predicted depression (beta = -0.10). CONCLUSION: These findings highlight the high prevalence of sleep problems in this population and suggest that they play a critical role in exacerbating FMS symptoms. Furthermore, they support limited existing findings that sleep predicts subsequent pain in this population, but also extend the literature, suggesting that sleep may be related to depression through pain and physical functioning.

Publication Types:
PMID: 18576297 [PubMed - indexed for MEDLINE]

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Identifying the clinical domains of fibromyalgia: contributions from clinician and patient Delphi exercises.

Mease PJ, Arnold LM, Crofford LJ, Williams DA, Russell IJ, Humphrey L, Abetz L, Martin SA.

Seattle Rheumatology Associates, Seattle, Washington 98104, USA. pmease@nwlink.com

OBJECTIVE: In evaluating the effectiveness of fibromyalgia (FM) therapies, it is important to assess the impact of those therapies on the full array of domains considered important by both clinicians and patients. The objective of this research was to identify and prioritize the key clinically relevant and important domains impacted by FM that should be evaluated by outcome assessment instruments used in FM clinical trials, and to approach consensus among clinicians and patients on the priority of those domains to be assessed in clinical care and research. METHODS: Group consensus was achieved using the Delphi method, a structured process of consensus building via questionnaires together with systematic and controlled opinion feedback. The Delphi exercises involved 23 clinicians with expertise in FM and 100 patients with FM as defined by American College of Rheumatology criteria. RESULTS: The Delphi exercise revealed that the domains ranked most highly by patients were similar to the domain rankings by clinicians. Pain was consistently ranked highest by both panels. Fatigue, impact on sleep, health-related quality of life, comorbid depression, and cognitive difficulty were also ranked highly. Stiffness was ranked highly by patients but not clinicians. In contrast, side effects was important to clinicians but was not identified as important in the patient Delphi exercise. CONCLUSION: The clinician and patient Delphi exercises identified and ranked key domains that need to be assessed in FM research. Based on these results, a conceptual framework for measuring patient-reported outcomes is proposed.

Publication Types:
PMID: 18576290 [PubMed - indexed for MEDLINE]

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Remotely attended home monitoring of sleep disorders.

Kayyali HA, Weimer S, Frederick C, Martin C, Basa D, Juguilon JA, Jugilioni F.

CleveMed, Cleveland, Ohio 44103, USA. hkayyali@clevemed.com

This research assessed the feasibility of homemonitoring of sleep disorders using small wireless technologies. There are many different types of sleep disorders that affect over 40 million patients. Sleep diagnosis is typically done in a laboratory where patients are asked to stay overnight, during which time various types of physiological signals are recorded. A more attractive alternative to in-lab testing is to evaluate patients in their own homes. In addition to convenience, the home environment is more conducive for natural sleep, which allows a true capture of disease symptoms. We describe a new easily deployable home monitor that will permit complete sleep evaluation in the patients' homes under direct remote supervision of a sleep specialist. The new technology, PSG@Home, consists of a 14-channel wearable wireless monitor and a cell phone-based Gateway to transfer data, including video, in real-time from the patient's home to a remote laboratory. Similar to in-lab recordings, data can be monitored and scored in real-time. The technology was tested on 10 fibromyalgia (FM) patients, whose constant pain has previously made them reluctant to travel to a sleep lab. All 10 studies were successful and generated high-fidelity recordings. One study experienced intermittent real-time data transmission due to sparse cellular coverage, but the data were recovered from a backup memory housed inside the patient monitor. No disconnections in sensor lead wires occurred. A new enabling home telehealth technology for real-time sleep disorders monitoring was developed and tested with encouraging preliminary results. The sample size is too small to derive any clinical conclusions about the sleep quality of FM patients. However, this study validates the underlying technology and demonstrates the role of new wireless technologies in the future of sleep disorders diagnosis.

Publication Types:
PMID: 18570567 [PubMed - indexed for MEDLINE]

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Best practice: E-Model--prescribing physical activity and exercise for individuals with fibromyalgia.

Busch AJ, Thille P, Barber KA, Schachter CL, Bidonde J, Collacott BK.

School of Physical Therapy, University of Saskatchewan, Saskatoon, SK, Canada. angela.busch@usask.ca

Fibromyalgia (FM) is a serious and debilitating condition, encompassing a wide range of symptoms. Physical therapists often advocate the incorporation of leisure time physical activity (exercise training or recreational physical activity) as an important management strategy for individuals with FM. Decisions about physical activity prescription in clinical practice are informed by a variety of sources. This topical review considers physical activity prescription using the E-Model as a framework for best practice decision making. We examine findings from randomized trials, published experts, and qualitative studies through the lens of the model's five Es: 1) evidence, 2) expectations, 3) environment, 4) ethics, and 5) experience. This approach provides a robust foundation from which to make best practice decisions. Application of this model also facilitates the identification of gaps and discrepancies in the literature, future opportunities for knowledge exchange and translation, and future research.

Publication Types:
PMID: 18569853 [PubMed - indexed for MEDLINE]

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Chronic suicidality in a physician: an alliance yet to become therapeutic.

Koekkoek B, Gunderson JG, Kaasenbrood A, Gutheil TG.

Altrecht Mental Health Care, Outpatient Community Care, Zeist, The Netherlands. b.koekkoek@altrecht.nl

Publication Types:
PMID: 18569040 [PubMed - indexed for MEDLINE]

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[Neurasthenia]

[Article in German]

Hess CW.

Neurologische UniversitŠtsklinik, Inselspital, Ch-3010 Bern.

PMID: 18561600 [PubMed - indexed for MEDLINE]

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Priority-setting tools for rheumatology disease referrals: a review of the literature.

De Coster C, Fitzgerald A, Cepoiu M; Investigators of the Western Canada Waiting List Project (WCWL).

Health Outcomes, Calgary Health Region, 4520 16th Avenue NW, Calgary, Alberta, T3B 0M6, Canada, Carolyn.DeCoster@calgaryhealthregion.ca.

As part of a larger body of work to develop a rheumatology priority referral score, a literature review was conducted. The objective of the literature review was to identify preexisting priority-setting, triage, and referral tools/scales developed to guide referrals from primary care to specialist care/consultation usually provided by a rheumatologist. Using a combination of database, citation, Internet, and hand-searching, 20 papers were identified that related to referral prioritization in three areas: rheumatoid arthritis (RA; 5), musculoskeletal (MSK) diseases other than RA (3), and MSK diseases in general (12). No single set of priority-setting criteria was identified for rheumatologic disorders across the spectrum of patients who may be referred from primary care providers (PCPs) to rheumatologists. There appears to be more congruence on conditions at either end of the urgency spectrum with conditions such as suspected cranial arteritis or systemic vasculitis deemed to be emergency referrals and fibromyalgia and other soft-tissue syndromes deemed to be more routine referrals. Between these two extremes, there is a divergence of opinion about urgency and few papers on the issue. The exception to this is referral for early RA for which several criteria have been established. Despite the inherent complexities in developing a tool to prioritize patients referred by PCPs to rheumatologists, there are compelling reasons to proceed. With the aging of the population, the number of patients being referred to rheumatologists is expected to increase. With pharmaceutical advances, there are demonstrable benefits in early referral for some conditions. These trends have led to increased pressure on scarce rheumatological human resources. A tool to prioritize referrals is a critical component of improving access and the referral process.

PMID: 18560920 [PubMed - as supplied by publisher]

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Commentary on the EULAR recommendations for the management of fibromyalgia.

Clauw DJ.

Clinical and Translational Research at University of Michigan, Ann Arbor, MI, USA. dclauw@med.umich.edu

PMID: 18560385 [PubMed - in process]

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Muscle characteristics of persons with fibromyalgia syndrome.

Jegede AB, Gilbert C, Tulkin SR.

California School of Professional Psychology, Alliant International University, San Francisco, CA, USA. Ba3de@hotmail.com

PURPOSE: To explore agonist and antagonist muscle characteristics, depression and physical functioning of patients with Fibromyalgia Syndrome (FMS). METHOD: Individuals with FMS (N=34) and chronic pain (N=36) were recruited from a chronic pain program. Normal controls (N=37) were recruited from the general community. MEASURES: Demographic data (age, gender, marital status, ethnicity, and employment status), self-report physical and psychological functioning, current level of pain, level of depression, and agonist and antagonist muscle activity (SCM, Biceps/triceps, Forearm flexor/extensor, Lower leg tibialis anterior/gastrocnemius) were measured with sEMG. RESULTS: There was a significant difference in upper arm muscle contra-activation between the FMS patients and normal controls but not between the non-FMS chronic pain patients and normal controls. When compared to normal controls, the FMS group reported more depression and a higher level of physical functioning problems, but it was not significantly different from the mean score for the non-FMS chronic pain group. Problems with physical functioning and depression did not predict strength of contra-activation in the upper arm muscle. CONCLUSION: These findings suggest presence of unusual muscle activity occurring in the bicep muscle of FMS and non-FMS chronic pain patients, which establishes a possible link between muscle dysfunction, mood and pain.

PMID: 18560138 [PubMed - indexed for MEDLINE]

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Relaxation and guided imagery in Hispanic persons diagnosed with fibromyalgia: a pilot study.

Menzies V, Kim S.

School of Nursing, Virginia Commonwealth University, Richmond, VA 23298, USA. vsmenzies@vcu.edu

Fibromyalgia (FM) is a chronic pain disorder affecting 2% of the population in the United States. Another 16 million Hispanics suffer from generically identified rheumatic diseases that likely include FM. Because there are few reported studies of Hispanics with FM, a pilot study using a repeated-measures pretest-posttest design investigated the effects of a 10-week mind-body intervention (visual imagery with relaxation) on symptom management. The change in means from baseline to week 10 demonstrated improvement in self-efficacy for managing pain and other symptoms and functional status. Visual imagery with relaxation is a mind-body intervention that may be used for symptom management in this population.

Publication Types:
PMID: 18552601 [PubMed - indexed for MEDLINE]

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Efficacy of Raloxifen in treatment of fibromyalgia in menopausal women.

Sadreddini S, Molaeefard M, Noshad H, Ardalan M, Asadi A.

Tabriz University of Medical Sciences, Iran. shahramsd2005@yahoo.com

BACKGROUND: This study compared Raloxifen (Evista) with placebo in treatment of fibromyalgia. METHODS: One hundred menopausal women with fibromyalgia enrolled in a double-blind randomized study from Feb 2005 until Oct 2006. We compared efficacy of Raloxifen, and placebo over 16 weeks of treatment. Fifty patients received Raloxifen 49 of which (98%) completed the study and 47 (94%) of 50 patients who received placebo completed the study. Raloxifen in 60 mg or identical placebo dose was given every other day over 16 weeks and patients were followed up. Improved recovery for a treatment group was assessed by a significantly higher mean score from baseline to the end of the treatment trial, compared with patients treated with placebo, on measures of Stanford Health Assessment Questionnaire (HAQ); Iranian version of Hospital Anxiety and Depression questionnaire (IHAD); sleep disturbance; number of tender points; reduction of pain and fatigue based on Visual Analogue Score (VAS). RESULTS: Raloxifen produced a significantly higher response rate than placebo in treating fibromyalgia by improving pain and fatigue, reducing of the tender point count, sleep disturbance and recovery of usual activities as measured by the Stanford Health Assessment Questionnaire (HAQ). The significant effect of Raloxifen on HAD score among patients with fibromyalgia was not seen. CONCLUSION: Raloxifen was superior to placebo in the treatment of menopausal patients with fibromyalgia.

Publication Types:
PMID: 18549938 [PubMed - indexed for MEDLINE]

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[Intensification of a diffuse chronic pain syndrome by the introduction of an aromatase inhibitor]

[Article in French]

Nemitz N, Kurmann PT, Van Linthoudt D.

DŽpartement de MŽdecine, service de Rhumatologie, H™pital Neuch‰telois, La Chaux-de-Fonds.

A case of a menopausal woman known for a chronic diffuse pain syndrome and breast cancer positive for estrogen receptors is presented. She developed an increase of her diffuse pain syndrome and joint aches after the introduction of an aromatase inhibitor. Soreness quickly improved after the interruption of the drug. We emphasize some etiological hypotheses concerning the painful symptoms, especially the role of aromatase and estrogens.

Publication Types:
PMID: 18549014 [PubMed - indexed for MEDLINE]

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Fibromyalgia remains a controversial medical enigma.

Richardson JP.

Publication Types:
PMID: 18543430 [PubMed - indexed for MEDLINE]

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Comment on:
Fibromyalgia remains a controversial medical enigma.

Abeles M, Abeles SR, Abeles AM.

Publication Types:
PMID: 18543429 [PubMed - indexed for MEDLINE]

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Mind-body interventions: applications in neurology.

Wahbeh H, Elsas SM, Oken BS.

Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CR120, Portland, OR 97239, USA.

OBJECTIVE: Half of the adults in the United States use complementary and alternative medicine with mind-body therapy being the most commonly used form. Neurology patients often turn to their physicians for insight into the effectiveness of the therapies and resources to integrate them into their care. The objective of this article is to give a clinical overview of mind-body interventions and their applications in neurology. METHODS: Medline and PsychInfo were searched on mind-body therapies and neurologic disease search terms for clinical trials and reviews and published evidence was graded. RESULTS: Meditation, relaxation, and breathing techniques, yoga, tai chi, and qigong, hypnosis, and biofeedback are described. Mind-body therapy application to general pain, back and neck pain, carpal tunnel syndrome, headaches, fibromyalgia, multiple sclerosis, epilepsy, muscular dysfunction, stroke, aging, Parkinson disease, stroke, and attention deficit-hyperactivity disorder are reviewed. CONCLUSIONS: There are several conditions where the evidence for mind-body therapies is quite strong such as migraine headache. Mind-body therapies for other neurology applications have limited evidence due mostly to small clinical trials and inadequate control groups.

Publication Types:
PMID: 18541886 [PubMed - indexed for MEDLINE]

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Comment on:
Intention-to-treat analysis may better represent the actual efficacy.

Vlad SC, LaValley MP.

Publication Types:
PMID: 18541834 [PubMed - indexed for MEDLINE]

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Comment on:
Detrimental effect of statin therapy in women with fibromyalgia.

Mascitelli L, Pezzetta F, Goldstein MR.

Publication Types:
PMID: 18541833 [PubMed - indexed for MEDLINE]

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Comment on:
Fibromyalgia remains a controversial medical enigma.

Adams SM.

Publication Types:
PMID: 18540486 [PubMed - indexed for MEDLINE]

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Comment on:
Fibromyalgia remains a controversial medical enigma.

Tocks JB.

Publication Types:
PMID: 18540485 [PubMed - indexed for MEDLINE]

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Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome.

Goebel A, Buhner S, Schedel R, Lochs H, Sprotte G.

Pain Management Centre, University Hospital Wuerzburg, Germany. andreasgoebel@rocketmail.com

OBJECTIVES: The pain intensity of patients with FM has recently been reported to be correlated with the degree of small intestinal bacterial overgrowth (SIBO). SIBO is often associated with an increased intestinal permeability (IP). Increased IP, if shown in FM, may have pathogenetic relevance because it leads to the exposure of immune cells to luminal antigens and consequent immune modulation. It is currently unknown whether IP is altered in FM. We therefore examined the IP in a group of patients with primary FM and in two control groups, healthy volunteers and patients with an unrelated chronic pain syndrome, complex regional pain syndrome (CRPS). We hypothesized that patients with FM, but not volunteers or those patients with CRPS, would have altered IP. METHODS: Both gastroduodenal and small IP were assessed using an established three-sugar test, where urinary disaccharide excretion reflecting intestinal uptake was measured using HPLC. RESULTS: Forty patients with primary FM, 57 age- and sex-matched volunteers and 17 patients with CRPS were enrolled in this study. In the FM group, 13 patients had raised gastroduodenal permeability and 15 patients had raised small intestinal permeability, but only one volunteer had increased gastroduodenal permeability (P < 0.0001, chi-square test for the three groups). The IP values were significantly increased in the patient groups (P < 0.0003 for all comparisons, one-way analysis of variance). CONCLUSIONS: The IPs in primary FM and, unexpectedly, CRPS are increased. This study should stimulate further research to determine the implication of altered IP in the disease pathophysiology of FM and CRPS.

PMID: 18540025 [PubMed - in process]

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Cutaneous C-fiber pain abnormalities of fibromyalgia patients are specifically related to temporal summation.

Staud R, Bovee CE, Robinson ME, Price DD.

Department of Medicine, University of Florida College of Medicine, Gainesville, FL 32610-0221, United States.

Temporal summation of "second pain" (TSSP) is considered to be the result of C-fiber-evoked responses of dorsal horn neurons, termed 'windup'. TSSP is dependent on stimulus frequency (0.33Hz) and is relevant for central sensitization and chronic pain. We have previously shown that compared to normal controls (NC), fibromyalgia (FM) subjects show abnormal TSSP, requiring lower stimulus intensities/frequencies to achieve similar TSSP. However, it is unknown whether abnormal TSSP in FM is influenced by peripheral sensitization of C-fiber nociceptors and/or bias in pain ratings. Thus, we evaluated 14 FM subjects and 19 NC with pain threshold tests to selective C-fiber stimulation, 30s heat stimuli, and repetitive brief (1.5s) heat pulses at 0.33Hz using a contact heat stimulator (CHEPS). The intensity of heat pulses was varied to achieve maximal TSSP ratings of 45+/-10 (numerical pain scale 0-100) in both FM and NC groups. We found that NC and FM subjects had similar pain thresholds to C-fiber stimulation and yet FM subjects required lower heat pulse temperatures to generate the same magnitudes of TSSP (p<.05). This combination of findings does not support peripheral sensitization and suggests central TSSP abnormalities in FM subjects. In a second experiment, all aspects of individually adjusted TSSP heat pulses were kept the same except that the baseline temperature (BT) between heat pulses was surreptitiously alternated between 35 degrees C and 40 degrees C. These changes of BT resulted in significantly greater TSSP ratings of FM subjects compared to NC subjects, both at 35 degrees C and at 40 degrees C, but did not change their response to the first heat pulse of a stimulus train. These findings provide strong support for alterations of central pain sensitivity and not peripheral sensitization or rating bias as responsible for TSSP differences between NC and FM subjects.

PMID: 18538477 [PubMed - as supplied by publisher]

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Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: new concepts in treatment.

Gur A, Oktayoglu P.

Department of Physical Medicine and Rehabilitation, Medical Faculty, Dicle University, 21280 Diyarbakir, Turkey. alig@dicle.edu.tr

Fibromyalgia (FM) and chronic fatigue syndrome (CFS) are poorly understood disorders that share similar demographic and clinical characteristics. The etiology and pathophysiology of these diseases remain unclear. Because of the similarities between both disorders it was suggested that they share a common pathophysiological mechanisms, namely, central nervous system (CNS) dysfunction. Current hypotheses center on atypical sensory processing in the CNS and dysfunction of skeletal muscle nociception and the hypothalamic-pituitary-adrenal (HPA) axis. Researches suggest that the (CNS) is primarily involved in both disorders in regard to the pain, fatigue and sleep disturbances. Many patients experience difficulty with concentration and memory and many others have mood disturbance, including depression and anxiety. Although fibromyalgia is common and associated with substantial morbidity and disability, there are no US Food and Drug Administration (FDA)-approved treatments except pregabalin. Recent pharmacological treatment studies about fibromyalgia have focused on selective serotonin and norepinephrine (NE) reuptake inhibitors, which enhance serotonin and NE neurotransmission in the descending pain pathways and lack many of the adverse side effects associated with tricyclic medications. CFS is a descriptive term used to define a recognisable pattern of symptoms that cannot be attributed to any alternative condition. The symptoms are currently believed to be the result of disturbed brain function. To date, no pharmacological agent has been reliably shown to be effective treatment for CFS. Management strategies are therefore primarily directed at relief of symptoms and minimising impediments to recovery. This chapter presents data demonstrating CFS, abnormal pain processing and autonomic nervous system (ANS) dysfunction in FM and CFS and concludes by reviewing the new concepts in treatments in CFS and FM.

Publication Types:
PMID: 18537652 [PubMed - indexed for MEDLINE]

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High plasma levels of MCP-1 and eotaxin provide evidence for an immunological basis of fibromyalgia.

Zhang Z, Cherryholmes G, Mao A, Marek C, Longmate J, Kalos M, Amand RP, Shively JE.

Division of Immunology, Beckman Research Institute of the City of Hope, 1450 E. Duarte Road, Duarte, CA 91010, USA.

Fibromyalgia (FMS), a predominantly female (85%) syndrome, affects an estimated 2% of the US population with skeletal muscle ache, fatigue, headache, and sleep disorder. The pathogenesis of FMS is unknown and there is no laboratory test for diagnosis. In this study, plasma levels of 25 cytokines and chemokines in 92 female patients with FMS and 69 family members were measured compared to 77 controls. Trans-endothelial migration of normal leukocytes in response to FMS plasma and the cytokine profile of human myoblasts were analyzed. High levels of MCP-1 (P<0.001) and eotaxin (P<0.01) were found in patients and family members compared to controls. Patients (56/92) treated with the single agent guaifenesin (>3 months) had higher levels of eotaxin than those not treated (P<0.01). Diluted plasma from patients increased the migration of normal eosinophils and monocytes, but not neutrophils, through an endothelial/Matrigel barrier only when mast cells are included in the lower wells (P<0.05). Furthermore, myoblasts can secrete MCP-1, eotaxin, and IP-10, while treatment with MCP-1 caused secretion of IL-1beta, eotaxin and IP-10. FMS is associated with inflammatory chemokines, that MCP-1 and eotaxin may contribute to the symptoms of FMS, and that similar cytokine profiles found in family members support the idea that FMS has a genetic component. Furthermore, the chemokine profile associated with FMS has direct effects on the migration of eosinophils and monocytes in the presence of mast cells, and skeletal muscle itself may secrete.

Publication Types:
PMID: 18535166 [PubMed - in process]

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A distinct pattern of myofascial findings in patients after whiplash injury.

Ettlin T, Schuster C, Stoffel R, BrŸderlin A, Kischka U.

Reha Rheinfelden Rehabilitation Center, Rheinfelden, Switzerland. th.ettlin@reha-rhf.ch

OBJECTIVE: To identify objective clinical examinations for the diagnosis of whiplash syndrome, whereby we focused on trigger points. DESIGN: A cross-sectional study with 1 measurement point. SETTING: A quiet treatment room in a rehabilitation center. PARTICIPANTS: Patients (n=124) and healthy subjects (n=24) participated in this study. Among the patient group were patients with whiplash-associated disorders (n=47), fibromyalgia (n=21), nontraumatic chronic cervical syndrome (n=17), and endogenous depression (n=15). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Each patient and control subject had a manual examination for trigger points of the semispinalis capitis, trapezius pars descendens, levator scapulae, scalenus medius, sternocleidomastoideus, and masseter muscles bilaterally. RESULTS: Forty (85.1%) of the patients with whiplash had positive trigger points in the semispinalis capitis muscle. The patients with whiplash had a significantly higher prevalence of positive trigger points in the semispinalis capitis muscle than any of the control groups (P<.05). For the other examined muscles, the prevalence of trigger points in the patients with whiplash did not differ significantly from the patients with fibromyalgia or nontraumatic chronic cervical syndrome. It did differ from the patients with endogenous depression and the healthy controls. CONCLUSIONS: Patients with whiplash showed a distinct pattern of trigger point distribution that differed significantly from other patient groups and healthy subjects. The semispinalis capitis muscle was more frequently affected by trigger points in patients with whiplash, whereas other neck and shoulder muscles and the masseter muscle did not differentiate between patients with whiplash and patients with nontraumatic chronic cervical syndrome or fibromyalgia.

PMID: 18534552 [PubMed - indexed for MEDLINE]

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Toward "pain-free" statin prescribing: clinical algorithm for diagnosis and management of myalgia.

Jacobson TA.

Office of Health Promotion and Disease Prevention, Emory University, Faculty Office Building, 49 Jessie Hill Jr Dr SE, Atlanta, GA 30303, USA. tjaco02@emory.edu

Myalgia, which often manifests as pain or soreness in skeletal muscles, is among the most salient adverse events associated with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). Clinical issues related to statin-associated myotoxicity include (1) incidence in randomized controlled trials and occurrence in postmarketing surveillance databases; (2) potential differences between statins in their associations with such adverse events; and (3) diagnostic and treatment strategies to prevent, recognize, and manage these events. Data from systematic reviews, meta-analyses, clinical and observational trials, and post-marketing surveillance indicate that statin-associated myalgia typically affects approximately 5.0% of patients, as myopathy in 0.1% and as rhabdomyolysis in 0.01%. However, studies also suggest that myalgia is among the leading reasons patients discontinue statins (particularly high-dose statin monotherapy) and that treatment with certain statins (eg, fluvastatin) is unlikely to result in such adverse events. This review presents a clinical algorithm for monitoring and managing statin-associated myotoxicity. The algorithm highlights risk factors for muscle toxicity and provides recommendations for (1) creatine kinase measurements and monitoring; (2) statin dosage reduction, discontinuation, and rechallenge; and (3) treatment alternatives, such as extended-release fluvastatin with or without ezetimibe, low-dose or alternate-day rosuvastatin, or ezetimibe with or without colesevelam. The algorithm should help to inform and enhance patient care and reduce the risk of myalgia and other potentially treatment-limiting muscle effects that might undermine patient adherence and compromise the overall cardioprotective benefits of statins.

Publication Types:
PMID: 18533086 [PubMed - indexed for MEDLINE]

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Fecal microbiota in early rheumatoid arthritis.

Vaahtovuo J, Munukka E, KorkeamŠki M, Luukkainen R, Toivanen P.

CyFlo Ltd.,Turku, Finland. jussi.vaahtovuo@cyflo.fi

OBJECTIVE: To compare the composition of intestinal microbiota of patients with early rheumatoid arthritis (RA) or fibromyalgia (FM), fecal samples were collected from 51 patients with RA and 50 with FM. METHODS: RA patients fulfilled the RA criteria of the American College of Rheumatology, and duration of their disease was < or = 6 months. Only nonhospitalized patients from outpatient care were included. Patients having extreme diets or previous disease modifying antirheumatic drug or glucocorticoid medication were excluded, as were those taking antibiotics or having gastroenteritis for at least 2 months prior to sampling. Fecal bacterial composition was analyzed with a method based on flow cytometry, 16S rRNA hybridization, and DNA-staining. A set of 8 oligonucleotide probes was used. RESULTS: In comparison to patients with FM, the RA patients had significantly less bifidobacteria and bacteria of the Bacteroides-Porphyromonas-Prevotella group, Bacteroides fragilis subgroup, and Eubacterium rectale--Clostridium coccoides group. Results from the 8 probes showed a significant overall difference between the 2 patient groups, indicating widespread microbial differences. CONCLUSION: These findings support the hypothesis that intestinal microbes participate in the etiopathogenesis of RA.

Publication Types:
PMID: 18528968 [PubMed - in process]

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Circulating cytokine levels compared to pain in patients with fibromyalgia -- a prospective longitudinal study over 6 months.

Wang H, Moser M, Schiltenwolf M, Buchner M.

Department of Orthopaedic Surgery, Ruprecht-Karls-University of Heidelberg, Heidelberg; and SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany. haili.wang@ok.uni-heidelberg.de

OBJECTIVE: This prospective study examined circulating cytokines in patients with fibromyalgia (FM) over 6 months rather than at only one timepoint, and investigated correlations between serum cytokine concentrations and pain intensity in FM patients receiving multidisciplinary pain therapy. METHODS: Serum concentrations of proinflammatory cytokines interleukin 6 (IL-6), IL-8, and tumor necrosis factor-alpha (TNF-alpha) and antiinflammatory cytokines IL-4 and IL-10 were measured (Bio-Plex system) in 20 FM patients and 80 healthy subjects on admission and 10, 21, and 180 days after initiation of treatment and correlated to pain intensity. RESULTS: On admission, serum levels of IL-8 (p < 0.001) and TNF-alpha (p < 0.001), but not IL-6, were elevated in patients with FM. No significant difference in IL-4 and IL-10 was found between FM patients and controls. High IL-8 levels remained consistent during the followup, but TNF-alpha was already reduced after 10 days and until 6 months after therapy. After 6 months' treatment with multidisciplinary pain therapy, IL-8 and TNF-alpha levels were significantly lower than at the beginning (p < 0.05 for IL-8, p < 0.001 for TNF-alpha). IL-8 but not TNF-alpha serum levels were correlated with pain intensity (r = -0.782, p = 0.001) in FM patients after 6 months' multidisciplinary pain therapy. CONCLUSION: Our results suggest that proinflammatory cytokines TNF-alpha and IL-8 are involved in FM, but they do not apparently provoke the pain of FM directly. Multidisciplinary pain therapy modified the cytokine profile in patients with FM during the observation period.

PMID: 18528959 [PubMed - in process]

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Medical skepticism and the use of complementary and alternative health care providers by patients followed by rheumatologists.

Callahan LF, Freburger JK, Mielenz TJ, Wiley-Exley EK.

Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7280, USA. Leigh_Callahan@med.unc.edu

BACKGROUND: Our understanding of the determinants of use of complementary and alternative (CAM) providers is limited, especially in regard to medical skepticism (ie, doubt in the ability of conventional medical care to appreciably alter health status). OBJECTIVES: To determine whether medical skepticism was associated with CAM provider use in patients with arthritis and to explore the association between medical skepticism and demographic and health-related characteristics of persons with arthritis. METHODS: A cross-sectional analysis of data from patients (N = 721) with osteoarthritis, rheumatoid arthritis, or fibromyalgia who completed a questionnaire about their health, health care use, and health-related attitudes/behaviors, including medical skepticism. Patients were recruited from 14 rheumatology practices in North Carolina. A multiple logistic regression analysis was conducted to examine the relationship between medical skepticism and the use of any CAM providers. Multiple linear regression analysis was conducted to examine relationships between medical skepticism and demographic and health-related measures. RESULTS: Fifteen percent of the sample used one or more CAM providers. Medical skepticism was positively associated with CAM provider use. A one point increase in skepticism increased the probability of CAM provider use by approximately 70% (odds ratios =1.70; 95% confidence intervals [1.13-2.56]). Individuals, who were younger, had better perceived health, and had a diagnosis of osteoarthritis or fibromyalgia had greater skepticism. CONCLUSIONS: By knowing more about medical skepticism and other determinants of CAM provider use, conventional practitioners can target patients to improve their uptake of appropriate conventional care, while also monitoring patients alternative therapy use.

Publication Types:
PMID: 18525432 [PubMed - indexed for MEDLINE]

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A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia.

Arnold LM, Russell IJ, Diri EW, Duan WR, Young JP Jr, Sharma U, Martin SA, Barrett JA, Haig G.

University of Cincinnati College of Medicine, Cincinnati, Ohio 45219, USA. Lesley.Arnold@uc.edu

The purpose of the study was to assess the efficacy and safety of pregabalin monotherapy in patients with fibromyalgia in a randomized, double-blinded, placebo-controlled trial. After 1 week of single-blinded administration of placebo, 750 patients meeting American College of Rheumatology criteria for fibromyalgia were randomly assigned to pregabalin (300 mg/d, 450 mg/d, 600 mg/d) or placebo, administered twice daily for 14 weeks. The primary outcome variable was comparison of end point mean pain scores, derived from daily diary ratings of pain intensity (0 to 10 scale), between each of the pregabalin groups and the placebo group. If positive, additional primary efficacy parameters included the Patient Global Impression of Change (PGIC) and the Fibromyalgia Impact Questionnaire (FIQ) total score. Compared with placebo-treated patients, mean changes in pain scores at the end point in pregabalin-treated patients were significantly greater (P < .001: 300 mg/d, -0.71; 450 mg/d, -0.98; 600 mg/d, -1.00). Compared with placebo, significantly more pregabalin-treated patients reported improvement on PGIC (P < .01 for all 3 pregabalin doses) and significant improvements in total FIQ score for the 450 mg/d (P = .004) and the 600 mg/d (P = .003) doses. Compared with placebo, all 3 doses of pregabalin were associated with significant improvement in sleep. The most commonly reported pregabalin-related adverse events were dizziness and somnolence, which tended to be dose-related. PERSPECTIVE: This randomized, placebo-controlled trial of 300, 450, and 600 mg/d of pregabalin monotherapy demonstrated that all 3 doses were efficacious for up to 14 weeks for the treatment of fibromyalgia and were well tolerated by most patients. These results provide evidence that pregabalin is an important treatment option for patients with fibromyalgia.

Publication Types:
PMID: 18524684 [PubMed - in process]

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Hypnotic treatment synergizes the psychological treatment of fibromyalgia: a pilot study.

Mart’nez-Valero C, Castel A, Capafons A, Sala J, Espejo B, Carde–a E.

Centro de Aplicaciones Psicol—gicas, Valencia, Spain.

In this pilot study, we compare the efficacy for fibromyalgia of multimodal cognitive behavioral treatments, with and without hypnosis, with that of a purely pharmacological approach, with a multiple baseline N = 1 design. We randomly assigned six hospital patients to the three experimental conditions. The results suggest that psychological treatment produces greater symptom benefits than the conventional medical treatment only, especially when hypnosis is added. We conclude that hypnosis may be a useful tool to help people with fibromyalgia manage their symptomatology.

PMID: 18524298 [PubMed - indexed for MEDLINE]

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[In fibromyalgia unfortunately not only the muscles are involved]

[Article in German]

[No authors listed]

PMID: 18522351 [PubMed - indexed for MEDLINE]

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Comment on:
Readers' and author's responses to "Fibromyalgia is not a rheumatologic disease anymore".

Lincourt J.

Publication Types:
PMID: 18521989 [PubMed - indexed for MEDLINE]

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Comment on:
Readers' and author's responses to "Fibromyalgia is not a rheumatologic disease anymore".

Peterson EM.

Publication Types:
PMID: 18521988 [PubMed - indexed for MEDLINE]

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Are cannabinoids a new treatment option for pain in patients with fibromyalgia?

Staud R, Koo EB.

College of Medicine and Center for Musculoskeletal Pain Research, University of Florida, Gainesville, FL 32610-0221, USA. staudr@ufl.edu

Preliminary studies suggest that the synthetic cannabinoid nabilone might be an effective therapy in patients with fibromyalgia. Skrabek et al. performed a double-blind, randomized, placebo-controlled clinical trial to analyze the effects of nabilone on pain and quality of life in patients with fibromyalgia. After 4 weeks of treatment (0.5 mg once daily in week 1, 0.5 mg twice daily in week 2, 0.5 mg in the morning and 1 mg in the evening in week 3, and 1 mg twice daily in week 4), patients who received nabilone (n = 15) experienced significant improvements in clinical pain, measured on a visual analog scale (P <0.02), Fibromyalgia Impact Questionnaire score (P <0.02) and the 10-point anxiety scale of the Fibromyalgia Impact Questionnaire (P <0.02). After a 4-week wash-out period at the end of the trial, all benefits were lost in the nabilone cohort, which returned to their baseline levels of pain and quality of life. Patients who received placebo (n = 18) experienced no change throughout the study. Although nabilone was not associated with serious adverse effects, some patients did experience drowsiness, dry mouth, vertigo and ataxia as a result of treatment.

PMID: 18521112 [PubMed]

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Land- and water-based exercise therapies for musculoskeletal conditions.

Dziedzic K, Jordan JL, Foster NE.

Primary Care Musculoskeletal Research Centre, Keele University, Keele, Staffordshire ST5 5BG, UK. k.s.dziedzic@cphc.keele.ac.uk

This chapter summarizes current evidence from recently published systematic reviews of land- and water-based exercise therapies for musculoskeletal conditions. The aim is to present an overview of the evidence and highlight gaps where more research is still needed. This is not a systematic review, but a systematic search of the literature and a summary of results of the best, most recent systematic reviews evaluating interventions for musculoskeletal conditions. There have been two previous summaries of systematic reviews of evidence for exercise therapies in musculoskeletal conditions. We have updated these searches, and additionally considered the evidence for the clinical effectiveness of exercise in fibromyalgia and chronic widespread pain and of hydrotherapy and water-based exercise treatments on pain and disability.

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PMID: 18519096 [PubMed - in process]

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Economic impact of chronic prostatitis.

Duloy AM, Calhoun EA, Clemens JQ.

Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 16-703, Chicago, IL 60611, USA.

There are four types of prostatitis, including type I (acute bacterial prostatitis), type II (chronic bacterial prostatitis), type III (chronic prostatitis/chronic pelvic pain syndrome, or CP/CPPS), and type IV (asymptomatic inflammatory prostatitis). These prostatitis conditions account for approximately 2 million office visits each year to primary care physicians and urologists. The annual cost to treat prostatitis is approximately $84 million. Compared with control subjects, men with prostatitis incur significantly greater costs, predominantly due to increased outpatient visits and pharmacy expenses. CP/CPPS is the most common type of prostatitis. The condition is characterized by chronic, idiopathic pelviperineal pain. Due to the lack of effective treatments for CP/CPPS, the per-person costs associated with the condition are substantial and are similar to those reported for peripheral neuropathy, low back pain, fibromyalgia, and rheumatoid arthritis. Costs appear to be higher in men with more severe symptoms. Indirect costs (eg, work and productivity loss) are incurred by many patients with CP/CPPS. Identification of effective treatments for CP/CPPS would be expected to substantially reduce the costs associated with the condition.

Publication Types:
PMID: 18519019 [PubMed - indexed for MEDLINE]

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Attitudes towards fibromyalgia: a survey of Canadian chiropractic, naturopathic, physical therapy and occupational therapy students.

Busse JW, Kulkarni AV, Badwall P, Guyatt GH; Medically Unexplained Syndromes Study Group.Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. j.busse@utoronto.ca

BACKGROUND: The frequent use of chiropractic, naturopathic, and physical and occupational therapy by patients with fibromyalgia has been emphasized repeatedly, but little is known about the attitudes of these therapists towards this challenging condition. METHODS: We administered a cross-sectional survey to 385 senior Canadian chiropractic, naturopathic, physical and occupational therapy students in their final year of studies, that inquired about attitudes towards the diagnosis and management of fibromyalgia. RESULTS: 336 students completed the survey (response rate 87%). While they disagreed about the etiology (primarily psychological 28%, physiological 23%, psychological and physiological 15%, unsure 34%), the majority (58%) reported that fibromyalgia was difficult to manage. Respondants were also conflicted in whether treatment should prioritize symptom relief (65%) or functional gains (85%), with the majority (58%) wanting to do both. The majority of respondents (57%) agreed that there was effective treatment for fibromyalgia and that they possessed the required clinical skills to manage patients (55%).Chiropractic students were most skeptical in regards to fibromyalgia as a useful diagnostic entity, and most likely to endorse a psychological etiology. In our regression model, only training in naturopathic medicine (unstandardized regression coefficient = 0.33; 95% confidence interval = 0.11 to 0.56) and the belief that effective therapies existed (unstandardized regression coefficient = 0.42; 95% confidence interval = 0.30 to 0.54) were associated with greater confidence in managing patients with fibromyalgia. CONCLUSION: The majority of senior Canadian chiropractic, naturopathic, physical and occupational therapy students, and in particular those with naturopathic training, believe that effective treatment for fibromyalgia exists and that they possess the clinical skillset to effectively manage this disorder. The majority place high priority on both symptom relief and functional gains when treating fibromyalgia.

Publication Types:
PMID: 18513441 [PubMed - indexed for MEDLINE]

PMCID: PMC2424029


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The relationship between affect balance style and clinical outcomes in fibromyalgia.

Hassett AL, Simonelli LE, Radvanski DC, Buyske S, Savage SV, Sigal LH.

Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Division of Rheumatology and Connective Tissue Research, New Brunswick, NJ 80903-0019, USA. a.hassett@umdnj.edu

OBJECTIVE: Affective balance, relative levels of negative affect (NA) and positive affect (PA), better describes emotional functioning than NA or PA alone. Affect balance styles and their relationship to clinical outcomes were compared between patients with fibromyalgia (FM) and controls. METHODS: FM patients (n = 79) were compared with patients with other medical conditions (controls; n = 92). Patients underwent a physical examination, completed questionnaires, and were screened for clinical disorders such as depression, with diagnoses confirmed by structured interview. Affect balance style categories were calculated as follows: healthy (high PA/low NA), low (low PA/low NA), reactive (high PA/high NA), and depressive (low PA/high NA). RESULTS: Compared with controls, FM patients had lower levels of PA (P = 0.0031; P values are adjusted for multiple testing), higher levels of NA (P = 0.0061), lower levels of functioning (P < 0.0001), and more clinical disorders (P = 0.0031). Groups differed regarding affect balance style (P = 0.0061), with FM patients being more likely than controls to be categorized as depressive (odds ratio 5.60) and reactive (odds ratio 3.81). FM patients and controls with reactive and depressive affect balance styles reported poorer functioning (P < 0.0001) compared with patients with healthy affect balance style. Finally, there was an association between affect balance style and psychiatric comorbidity (P < 0.0001), with patients with depressive and reactive affect balance styles having a 9.00 and 4.75 odds ratio, respectively, of having psychiatric comorbidity compared with patients with healthy affect balance style. CONCLUSION: Depressive (low PA, high NA) and reactive (high PA, high NA) affect balance styles were predominant in FM patients and related to poor functioning and psychiatric comorbidity.

Publication Types:
PMID: 18512724 [PubMed - indexed for MEDLINE]

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From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: Application of pain neurophysiology in manual therapy practice.

Nijs J, Van Houdenhove B.

Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Belgium; Division of Musculoskeletal Physiotherapy, Department of Health Care Sciences, University College Antwerp, Van Aertselaerstraat 31, B-2170 Merksem, Belgium.

During the past decade, scientific research has provided new insight into the development from an acute, localised musculoskeletal disorder towards chronic widespread pain/fibromyalgia (FM). Chronic widespread pain/FM is characterised by sensitisation of central pain pathways. An in-depth review of basic and clinical research was performed to design a theoretical framework for manual therapy in these patients. It is explained that manual therapy might be able to influence the process of chronicity in three different ways. (I) In order to prevent chronicity in (sub)acute musculoskeletal disorders, it seems crucial to limit the time course of afferent stimulation of peripheral nociceptors. (II) In the case of chronic widespread pain and established sensitisation of central pain pathways, relatively minor injuries/trauma at any locations are likely to sustain the process of central sensitisation and should be treated appropriately with manual therapy accounting for the decreased sensory threshold. Inappropriate pain beliefs should be addressed and exercise interventions should account for the process of central sensitisation. (III) However, manual therapists ignoring the processes involved in the development and maintenance of chronic widespread pain/FM may cause more harm then benefit to the patient by triggering or sustaining central sensitisation.

PMID: 18511329 [PubMed - as supplied by publisher]

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Occurrence of organ-specific and systemic autoimmune diseases among the first- and second-degree relatives of Caucasian patients with connective tissue diseases: report of data obtained through direct patient interviews.

Mosca M, Carli L, d'Ascanio A, Tani C, Talarico R, Baldini C, Bazzichi L, Tavoni A, Migliorini P, Bombardieri S.

Department of Internal Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy. marta.mosca@int.med.unipi.it

Studies have demonstrated a familial aggregation of systemic and organ-specific autoimmune diseases. The aim of the present survey was to obtain, by patient interviews, a preliminary estimate of the prevalence of systemic and organ-specific autoimmune diseases among the first- and second-degree relatives of Caucasian patients with connective tissue diseases (CTD) or inflammatory arthritis followed at our unit. Between June 2007 and January 2008, 626 patients and 85 controls (patients with osteoarthritis, osteoporosis, or fibromyalgia) were interviewed. Three hundred ten patients (50%) versus 21 controls (25%) were found to have at least one relative affected with an autoimmune condition (p < 0.0001). The most common conditions were organ-specific autoimmune diseases: 160 (34%) autoimmune thyroid (AT) disease, 112 (24%) psoriasis, 21 vitiligo, and 19 insulin-dependent diabetes mellitus. Systemic autoimmune diseases were reported in 126 relatives: rheumatoid arthritis (66 cases, 14%), 16 sacroileitis, and CTD (43 cases). A significant difference was observed in the prevalence of AT disease between the relatives of the patients and controls (3% versus 0.5%). In conclusion, these data confirm the high prevalence of autoimmune conditions, particularly of AT disease, among the relatives of patients.

PMID: 18509714 [PubMed - in process]

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Stress induces a switch of intracellular signaling in sensory neurons in a model of generalized pain.

Khasar SG, Burkham J, Dina OA, Brown AS, Bogen O, Alessandri-Haber N, Green PG, Reichling DB, Levine JD.

Department of Oral and Maxillofacial Surgery, University of California, San Francisco, California 94143-0440, USA.

Stress dramatically exacerbates pain in diseases such as fibromyalgia and rheumatoid arthritis, but the underlying mechanisms are unknown. We tested the hypothesis that stress causes generalized hyperalgesia by enhancing pronociceptive effects of immune mediators. Rats exposed to nonhabituating sound stress exhibited no change in mechanical nociceptive threshold, but showed a marked increase in hyperalgesia evoked by local injections of prostaglandin E(2) or epinephrine. This enhancement, which developed more than a week after exposure to stress, required concerted action of glucocorticoids and catecholamines at receptors located in the periphery on sensory afferents. The altered response to pronociceptive mediators involved a switch in coupling of their receptors from predominantly stimulatory to inhibitory G-proteins (G(s) to G(i)), and for prostaglandin E(2), emergence of novel dependence on protein kinase C epsilon. Thus, an important mechanism in generalized pain syndromes may be stress-induced coactivation of the hypothalamo-pituitary-adrenal and sympathoadrenal axes, causing a long-lasting alteration in intracellular signaling pathways, enabling normally innocuous levels of immune mediators to produce chronic hyperalgesia.

Publication Types:
PMID: 18509033 [PubMed - indexed for MEDLINE]

PMCID: PMC2518401 [Available on 11/28/08]


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Comment on:
Readers' and author's responses to "Fibromyalgia is not a rheumatologic disease anymore".

Egna KL.

Publication Types:
PMID: 18504489 [PubMed - indexed for MEDLINE]

PMCID: PMC2390700


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Development of a symptoms questionnaire for complex regional pain syndrome and potentially related illnesses: the Trauma Related Neuronal Dysfunction Symptoms Inventory.

Collins S, van Hilten JJ, Marinus J, Zuurmond WW, de Lange JJ, Perez RS.

Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands. s.collins@vumc.nl

OBJECTIVE: To develop a questionnaire to evaluate symptoms of complex regional pain syndrome type I (CRPS-I), fibromyalgia, and repetitive strain injury to determine the test-retest reliability and investigate concurrence in the clinical manifestations of CRPS-I and fibromyalgia. DESIGN: The Trauma Related Neuronal Dysfunction Symptoms Inventory (TSI) was developed by determining the content validity and the practical use of the questionnaire. Furthermore, the test-retest reliability was assessed on 2 identical questionnaires filled out within a 7-day interval by CRPS-I and fibromyalgia patients. SETTING: Outpatient pain clinic of a Dutch medical center. PARTICIPANTS: CRPS-I (n=26; mean age, 54y) and fibromyalgia patients (n=42; mean age, 45.4y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Test-retest reliability calculated with intraclass correlation (ICC). RESULTS: Reliability scores were good for the whole questionnaire, its categories, and domains (ICC>.75) for both CRPS-I and fibromyalgia patients. Sensory complaints (except for change in cold perception), motor complaints, and visceral complaints (diarrhea and incontinence) were reported by both CRPS-I and fibromyalgia patients. A change in cold perception, discoloration, change in skin temperature, change in sweating behavior, change in the severity of edema during exercise, and trophic changes of skin were reported significantly more often by CRPS-I patients, whereas complaints of the (upper and lower) back, constipation, urine retention, and experiencing a dry mouth were reported significantly more often by fibromyalgia patients. CONCLUSIONS: The TSI is a reliable instrument with good content validity, which can be used in the evaluation of similarities and differences between CRPS-I and fibromyalgia. The systematic evaluation of symptoms of CRPS-I and potentially related illnesses may provide a better basis for future research into the underlying mechanism(s).

Publication Types:
PMID: 18503808 [PubMed - indexed for MEDLINE]

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Duloxetine: An emerging evidence for fibromyalgia.

Pae CU, Marks DC, Han C, Patkar AA, Masand PS.

Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, South Korea; Department of Psychiatry and Behavioral Medicines, Duke University Medical Center, Durham, NC, USA.

Publication Types:
PMID: 18502090 [PubMed - as supplied by publisher]

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Somatic comorbidities of irritable bowel syndrome: a systematic analysis.

Riedl A, Schmidtmann M, Stengel A, Goebel M, Wisser AS, Klapp BF, Mšnnikes H.

Division of Hepatology, Gastroenterology, and Endocrinology, Department of Medicine, CharitŽ-University Medical Center, Campus Virchow, Berlin, Germany.

OBJECTIVE: A large number of irritable bowel syndrome (IBS) patients are additionally afflicted with other somatic intestinal and/or extraintestinal comorbidities. The occurrence of one or more comorbidities is correlated with enhanced medical help seeking, worse prognosis, and higher rates of anxiety and depression-all resulting in a reduced quality of life. The aims of this study were, firstly, to review the literature on comorbidities of IBS and to assess gastrointestinal and extraintestinal comorbidities, and, secondly, to evaluate explanatory hypotheses and possible common pathophysiological mechanisms. METHODS: We systematically reviewed the scientific literature in the past 25 years, as cited in MEDLINE. RESULTS: IBS patients present with a twofold increase in somatic comorbidities compared to controls, possibly caused by common pathophysiological mechanisms. Nevertheless, to date, there has been no convincing evidence for a consolidated underlying pathophysiology or somatization. Gastrointestinal disorders, such as functional dyspepsia, gastroesophageal reflux disease, functional constipation, and anal incontinence, occur in almost half of the patients. In a broad variety of extraintestinal comorbidities, fibromyalgia, chronic fatigue syndrome, and chronic pelvic pain are best documented and appear in up to 65%. CONCLUSION: The knowledge and structured assessment of comorbid somatic symptoms might allow to identify subgroups of IBS patients with special characteristics and lead to adaptation of the therapeutic concept.

PMID: 18501257 [PubMed - in process]

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A fibromyalgia patient with traumatic cerebrospinal fluid leak: a case report.

Toda K, Moriyama E, Ishikawa S.

Department of Rehabilitation, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijyou, Higashi-Hiroshima, Hiroshima, 739-0036, Japan, goutattack@yahoo.co.jp.

We present a fibromyalgia patient with traumatic cerebrospinal fluid (CSF) leak. A woman was referred because of widespread pain, general fatigue, dizziness, nausea, vomiting, and deterioration of memory after a traffic accident. These signs and symptoms in a sitting or standing position were more deteriorated than in a recumbent position. Although she was diagnosed with fibromyalgia, her widespread pain was unusually severe. She was diagnosed with traumatic CSF leak based on radioisotope cisternography. Her widespread pain was slightly decreased after epidural blood patches, but the nausea completely disappeared and dizziness was eased. A second radioisotope cisternography revealed that the leak of cerebrospinal fluid was discontinued. CSF leak is characterized by headache, nausea, dizziness, and visual impairment. The symptoms and signs resemble Barre-Lieou syndrome. Another characteristic is that these symptoms and signs in a sitting or standing position are more deteriorated than in a recumbent position. Fibromyalgia after trauma is sometimes comorbid with traumatic CSF leak. Radioisotope cisternography is essential for diagnosis. It demonstrates direct findings such as radioisotope leak into the spinal epidural space and indirect findings such as early bladder filling and/or the rapid disappearance of radioisotopes from the CSF space. A beneficial treatment is an epidural blood patch. Patients with fibromyalgia and traumatic CSF leak are likely to suffer more severe signs and symptoms such as increased widespread pain than patients with fibromyalgia alone. Patients with fibromyalgia and traumatic CSF leak are often refractory to treatment.

PMID: 18500438 [PubMed - in process]

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Hypovitaminosis D among rheumatology outpatients in clinical practice.

Mouyis M, Ostor AJ, Crisp AJ, Ginawi A, Halsall DJ, Shenker N, Poole KE.

Box 157, Department of Medicine, Division of Bone Research, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.

OBJECTIVES: A role for vitamin D in the pathogenesis of autoimmune and inflammatory diseases is emerging. We undertook an audit of 25-hydroxyvitamin D (25OHD) investigation and treatment in rheumatology outpatients. METHODS: Serum 25OHD requests were matched to electronic medical records from rheumatology and metabolic bone clinics (April 2006-March 2007). Data were analysed separately for two groups, 'Documented osteoporosis/osteopaenia' (Group 1) and 'General rheumatology outpatients' (Group 2, sub-divided by diagnosis). Hypovitaminosis D was defined by 25OHD levels <50 nmol/l. Values were compared with healthy adults to calculate geometric z-scores. RESULTS: A total of 263 patients were included (Group 1, n = 122; Group 2, n = 141) with an overall median 25OHD of 44 nmol/l.The 25OHD level among general rheumatology patients (median 39 nmol/l, mean z score -1.2, was statistically significantly lower than among osteoporotic/osteopaenic patients (median 49 nmol/l, mean z score of -0.9, p < 0.05 for the difference). 25OHD was lower in inflammatory arthritis and chronic pain/fibromyalgia than in other groups. Prescribing was recorded in 100 in Group 1 (of whom 95% were prescribed calcium/800 IU cholecalciferol) and 83 in Group 2 (91% calcium/800 IU). Only 31% of the patients with 25OHD <50 nmol/l would have been identified using general guidelines for screening patients at 'high risk' of hypovitaminosis D. CONCLUSIONS: Improved guidelines for managing hypovitaminosis D in rheumatology patients are needed. We found a high prevalence of hypovitaminosis D among secondary care patients in rheumatology and widespread supplementation with 800 IU cholecalciferol. Substantially reduced levels of serum 25OHD were identified among patients with inflammatory arthritis and chronic pain.

Publication Types:
PMID: 18499714 [PubMed - in process]

PMCID: PMC2518945


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Positional cervical spinal cord compression and fibromyalgia: a novel comorbidity with important diagnostic and treatment implications.

Holman AJ.

Pacific Rheumatology Research Inc., Renton, Washington 98055, USA. AJHSeattle@aol.com

The variable presentation and treatment response of fibromyalgia (FM) may be related to comorbidities, including positional cervical cord compression (PC3). Prevalence of PC3 among routine referrals for rheumatology consultation was assessed over 2 random months (January and February 2006) from a 4-year experience of 1100 patients. PC3 was defined as cord abutment, compression or flattening with a spinal canal diameter of <10 mm by magnetic resonance sagittal flexion, neutral, and extension images. Of 107 referrals, 53 had FM, 32 had a connective tissue disease (CTD) without FM, and 22 had chronic widespread pain (CWP) without FM criteria. The dynamic cervical spine images were obtained in 70 patients: 49 of 53 with FM, 20 of 22 with CWP and 1 of 32 with CTD, based on history and examination. Among those who received magnetic resonance imaging [MRI], 52 patients met PC3 criteria (71% of FM group [35/49], 85% of CWP group [17/20]). Two patients had a Chiari malformation (FM), 1 had multiple sclerosis (CWP), and 1 had multiple myeloma (CWP). Extension views were required for diagnosis for 37 of these 52 (71%) subjects, as well as for 8 patients who also had cervical spinal cord flattening. The pilot data suggest that further evaluation of PC3 in a controlled trial is warranted among patients with FM and CWP. PERSPECTIVE: Fibromyalgia is complex and poorly understood. Recognition of unsuspected, comorbid cervical cord compression may provide new insight into its variable presentation, leading to novel treatment considerations. Also, dissemination of this dynamic MRI protocol may promote further study of this emerging concept of cervical cord irritation.

PMID: 18499527 [PubMed - indexed for MEDLINE]

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Ottawa Panel evidence-based clinical practice guidelines for strengthening exercises in the management of fibromyalgia: part 2.

Brosseau L, Wells GA, Tugwell P, Egan M, Wilson KG, Dubouloz CJ, Casimiro L, Robinson VA, McGowan J, Busch A, Poitras S, Moldofsky H, Harth M, Finestone HM, Nielson W, Haines-Wangda A, Russell-Doreleyers M, Lambert K, Marshall AD, Veilleux L; Ottawa Panel Members.Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada. Lucie.Brosseau@uottawa.ca

BACKGROUND AND PURPOSE: The objective of this study was to create guidelines for the use of strengthening exercises in the management of adult patients (>18 years of age) with fibromyalgia (FM), as defined by the 1990 American College of Rheumatology criteria. METHODS: Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D-). From the rigorous literature search, 5 randomized controlled trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found. RESULTS: There were 5 positive recommendations: 2 grade A and 3 grade C+. All 5 were of clinical benefit. DISCUSSION AND CONCLUSION: The Ottawa Panel recommends strengthening exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.

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PMID: 18497302 [PubMed - indexed for MEDLINE]

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Ottawa Panel evidence-based clinical practice guidelines for aerobic fitness exercises in the management of fibromyalgia: part 1.

Brosseau L, Wells GA, Tugwell P, Egan M, Wilson KG, Dubouloz CJ, Casimiro L, Robinson VA, McGowan J, Busch A, Poitras S, Moldofsky H, Harth M, Finestone HM, Nielson W, Haines-Wangda A, Russell-Doreleyers M, Lambert K, Marshall AD, Veilleux L; Ottawa Panel Members.Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada. Lucie.Brosseau@uottawa.ca

BACKGROUND AND PURPOSE: The objective of this study was to create guidelines for the use of aerobic fitness exercises in the management of adult patients (>18 years of age) with fibromyalgia, as defined by the 1990 American College of Rheumatology criteria. METHODS: Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D-). From the rigorous literature search, 13 randomized control trials and 3 controlled clinical trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found. RESULTS: There were 24 positive recommendations: 10 grade A, 1 grade B, and 13 grade C+. Of these 24 positive recommendations, only 5 were of clinical benefit. DISCUSSION AND CONCLUSION: The Ottawa Panel recommends aerobic fitness exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.

Publication Types:
PMID: 18497301 [PubMed - indexed for MEDLINE]

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[Immune-mediated inflammatory diseases and psoriasis]

[Article in French]

Delaporte E.

UniversitŽ de Lille II et Clinique de Dermatologie, H™pital Claude-Huriez, CHRU, Rue Michel Polonovski, 59037 Lille cedex. edelaporte@chru-lille.fr

The association of some immune-mediated inflammatory disease in a same patient is known. Nevertheless, this is difficult to appreciate practically for the psoriasis due to the absence of prospective study. The strongest link is with Crohn's disease and the spondyloartropathies. It is sustained by, i) genetic data obtained by genome-wide association study showing some common loci and/or genes involved in innate immunity, ii) immunologic data, these conditions sharing effector cells among which Th17 lymphocytes and inflammatory mediators (TNF-alpha, IL-1,17,23...), that explain the related efficacy of some biologics like anti-TNF-alpha, IL-12/23 antibody and others in progress and iii) environmental triggers among which bacterial infections are probably determining in the genesis of these diseases even if this is still only an hypothesis.

Publication Types:
PMID: 18466796 [PubMed - indexed for MEDLINE]

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The relationship between serum trace element levels and clinical parameters in patients with fibromyalgia.

Sendur OF, Tastaban E, Turan Y, Ulman C.

Department of Physical Medicine and Rehabilitation, Adnan Menderes University Medicine School Hospital, Aydin, Turkey.

We examined the association between serum trace elements and clinical findings such as number of sensitive tender points, severity of fatigue and functional status in patients with fibromyalgia (FM). Thirty-two patients diagnosed as having FM according to the ACR 1990 criteria and 32 normal healthy controls (NHC) were included in this study. The demographic data, disease duration, number of tender points and accompanying symptoms (fatigue, sleep disorders, headache, paresthesia, irritable bowel syndrome, sicca symptoms, Raynaud's phenomena) of the patients were noted. Visual analog scale (10 cm) was implemented to estimate daily severity of pain and fatigue. Fibromyalgia impact questionnaire was used for functional assessment. Serum selenium (mug/dL) and serum zinc (mug/dL) levels were measured by atomic absorption spectrometer. Serum magnesium (mmol/L) level was measured by the original kits of Abbott Aeroset auto-analyzer. The mean age of patients in FM group and NHC were calculated as 42.9 (SD = 7.7) years and 41.3 (SD = 9.7) years, respectively. Serum levels of zinc (P = 0.001) and magnesium (P = 0.002) were significantly decreased by FM groups, whereas there was no considerable difference with selenium levels of both groups (P > 0.05). Association between serum zinc level and number of tender points (P = 0.008) and that between fatigue and magnesium level (P = 0.003) was found as meaningful. According to the results of this study, it was asserted that serum magnesium and zinc levels may play an important role in the pathophysiology of FM.

PMID: 18496697 [PubMed - in process]

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Efficacy of neurotropin in fibromyalgia: a case report.

Toda K, Tobimatsu Y.

Department of Rehabilitation, Hiroshima Prefectural Rehabilitation Center, Saijyou, Higashi-Hiroshima, Japan. goutattack@yahoo.co.jp

Fibromyalgia is a refractory disorder that often necessitates long-term treatment. A 45-year-old woman has suffered from a stiff neck for 27 years and severe widespread pain for 4 years. Her visual analog scale (VAS), global-VAS, self-rating depression scale (SDS), and face scale were 48, 38, 42, and 15, respectively. She met the American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Four tablets of Neurotropin (NT) per day alone were administered, and her pain was gradually alleviated over 3 weeks. Her heavy sensation of the body and morning stiffness had almost disappeared 5 months later. Her VAS was 40 after 6 months, but the subjective pain decreased to half that at the initial visit. Her global-VAS, SDS, and face scale were 0, 35, and 8, respectively. No adverse effects were observed. NT, a nonprotein extract from the inflamed skin of rabbits inoculated with vaccinia virus, is a commonly prescribed analgesic drug for chronic pain in Japan. One of the advantages of NT is its few and slight adverse effects. Because NT does not suppress the synthesis of prostaglandin, NT does not cause digestive ulcers. Recent studies suggest that the analgesic mechanism of NT is due to the activation of a descending pain inhibitory system in the brain. Two open studies have shown the efficacy of NT for fibromyalgia. In order to determine whether NT is effective for fibromyalgia, a rigid clinical study, such as a double-blinded, placebo-controlled study, is needed.

Publication Types:
PMID: 18489636 [PubMed - indexed for MEDLINE]

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Sleep and rheumatologic disorders.

Abad VC, Sarinas PS, Guilleminault C.

Clinical Monitoring Sleep Disorders Center, Camino Medical Group, Palo Alto Medical Foundation, USA. vcabad@gmail.com

Arthritis is the leading cause of chronic illness in the United States. Seventy-two percent of the adults aged 55 years and older with arthritis report sleep difficulties. This review discusses sleep disorders associated with rheumatoid arthritis, juvenile rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, scleroderma, Behcet's disease, seronegative spondyloarthropathies, osteoarthritis, sarcoidosis, and fibromyalgia. We describe the inter-relationship between sleep complaints, disease activity, depression, sleep deprivation, and cytokines. An algorithm for evaluation and treatment of sleep disorders associated with rheumatologic diseases is proposed.

PMID: 18486034 [PubMed - in process]

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Prevalence, risk, and risk factors for oral and ocular dryness with particular emphasis on rheumatoid arthritis.

Wolfe F, Michaud K.

National Data Bank for Rheumatic Diseases, 1035 N. Emporia, Suite 288, Wichita, KS 67214, USA. fwolfe@arthritis-research.org

OBJECTIVE: To determine, primarily in rheumatoid arthritis (RA), the prevalence, relative risk, and risk factors for oral and ocular dryness. METHODS: We studied self-reported persistent ocular and oral dryness (PD) present in 2 consecutive observations, and sporadic dryness (SD) present in 1 of 2 consecutive observations, during semiannual assessments in 9921 patients with RA and in 2851 with a noninflammatory rheumatic disorder (NIRD) (not fibromyalgia; FM). We also evaluated prevalence in 2867 patients with FM. RESULTS: In RA, PD was noted in 11.6% and SD in 17.5%. Compared with NIRD, the age and sex adjusted relative risk (RR) for PD was 1.34 (95% CI 1.17-1.51) and the severity and treatment adjusted RR was 1.46 (95% CI 1.26-1.6). The adjusted RR for FM compared with RA and NIRD was 2.02 (95% CI 1.85-2.20). Dryness prevalence increased 10% to 13% every 10 years, and was associated with therapy. The treatment attributable risk was 27.5%. Fatigue and body pain (Symptom Intensity Scale) was more strongly associated with dryness than was any other clinical scale, including Health Assessment Questionnaire, pain, and Medical Outcomes Study Short Form-36 Health Survey. SD was associated with a covariate adjusted decrease in quality of life of 0.020 (95% CI 0.012-0.029) utility units. CONCLUSION: Dryness is increased in RA and is contributed to by severity and therapy. The combination of body pain and fatigue is the strongest clinical correlate of dryness, and is independent of diagnosis of FM. Any factor that increases illness severity or distress results in an increase in dryness.

PMID: 18484696 [PubMed - in process]

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Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic resonance spectroscopy.

Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ.

Department of Rheumatology and Rehabilitation, Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt. yasseremad68@yahoo.com

OBJECTIVE: (1) To investigate dysfunction of hippocampus in patients with fibromyalgia syndrome (FM) using proton magnetic resonance spectroscopy (1H-MRS), and to compare these findings with healthy controls. (2) To correlate levels of metabolites obtained with aspects of cognition, depression, and sleep symptoms in the patient group. METHODS: The case-control study was performed in 15 female patients, who met American College of Rheumatology criteria for classification of FM, and 10 healthy age-matched female controls. Patients and controls were receiving no medications known to affect cognitive functioning or central nervous system metabolites before their participation in the study. In all patients and controls, 1H-MRS was used to assess N-acetylaspartate (NAA), choline (Cho), creatine (Cr), and their ratios from both hippocampi. Levels of metabolites and their ratios were determined and the findings compared between the groups. All patients and controls underwent psychological assessment to assess cognitive function, depression, and structured sleep interview with sleep diary; Fibromyalgia Impact Questionnaire (FIQ), number of tender points, and visual analog scale (VAS) for pain were assessed in all patients. RESULTS: NAA levels of right and left hippocampi differed significantly between patients and controls (p < 0.05). Cho levels in the right hippocampus were higher in the patient group than in controls (p = 0.005), while no differences were found with respect to Cr levels in both hippocampi. NAA/Cho and NAA/Cr ratios differed significantly between patients and controls (p <0.05), while the Cho/Cr ratio showed no differences. Significant correlations were found between language score and right Cho and right Cr levels (p = 0.041, p = 0.006, respectively), while no significant correlations were found between metabolites and their ratios with FIQ, VAS for pain, or number of tender points. CONCLUSION: The hippocampus was dysfunctional in patients with FM, as shown by lower NAA levels compared to controls, representing neuronal or axonal metabolic dysfunction. As the hippocampus plays crucial roles in maintenance of cognitive functions, sleep regulation, and pain perception, we suggest that metabolic dysfunction of hippocampus may be implicated in the appearance of these symptoms associated with this puzzling syndrome.

PMID: 18484688 [PubMed - in process]

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The issues and challenges of orofacial pain in the elderly.

Cox MO.

University of Colorado School of Dentistry, USA.

Dental pain is among the most prevalent of all pain complaints, and pain is frequently given as a common reason for both avoiding and seeking dental care. Pain is frequently an essential component in the differential diagnosis of many diseases; however, in the elderly, diagnosis is more difficult due to a greater frequency of multiple chronic diseases and an altered pain response. It is important to understand the nature and prevalence of pain in this group, and one should be cautious to avoid the oversimplification that "pain decreases with age." Current studies involving the differences in assessing pain and therapeutic pain control between younger and older age groups are discussed. Pain prevalence is discussed along with herpes zoster, post-herpetic neuralgia, fibromyalgia, toothache pain, burning mouth syndrome, and trigeminal neuralgia as they relate to the elderly. Pain assessment can be made by means of pain scales and specific open- and closed-ended questions. There is evidence that some practitioners may be underestimating the severity of pain in the elderly, and thus not prescribing adequate analgesics when indicated. When analgesics are prescribed, a thorough analysis of the patients' current medications and condition should lead to a customized prescription and dosage.

Publication Types:
PMID: 18481416 [PubMed - indexed for MEDLINE]

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[Impact of a motivational intervention on coping with chronic pain : Results of a controlled efficacy study.]

[Article in German]

Rau J, Ehlebracht-Kšnig I, Petermann F.

Zentrum fŸr Klinische Psychologie und Rehabilitation, UniversitŠt Bremen, Grazer Str. 6, 28359, Bremen, Deutschland, jrau@uni-bremen.de.

BACKGROUND: For effective self-management of chronic pain changes of cognitive and behavioral attitudes are required. The readiness to change can be described within the framework of the transtheoretical model (TTM) and is facilitated through motivational interviewing. This prospective study evaluated the effectiveness of brief motivational interviewing by telephone for the variables self-efficacy, cognitive and behavioral coping and psychological strain through chronic pain over a period of 9 months. METHODS: Different questionnaires, the self-efficacy expectations (ASES-D), cognitive, behavioral coping and psychological strain through chronic pain (FESV) and the German version of the pain stages of change questionnaires (PSOCQ), the FF-STABS were distributed to 147 patients at a rehabilitation clinic (indications: fibromyalgia syndrome, rheumatoid arthritis, ankylosing spondylitis). The intervention group participants received 3 telephone calls at intervals of 2 months with a follow-up time of 9 months after first study admission. At the end of the study 91 patients were enrolled for analysis (drop out rate 38%). To evaluate the effects of treatment nonparametric-analysis for longitudinal data was used. RESULTS AND CONCLUSION: The analysis showed significant positive effects in the intervention group for cognitive coping (U-value -2.423; p=0.015 group x time-effect) and for coping with emotional strains of chronic pain (subscale anxiety: U-value -2.3618; p=0.018; subscale anger: U-value 2.8638; p=0.004; group x time-effect). No significant effects were shown for self-efficacy expectations and behavioral coping with pain. Further explorative analysis of subgroups revealed slightly better treatment effects for patients with rheumatoid arthritis and ankylosing spondylitis than for those with fibromyalgia syndrome.

PMID: 18481115 [PubMed - as supplied by publisher]

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[Drugs for controversial diseases]

[Article in Swedish]

Milerad J.

Publication Types:
PMID: 18478743 [PubMed - indexed for MEDLINE]

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[Definition, classification and diagnosis of fibromyalgia syndrome]

[Article in German]

Eich W, HŠuser W, Friedel E, Klement A, Herrmann M, Petzke F, OffenbŠcher M, Schiltenwolf M, Sommer C, Tšlle T, Henningsen P.

Abteilung Innere Medizin II (Allgemeine Klinische und Psychosomatische Medizin), UniversitŠtsklinikum Heidelberg, Im Neuenheimer Feld 410, 69210, Heidelberg. wolfgang.eich@med.uni-heidelberg.de

BACKGROUND: Interdisciplinary guidelines for the definition, classification and diagnosis of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) were developed by collaboration of 10 German medical and psychological associations and 2 patient self-help organizations. METHODS: A systematic literature search was performed in the Cochrane Library (1993-12/2006), Medline (1980-2006), PsychInfo (1966-12/2006), and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strength of recommendation was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: CWP is defined by the criteria of the American College of Rheumatology (ACR--strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).

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PMID: 18478271 [PubMed - in process]

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[Principles of treatment, coordination of medical care and patient education in fibromyalgia syndrome and chronic widespread pain]

[Article in German]

Klement A, HŠuser W, BrŸckle W, Eidmann U, Felde E, Herrmann M, KŸhn-Becker H, OffenbŠcher M, Settan M, Schiltenwolf M, von Wachter M, Eich W.

Institut fŸr Allgemeinmedizin, Martin-Luther-UniversitŠt Halle-Wittenberg, 06112 Halle. andreas.klement@medizin.uni-halle.de

BACKGROUND: A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: Patient's information at first diagnosis of FMS is strongly recommended (grade A). Patient-centered communication is recommended (grade B). A stepwise treatment approach depending on the adapatation to restrictions in daily life and response to treatment options can be considered (grade C). CONCLUSIONS: The long-term treatment should be based on principles of basic psychosomatic care and shared decision making on treatment options.

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PMID: 18478270 [PubMed - in process]

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Inhibition of cortisol production by metyrapone enhances trace, but not delay, eyeblink conditioning.

Nees F, Richter S, Lass-Hennemann J, Blumenthal TD, SchŠchinger H.

Institute of Psychobiology, University of Trier, Trier, Germany.

RATIONALE: Hypocortisolism impairs trace classical conditioning of the eyeblink response to an air puff but does not affect delay conditioning. OBJECTIVES: The opposite neurohormonal condition, hypocortisolism, may facilitate trace classical conditioning, which might be informative in understanding the role of classical conditioning in stress-sensitive syndromes such as fibromyalgia. MATERIALS AND METHODS: Volunteers (n = 82) were randomized to receive either an inhibitor of cortisol production (metyrapone, 1500 mg) or placebo and to complete a delay or a trace eyeblink conditioning protocol (unconditioned stimulus: corneal air puff, 10 psi, 50 ms; conditioned stimulus: binaural pure tone, 75 dB, 1000 Hz, 400 ms; empty interval in trace conditioning: 600 ms), where conditioned eyeblink response probability was assessed electromyographically. RESULTS: Metyrapone induced hypocortisolism, reflected by a 30% decrease of salivary cortisol levels (p < 0.01), and facilitated trace eyeblink conditioning (p < 0.001), while delay eyeblink conditioning remained unaffected. Moreover, extinction of delay-conditioned eyeblink responses was impaired (p = 0.023), but extinction of trace-conditioned responses remained unaffected. CONCLUSIONS: We conclude that acute mild metyrapone-induced hypocortisolism facilitates hippocampus-mediated classical trace eyeblink conditioning but suppresses the extinction of cerebellum-based delay-conditioned responses. Both results may be of theoretical and clinical significance for the generation and persistence of psychosomatic symptoms in patient groups characterized by relative hypocortisolism (e.g., fibromyalgia and chronic fatigue).

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PMID: 18478206 [PubMed - in process]

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Comment on:
Fibromyalgia: what's in a name?

Hartrick CT.

Publication Types:
PMID: 18476894 [PubMed - indexed for MEDLINE]

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Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia.

Togo F, Natelson BH, Cherniack NS, FitzGibbons J, Garcon C, Rapoport DM.

Pain and Fatigue Study Center, Department of Neurosciences, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 30 Bergen Street, Newark, NJ 07103, USA. tougou@p.u-tokyo.ac.jp

INTRODUCTION: We evaluated polysomnograms of chronic fatigue syndrome (CFS) patients with and without fibromyalgia to determine whether patients in either group had elevated rates of sleep-disturbed breathing (obstructive sleep apnea or upper airway resistance syndrome) or periodic leg movement disorder. We also determined whether feelings of unrefreshing sleep were associated with differences in sleep architecture from normal. METHODS: We compared sleep structures and subjective scores on visual analog scales for sleepiness and fatigue in CFS patients with or without coexisting fibromyalgia (n = 12 and 14, respectively) with 26 healthy subjects. None had current major depressive disorder, and all were studied at the same menstrual phase. RESULTS: CFS patients had significant differences in polysomnograpic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. CFS patients as a group had less total sleep time, lower sleep efficiency, and less rapid eye movement sleep than controls. A possible explanation for the unrefreshing quality of sleep in CFS patients was revealed by stratification of patients into those who reported more or less sleepiness after a night's sleep (a.m. sleepier or a.m. less sleepy, respectively). Those in the sleepier group reported that sleep did not improve their symptoms and had poorer sleep efficiencies and shorter runs of sleep than both controls and patients in the less sleepy group; patients in the less sleepy group reported reduced fatigue and pain after sleep and had relatively normal sleep structures. This difference in sleep effects was due primarily to a decrease in the length of periods of uninterrupted sleep in the a.m. sleepier group. CONCLUSION: CFS patients had significant differences in polysomnographic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. This difference was due neither to diagnosable sleep disorders nor to coexisting fibromyalgia but primarily to a decrease in the length of periods of uninterrupted sleep in the patients with more sleepiness in the morning than on the night before. This sleep disruption may explain the overwhelming fatigue, report of unrefreshing sleep, and pain in this subgroup of patients.

Publication Types:
PMID: 18474105 [PubMed - in process]

PMCID: PMC2483445


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[Etiology and pathophysiology of fibromyalgia syndrome and chronic widespread pain]

[Article in German]

Sommer C, HŠuser W, Gerhold K, Joraschky P, Petzke F, Tšlle T, Ueyler N, Winkelmann A, Thieme K.

Neurologische Klinik, UniversitŠt WŸrzburg, WŸrzburg. sommer@mail.uni-wuerzburg.de

OBJECTIVE: To write a systematic review on the etiology and pathophysiology of the fibromyalgia syndrome (FMS) and of chronic widespread pain (CWP). METHODS: An interdisciplinary level-3 guideline (i.e. systematic literature search and assessment, logic analysis, formal consensus procedure) for the diagnosis and therapy of FMS was created in cooperation with 10 medical and psychological societies and 2 patient self-help organizations. A literature search was performed covering all available review articles on the etiology and pathophysiology of FMS and CWP using the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-2006), PsychInfo (1966-12/2006), and Scopus (1980-12/2006). For the assignment of evidence classes the system of the Oxford Centre for Evidence-Based Medicine was applied. Consensus was achieved by a multi-step nominal group procedure. RESULTS: FMS aggregates in families (evidence level 2c). Physical and psychological stress at the workplace are risk factors for the development of CWP and FMS. Affective disorders are risk factors for the development and maintenance of FMS. Operant learning mechanisms and sensitization are risk factors for the chronification of FMS (evidence levels 2b). Several factors are associated with the pathophysiology of FMS, but the causal relationship is unclear. This includes alterations of central pain pathways, hyporeactivity of the hypothalamus-pituitary-adrenal axis, increased systemic pro-inflammatory and reduced anti-inflammatory cytokine profiles and disturbances in the dopaminergic and serotonergic systems. CONCLUSIONS: FMS is the common final product of various etiological factors and pathophysiological mechanisms.

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PMID: 18470541 [PubMed - in process]

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[Juvenile fibromyalgia syndrome]

[Article in German]

Michels H, Gerhold K, HŠfner R, HŠuser W, Illhardt A, Mšnkemšller K, Richter M, Schuchmann L.

Deutsches Zentrum fŸr Kinder- und Jugendrheumatologie, Gehfeldstrasse 24, 82467, Garmisch-Partenkirchen. michels.hartmut@rummelsberger.net

OBJECTIVE: The aim was to develop a guideline for diagnostic procedures and treatment of juvenile fibromyalgia syndrome (JFMS) in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search, including all controlled studies evaluating diagnosis and treatment of JFMS, was performed in the Cochran Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was performed according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: Pain in children/adolescents involving several body areas and lasting >3 months without an obvious somatic cause is called JFMS or pain amplification syndrome. Therapeutically, a multidisciplinary concept with psychotherapy and physiotherapy, relaxation techniques and patient education is recommended. CONCLUSION: These guideline will contribute to a better recognition and standardized care of patients with JFMS and facilitate clinical studies.

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PMID: 18470540 [PubMed - in process]

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Pain ratings and somatosensory evoked responses to repetitive intramuscular and intracutaneous stimulation in fibromyalgia syndrome.

Diers M, Koeppe C, Yilmaz P, Thieme K, Markela-Lerenc J, Schiltenwolf M, van Ackern K, Flor H.

Department of Clinical and Cognitive Neuroscience, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.

To determine the presence of perceptual sensitization and related brain responses we examined 15 patients with fibromyalgia syndrome and 15 healthy controls comparable in age and sex. Multichannel EEG recordings and pain ratings were obtained during the presentation of 800 painful electrical intramuscular and intracutaneous stimuli to the left m. erector spinae and the left m. extensor digitorum. The stimulus intensity was adjusted to 50% between pain threshold and tolerance. Detection and pain thresholds were significantly lower in the fibromyalgia syndrome group. Sensitization occurred for both groups during intramuscular stimulation. In the EEG data the fibromyalgia syndrome patients showed higher N80 amplitudes compared with the healthy controls. Arm stimulation and intramuscular stimulation yielded higher N80 and N150 amplitudes compared with intracutaneous stimulation or stimulation of the back. These results indicate lower pain thresholds in the fibromyalgia syndrome patients after electrical stimulation and a higher N80 amplitude both indicative of enhanced sensory processing in this group.

Publication Types:
PMID: 18469725 [PubMed - indexed for MEDLINE]

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Glucocorticoid sensitivity in fibromyalgia patients: decreased expression of corticosteroid receptors and glucocorticoid-induced leucine zipper.

Macedo JA, Hesse J, Turner JD, Meyer J, Hellhammer DH, Muller CP.

Institute of Immunology, Laboratoire National de SantŽ, 20A rue Auguste Lumire, L-1011, Luxembourg.

In fibromyalgia (FM) patients, differences in glucocorticoid receptor (GR) affinity and disturbances associated with loss of hypothalamic-pituitary-adrenal (HPA) axis resiliency have been observed. Based on these studies, we investigated whether FM would be associated with abnormalities in glucocorticoid (GC) sensitivity. Salivary and blood samples were collected from 27 FM patients and 29 healthy controls. Total plasma cortisol and salivary free cortisol were quantified by ELISA and time-resolved fluorescence immunoassay, respectively. GR sensitivity to dexamethasone was evaluated through IL-6 inhibition in stimulated whole blood. The corticosteroid receptors, GR alpha and mineralocorticoid receptor, as well as the glucocorticoid-induced leucine zipper (GILZ) and the FK506 binding protein 5 mRNA expression were assessed in peripheral blood mononuclear cells (PBMCs) by real-time RT-PCR. Furthermore, the corticosteroid receptors were analysed for polymorphism. We observed lower basal plasma cortisol levels (borderline statistical significance) and a lower expression of corticosteroid receptors and GILZ in FM patients when compared to healthy controls. The MR rs5522 (I180V) minor allele was found more often in FM patients than in controls and this variant was recently associated with a mild loss of receptor function. The lower GR and MR expression and possibly the reduced MR function may be associated with an impaired function of the HPA axis in these patients which, compounded by lower anti-inflammatory mediators, may sustain some of symptoms that contribute to the clinical picture of the syndrome.

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PMID: 18468809 [PubMed - in process]

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Exercise for fibromyalgia: a systematic review.

Busch AJ, Schachter CL, Overend TJ, Peloso PM, Barber KA.

School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Angela.Busch@usask.ca

OBJECTIVE: Fibromyalgia (FM) is a syndrome expressed by chronic widespread pain often associated with reduced physical function. Exercise is a common recommendation in management of FM. We evaluated the effects of exercise training on global well-being, selected signs and symptoms, and physical function in individuals with FM. METHODS: We searched Medline, Embase, CINAHL, SportDiscus, PubMed, PEDro, and the Cochrane Central Register for Controlled Trials to July 2005 and included randomized trials evaluating cardiorespiratory endurance, muscle strength, and flexibility. Methodological quality was assessed using the van Tulder and Jadad instruments. Training protocols were evaluated using American College of Sports Medicine (ACSM) guidelines. Clinical heterogeneity limited metaanalysis to 6 aerobic and 2 strength studies. RESULTS: There were 2276 subjects across the 34 studies; 1264 subjects were assigned to exercise interventions. Metaanalysis of 6 studies provided moderate-quality evidence that aerobic-only exercise training at ACSM-recommended intensity levels has positive effects on global well-being (SMD 0.49, 95% CI 0.23-0.75) and physical function (SMD 0.66, 95% CI 0.41-0.92) and possibly on pain (SMD 0.65, 95% CI -0.09 to 1.39) and tender points (SMD 0.23, 95% CI -0.18 to 0.65). Strength and flexibility remain underevaluated; however, strength training may have a positive effect on FM symptoms. CONCLUSION: Aerobic-only training has beneficial effects on physical function and some FM symptoms. Strength-only training may improve FM symptoms, but requires further study. Large, high-quality studies of exercise-only interventions that provide detailed information on exercise prescription and adherence are needed.

PMID: 18464301 [PubMed - in process]

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WHO-ILAR COPCORD Study (Stage 1, Urban Study) in Iran.

Davatchi F, Jamshidi AR, Banihashemi AT, Gholami J, Forouzanfar MH, Akhlaghi M, Barghamdi M, Noorolahzadeh E, Khabazi AR, Salesi M, Salari AH, Karimifar M, Essalat-Manesh K, Hajialiloo M, Soroosh M, Farzad F, Moussavi HR, Samadi F, Ghaznavi K, Asgharifard H, Zangiabadi AH, Shahram F, Nadji A, Akbarian M, Gharibdoost F.

Rheumatology Research Center, Shariati Hospital, Medical Sciences/University of Tehran, Tehran, Iran. fddh@davatchi.net

OBJECTIVE: To find the prevalence of musculoskeletal complaints and rheumatic disorders in Iran. METHODS: Tehran, with one-ninth of the population of Iran and of mixed ethnic origins, was selected as the field. Subjects were randomly selected from the 22 districts. Interviews were conducted once a week, on the weekend. The 3 phases of stage 1 were done on the same day, in parallel, like the fast-track Community Oriented Program for Control of Rheumatic Diseases (COPCORD). RESULTS: Four thousand ninety-six houses were visited and 10,291 persons were interviewed. Musculoskeletal complaints during the past 7 days were detected in 41.9% of the interviewed subjects. The distribution was: shoulder 14.5%, wrist 10%, hands and fingers 9.4%, hip 7.1%, knee 25.5%, ankle 9.8%, toes 6.1%, cervical spine 13.4%, and dorsal and lumbar spine 21.7%. Degenerative joint diseases were detected in 16.6% of subjects: cervical spondylosis 1.8%, knee osteoarthritis (OA) 15.3%, hand OA 2.9%, and hip OA 0.32%. Low back pain was detected in 15.4% and soft tissue rheumatism in 4.6%. Inflammatory disorders were rheumatoid arthritis 0.33%, seronegative spondyloarthropathies 0.23%, ankylosing spondylitis 0.12%, systemic lupus erythematosus 0.04%, and Behet's disease 0.08%. Fibromyalgia was detected in 0.69% and gout in 0.13% of the studied population. CONCLUSION: The large urban COPCORD study in Iran showed a high prevalence of rheumatic complaints in the population over the age of 15 years, 41.9%. Knee OA and low back pain were the most frequent complaints.

Publication Types:
PMID: 18464299 [PubMed - in process]

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[Alternative and complementary therapies in fibromyalgia syndrome]

[Article in German]

Langhorst J, HŠuser W, Irnich D, Speeck N, Felde E, Winkelmann A, Lucius H, Michalsen A, Musial F.

Klinik fŸr Innere Medizin V, Naturheilkunde und Integrative Medizin, Kliniken Essen-Mitte, Am Deimelsberg 34a, 45276 Essen. jost.langhorst@gmx.de

INTRODUCTION: Interdisciplinary S3 level guidelines were devised in cooperation with 8 medical, 2 psychological and 2 patient support groups. Results were elaborated in a multilevel group process. METHODS: On the bases of the "Cochrane Library" (1993-2006), "Medline" (1980-2006), "PsychInfo" (2006) and "Scopus" (2006) controlled studies and meta-analyses of controlled studies were analyzed. RESULTS: Only few controlled studies were found supporting in part the effectiveness of CAM therapies in the treatment of fibromyalgia syndrome. Due to the lack of information on long term efficacy and cost-effectiveness, only limited recommendations for CAM therapies can be given. CONCLUSION: Within a multicomponent therapy setting, selective CAM therapies (acupuncture, vegetarian diet, homeopathy, Tai Chi, Qi Gong, music-oriented and body-oriented therapies) can be recommended for a limited period of time.

Publication Types:
PMID: 18463899 [PubMed - in process]

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[Multicomponent therapy for treatment of fibromyalgia syndrome]

[Article in German]

Arnold B, HŠuser W, Bernardy K, BrŸckle W, Friedel E, Kšllner V, KŸhn-Becker H, Richter M, Weigl M, Weiss T, OffenbŠcher M.

Abteilung fŸr Schmerztherapie, Klinikum Dachau, Krankenhausstr. 15, 85221, Dachau. bernhard.arnold@amperkliniken.de

BACKGROUND: A guideline for the treatment of fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies evaluating multicomponent therapy (MT) was performed in the Cochrane Library (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: MT is superior to control groups or routine treatment (evidence level 1A) and should be offered to FMS patients (recommendation strength A). CONCLUSIONS: Future studies should consider medication, other co-therapies and comorbidities. MT programs tailored to FMS subgroups should be tested.

Publication Types:
PMID: 18463898 [PubMed - in process]

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[Imagined exposure as treatment of catastrophizing in fibromyalgia: a pilot study]

[Article in Spanish]

Rodero B, Garc’a J, Casanueva B, Sobradiel N.

INTRODUCTION: We want to assess the effectiveness of a new approach (imagined exposure) for the Cognitive Behavioural Treatment (CBT) in fibromyalgia. STUDY DESIGN: Quasi-experimental design of a temporary nature in a single group with pre and post and with/without treatment. SUBJECTS AND METHODS: Fibromyalgia (FM) patients, who met the American College of Rheumatology's criteria for FM. In this study eight people took part, seven females and one male, selected from FM Cantabria Association. The CBT consisted of 11 group sessions and lasted 15 weeks. All patients were evaluated before and after the program. The data were based on the following scales: visual-analog scale (VAS) for pain intensity, the Fibromyalgia Impact Questionnaire (FIQ), the Pain Catastrophizing Scale (PCS) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Despite finding improvements in every variable, no significant differences were found between pre and postreatment in VAS, HADS and FIQ. However, after treatment, significant differences were found in PCS (p 0.05), and its three subscales. Moreover, rate decrease in rumination was higher after imagined exposure. CONCLUSION: These results suggest that CBT is effective either in catastrophizing decreasing or in rumination. Imagined exposure may enhance the results in particular cases. Further studies with larger samples are needed to confirm these results.

Publication Types:
PMID: 18461496 [PubMed - in process]

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[Aims of the guidelines for diagnostic and treatment of fibromyalgia syndrome]

[Article in German]

Schiltenwolf M, Eich W, Schmale-Grete R, HŠuser W.

Sektion Schmerztherapie, Stiftung OrthopŠdische UniversitŠtsklinik Heidelberg, Schlierbacher Landstrasse 200, 69118 Heidelberg, Deutschland. Marcus.Schiltenwolf@ok.uni-heidelberg.de

The guidelines aim to provide all professions involved in the treatment of fibromyalgia syndrome (FMS) a systematically developed basis for the diagnosis and therapy of FMS. Diagnostic criteria and empirically founded therapies are presented to reduce the currently insufficient medical care for FMS patients. Recommendations for a stepwise therapeutic approach are designed to improve the quality of medical care, the implementation of effective treatment options as well as reduction of the utilization of non-effective therapies and improvement of the patient-physician relationship. Recommendations on the coordination of medical care (inpatient and outpatient treatment by family physicians, medical specialists and other medical professions, care in emergency and rehabilitation hospitals) aim to reduce rivalry between medical societies and to promote an optimal use of resources. A patient version of the guidelines is aimed at improving patients' knowledge on the etiology and effective treatment options available thus promoting an effective self-management of patients.

Publication Types:
PMID: 18458961 [PubMed - in process]

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[Psychotherapy in patients with fibromyalgia syndrome]

[Article in German]

Thieme K, HŠuser W, Batra A, Bernardy K, Felde E, Gesmann M, Illhardt A, Settan M, Wšrz R, Kšllner V.

Institut fŸr Neuropsychologie und Klinische Psychologie, Zentralinstitut fŸr Seelische Gesundheit Mannheim, UniversitŠt Heidelberg , J5, 68159 Mannheim. thieme@zi-mannheim.de

BACKGROUND: A guideline for the treatment and diagnostic procedures in fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies of evaluated multicomponent therapy was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/ 2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: Cognitive and operant behavioral therapy is strongly recommended (grade A). Guided imagery/hypnotherapy and written emotional disclosure are recommended (grade B). CONCLUSIONS: Psychotherapeutic programs tailored to FMS subgroups should be developed and tested.

Publication Types:
PMID: 18458959 [PubMed - in process]

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[Pharmacological treatment of fibromyalgia syndrome]

[Article in German]

Sommer C, HŠuser W, Berliner M, BrŸckle W, Ehlers S, Mšnkemšller K, Moradi B, Petzke F, Ueyler N, Wšrz R, Winter E, Nutzinger DO.

Neurologische Klinik, UniversitŠt WŸrzburg, WŸrzburg. sommer@mail.uni-wuerzburg.de

BACKGROUND: An interdisciplinary guideline for the treatment of fibromyalgia syndrome (FMS) and chronic widespread pain (CWP) was developed in cooperation with ten German medical and psychological associations and two patients' self-help organizations. METHODS: Using the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-2006), PsychInfo (1966-12/2006), and Scopus (1980-12/ 2006) a systematic literature search was performed, which included all randomised controlled trials (RCT) evaluating multicomponent therapy in FMS and CWP. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. The strength of recommendation was graded according to the German program for disease management guidelines. Consensus was achieved using a multi-step nominal group procedure. RESULTS: The short-term use of amitriptyline is strongly recommended (grade A) and the short-term use of fluoxetine und duloxetine is recommended (grade B). CONCLUSIONS: The recommendations regarding pharmacological treatment of FMS are limited by the short duration of the RCT, the lack of follow-ups and absence of cost-effectiveness studies.

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PMID: 18458958 [PubMed - in process]

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Understanding fibromyalgia and its related disorders.

[No authors listed]

PMID: 18458727 [PubMed - in process]

PMCID: PMC2292439


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Use of repetitive transcranial magnetic stimulation in pain relief.

Lefaucheur JP.

Service de Physiologie, Explorations Fonctionnelles, H™pital Henri Mondor, Assistance Publique-H™pitaux de Paris, 51, Avenue de Lattre de Tassigny, 94010 CrŽteil, France. jean-pascal.lefaucheur@hmn.aphp.fr

Repetitive transcranial magnetic stimulation (rTMS) of the cerebral cortex is a noninvasive strategy that could have the potential to relieve severe chronic pain, at least partially and transiently. The most studied target of stimulation is the precentral (motor) cortex, but other targets, such as the dorsolateral prefrontal cortex or the parietal cortex, could be of interest. Analgesic effects have been produced by rTMS in patients with neuropathic pain, fibromyalgia or visceral pain. Therapeutic applications of rTMS in pain syndromes are limited by the short duration of the induced effects, but prolonged pain relief can be obtained by performing rTMS sessions every day for several weeks. In patients who respond to rTMS but relapse, surgical implantation of epidural cortical electrodes and a pulse generator can be proposed to make clinical effects more permanent. The rate of improvement produced by rTMS may be predictive for the outcome of the implanted procedure. The place of rTMS as a therapeutic tool in the management of chronic pain remains to be determined.

Publication Types:
PMID: 18457536 [PubMed - indexed for MEDLINE]

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Role of central dopamine in pain and analgesia.

Wood PB.

Angler Biomedical Technologies, LLC, 18401 Reed Parks Road, Jonestown, TX 78645, USA. pwood@anglerbiomedical.com

Recent insights have demonstrated a central role for dopaminergic neurotransmission in modulating pain perception and natural analgesia within supraspinal regions, including the basal ganglia, insula, anterior cingulate cortex, thalamus and periaqueductal gray. In addition, while the participation of serotonin and norepinephrine in spinal descending inhibition of pain is well known, a critical role for dopamine in descending inhibition has also been demonstrated. Decreased levels of dopamine likely contribute to the painful symptoms that frequently occur in Parkinson's disease. Moreover, abnormalities in dopaminergic neurotransmission have been objectively demonstrated in painful clinical conditions, including burning mouth syndrome, fibromyalgia and restless legs syndrome. Evidence from animal models and indirect evidence from pharmaceutical trials also suggest a role for dopamine in chronic regional pain syndrome and painful diabetic neuropathy. Several novel classes of medication with analgesic properties have bearing on dopaminergic activity as evident in the capacity of dopamine antagonists to attenuate their analgesic capacity. An expanded appreciation for the role of dopamine in natural analgesia provides the impetus for further study involving preclinical models and advanced neuroimaging techniques in humans, which may lead to the development of novel therapeutic strategies.

Publication Types:
PMID: 18457535 [PubMed - indexed for MEDLINE]

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The significance of the sleeping-waking brain for the understanding of widespread musculoskeletal pain and fatigue in fibromyalgia syndrome and allied syndromes.

Moldofsky H.

Faculty of Medicine, University of Toronto, Sleep Disorders Clinic of the Centre for Sleep and Chronobiology, 340 College Street, Suite 580, Toronto, ON MST 3A9, Canada. h.moldofsky@utoronto.ca

The clinical focus of rheumatologists on the widespread pain and numerous tender points in specific anatomic regions in their patients who show no evidence for disease pathology has lead to the characterization of such peripheral symptoms as a specific disorder of the musculoskeletal system, now commonly known as fibromyalgia. This rheumatologic diagnostic entity has resulted in relative inattention to an understanding of their patients' common complaints of unrefreshing sleep, chronic fatigue and psychological distress. Experimental evidence from humans and animal studies indicate that there is an inter-relationship of disturbances in the physiology of the sleeping-waking brain with the widespread musculoskeletal pain, chronic fatigue, and psychological distress in patients with hitherto unexplained pain/fatigue illnesses, e.g., fibromyalgia and chronic fatigue syndromes. The emerging knowledge of the dysfunction of the nervous system in such patients has lead to the study of novel medications that affect neurotransmitter functions, e.g., pregabalin, serotonin/noradrenaline compounds and sodium oxybate that are shown to improve many of the symptoms of such patients.

PMID: 18456536 [PubMed - in process]

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[Physiotherapy, exercise and strength training and physical therapies in the treatment of fibromyalgia syndrome]

[Article in German]

Schiltenwolf M, HŠuser W, Felde E, FlŸgge C, HŠfner R, Settan M, OffenbŠcher M.

Sektion Schmerztherapie, Stiftung OrthopŠdische UniversitŠtsklinik Heidelberg, Schlierbacher Landstrasse 200, 69118 Heidelberg. Marcus.Schiltenwolf@ok.uni-heidelberg.de

BACKGROUND: A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/ 2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: Aerobic exercise training is strongly recommended (grade A) and the temporary use of whole body hyperthermia, balneotherapy and spa therapy is recommended (grade B). CONCLUSION: The significance which can be assigned to most of the studies on the various procedures for therapy is restricted due to short study duration (mean 6-12 weeks) and small sample sizes.

Publication Types:
PMID: 18449569 [PubMed - in process]

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Comorbid somatic symptoms and functional status in patients with fibromyalgia and chronic fatigue syndrome: sensory amplification as a common mechanism.

Geisser ME, Strader Donnell C, Petzke F, Gracely RH, Clauw DJ, Williams DA.

Chronic Pain and Fatigue Research Center, Dept. of Internal Medicine, Div. of Rheumatology, Univ. of Michigan, Ann Arbor, MI 48108, USA. mgeisser@med.umich.edu

BACKGROUND: Somatic symptoms are common in conditions such as fibromyalgia (FM) and chronic fatigue syndrome (CFS). OBJECTIVE: Authors investigated a potential shared pathologic mechanism: a generalized perceptual abnormality where there is heightened responsiveness to varied sensory stimulation, including pain. METHOD: A composite measure of sensory sensitivity was created and compared with measures of somatic symptoms, comorbid psychological disturbances, and self-reported physical functioning in 38 patients with FM and/or CFS. RESULTS: Sensory amplification influenced physical functioning indirectly through pain intensity, and physical symptoms and fatigue also independently contributed to physical functioning. CONCLUSION: Sensory amplification may be an underlying pathophysiologic mechanism in these disorders that is relatively independent of depression and depressive symptoms.

PMID: 18448779 [PubMed - indexed for MEDLINE]

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Normalizing attributions may contribute to non-help-seeking behavior in people with fibromyalgia syndrome.

Gulec H.

Erenkoy Psychiatry Hospital, Kazasker, Istanbul, Turkey 090. huseyingulec@yahoo.com

BACKGROUND: Causal attributions of bodily perceptions indicate the possibility of some degree of control over events. Therefore, attributions are important to support the social significance of experience and confer meaning. OBJECTIVE: The aim of this study is to investigate whether non-patients with fibromyalgia (FMS) use more normalizing attributions than healthy control subjects and help-seeking patients. METHOD: Thirty-seven FMS patients attending tertiary care were compared with 38 non-patients and 34 healthy controls on mean anxiety, depression, attribution style, and alexithymia scores. RESULTS: Mean normalizing scores were greatest in the non-patient group, followed by the healthy-control group, and smallest in the tertiary-care attending group. Non-patients are using more normalizing explanations than the FMS patients and the healthy-control subjects. CONCLUSION: Thus, normalization may negatively influence help-seeking behavior and contribute to non-help-seeking behavior.

PMID: 18448775 [PubMed - indexed for MEDLINE]

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Is there any evidence to support the use of anti-depressants in painful rheumatological conditions? Systematic review of pharmacological and clinical studies.

Perrot S, Javier RM, Marty M, Le Jeunne C, Laroche F; CEDR (Cercle d'Etude de la Douleur en Rhumatologie France), French Rheumatological Society, Pain Study Section.

Internal Medicine Department and Pain Clinic, Hotel Dieu Hospital, Paris. serge.perrot@htd.aphp.fr;

The aim of this study was to review the evidence supporting the use of anti-depressants in painful rheumatological conditions. A systematic review of papers published between 1966 and 2007, in five European languages, on anti-depressants in rheumatological conditions was performed. Papers were scored using Jadad method and analgesic ES was calculated. We selected 78 clinical studies and 12 meta-analyses, from 140 papers. The strongest evidence of an analgesic effect of anti-depressants has been obtained for fibromyalgia. A weak analgesic effect is observed for chronic low back pain, with an efficacy level close to that of analgesics. In RA and AS, there is no analgesic effect of anti-depressants, but these drugs may help to manage fatigue and sleep disorders. There is no clear evidence of an analgesic effect inOA, but studies have poor methodological quality. Analgesic effects of anti-depressants are independent of their anti-depressant effects. Tricyclic anti-depressants (TCAs), even at low doses, have analgesic effects equivalent to those of serotonin and noradrenalin reuptake inhibitors (SNRIs), but are less well tolerated. Selective serotonin reuptake inhibitors (SSRIs) have modest analgesic effects, but higher doses are required to achieve analgesia. Anti-depressant drugs, particularly TCAs and SNRIs, have analgesic effects in chronic rheumatic painful states in which analgesics and NSAIDs are not very efficient, such as fibromyalgia and chronic low back pain. In inflammatory rheumatic diseases, anti-depressants may be useful for managing fatigue and sleep disorders. Further studies are required to compare anti-depressants with other analgesics in the management of chronic painful rheumatological conditions.

PMID: 18445628 [PubMed - in process]

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[Fibromyalgia syndrome: guideline principle for a fiction?]

[Article in German]

HŠuser W.

Zentrum fŸr Schmerztherapie, Klinikum SaarbrŸcken gGmbH, Winterberg 1, 66119 SaarbrŸcken, Deutschland. whaeuser@klinikum-saarbruecken.de

PMID: 18443830 [PubMed - in process]

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Responsiveness of five condition-specific and generic outcome assessment instruments for chronic pain.

Angst F, Verra ML, Lehmann S, Aeschlimann A.

Research department, Rehaclinic Zurzach, Bad Zurzach, Switzerland. fangst@datacomm.ch

BACKGROUND: Changes of health and quality-of-life in chronic conditions are mostly small and require specific and sensitive instruments. The aim of this study was to determine and compare responsiveness, i.e. the sensitivity to change of five outcome instruments for effect measurement in chronic pain. METHODS: In a prospective cohort study, 273 chronic pain patients were assessed on the Numeric Rating Scale (NRS) for pain, the Short Form 36 (SF-36), the Multidimensional Pain Inventory (MPI), the Hospital Anxiety and Depression Scale (HADS), and the Coping Strategies Questionnaire (CSQ). Responsiveness was quantified by effect size (ES) and standardized response mean (SRM) before and after a four week in-patient interdisciplinary pain program and compared by the modified Jacknife test. RESULTS: The MPI measured pain more responsively than the SF-36 (ES: 0.85 vs 0.72, p = 0.053; SRM: 0.72 vs 0.60, p = 0.027) and the pain NRS (ES: 0.85 vs 0.62, p < 0.001; SRM: 0.72 vs 0.57, p = 0.001). Similar results were found for the dimensions of role and social interference with pain. Comparison in function was limited due to divergent constructs. The responsiveness of the MPI and the SF-36 was equal for affective health but both were better than the HADS (e.g. MPI vs HADS depression: ES: 0.61 vs 0.43, p = 0.001; SF-36 vs HADS depression: ES: 0.54 vs 0.43, p = 0.004). In the "ability to control pain" coping dimension, the MPI was more responsive than the CSQ (ES: 0.46 vs 0.30, p = 0.011). CONCLUSION: The MPI was most responsive in all comparable domains followed by the SF-36. The pain-specific MPI and the generic SF-36 can be recommended for comprehensive and specific bio-psycho-social effect measurement of health and quality-of-life in chronic pain.

Publication Types:
PMID: 18439285 [PubMed - indexed for MEDLINE]

PMCID: PMC2386498


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Measuring health in patients with fibromyalgia: content comparison of questionnaires based on the International Classification of Functioning, Disability and Health.

Prodinger B, Cieza A, Williams DA, Mease P, Boonen A, Kerschan-Schindl K, Fialka-Moser V, Smolen J, Stucki G, Machold K, Stamm T.

Vienna University, Department of Internal Medicine III, Division of Rheumatology, Vienna, Austria. birgit.prodinger@meduniwien.ac.at

OBJECTIVE: To analyze the content of outcome measures commonly used to assess health in patients with fibromyalgia (FM) by linking the items of the instruments with the International Classification of Functioning, Disability and Health (ICF) in order to evaluate the adequacy of currently used measures. METHODS: Questionnaires used in FM were identified in a structured literature search. All concepts included in the items of the questionnaires were linked to ICF categories, according to previously published linking rules, by 2 independent health professionals. The percentages of linked ICF categories addressing the different ICF components were calculated. RESULTS: Generic and symptom-specific instruments were included. From the 296 items contained in all 16 instruments, 447 concepts were extracted and then linked to 52 ICF categories of the component body functions, 1 category of the component body structure, 40 categories of the component activities and participation, and 9 categories of the component environmental factors. More than half of the concepts identified were linked to body function, fewer were linked to activities and participation, and only concepts of 4 instruments were linked to the ICF component environmental factors. CONCLUSION: Many concepts were linked to the categories in the ICF component body functions. While linking to the broad category, purportedly similar instruments often covered widely varying areas of function at more fine-grained levels of detail. Some categories, such as environmental factors, were barely covered by any of the instruments and might constitute an important aspect of health deserving better coverage and future development.

Publication Types:
PMID: 18438895 [PubMed - indexed for MEDLINE]

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Chronic benign pain.

Klein DA, Greenfield DP.

Division of Consultation-Liaison Psychiatry, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

Chronic benign pain (CBP) can be defined as a type of unpleasant sensory experience that arises from inflammation, visceral stress or damage, or other such pathophysiologic process(es), and that is not associated with a metastatic process. A patient's complaint of pain should be taken seriously by the practitioner, both in terms of the discomfort evoked and the likelihood that the potential cause of the pain requires diagnostic evaluation. This article reviews the diagnosis and treatment of the following common conditions associated with CBP syndromes: fibromyalgia, lower back pain syndrome, sickle-cell disease, reflex sympathetic dystrophy syndrome, and peripheral neuropathies.

PMID: 18438318 [PubMed - in process]

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Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D.

Warner AE, Arnspiger SA.

Center for Rheumatic Disease, Saint Luke's Hospital of Kansas City, Kansas City, Missouri 64111, USA. annwarner@ix.netcom.com

BACKGROUND: Uncontrolled studies have suggested that vitamin D insufficiency causes diffuse musculoskeletal pain. OBJECTIVES: Comparison of vitamin D levels in patients with diffuse musculoskeletal pain with controls; evaluation of the effect of treatment with vitamin D on diffuse pain. METHODS: 25-Hydroxyvitamin D levels were measured in patients with diffuse musculoskeletal pain and osteoarthritis (controls) recruited from a community rheumatology practice. The diffuse pain patients with 25-hydroxyvitamin D levels < or = 20 ng/mL were randomized to receive placebo or ergocalciferol 50,000 IU once weekly for 3 months. Outcomes assessed were pain measured by visual analog scale (VAS) and functional pain score (FPS). RESULTS: One hundred eighty-four patients with diffuse pain and 104 with osteoarthritis entered the study. Mean 25-hydroxyvitamin D levels did not differ between the groups (diffuse pain 29.2 ng/mL +/- 13.0, controls 28.8 ng/mL +/- 10.5; P = 0.78); nor did the percent of patients in each group with vitamin D levels < or = 20 ng/mL (diffuse pain 29%, controls 20%; P = 0.09). Fifty patients with diffuse pain who had 25-hydroxyvitamin D levels < or = 20 ng/mL were randomized to receive vitamin D or placebo for 3 months. Vitamin D treatment had no effect on pain in comparison to baseline (VAS P = 0.73; FPS P = 0.18) or at 3 months in comparison to placebo (VAS P = 0.12; FPS P = 0.05, in favor of placebo). CONCLUSIONS: Low vitamin D levels are not associated with diffuse musculoskeletal pain, and treatment with vitamin D does not reduce pain in patients with diffuse pain who have low vitamin D levels.

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PMID: 18431091 [PubMed - indexed for MEDLINE]

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Impact of musculoskeletal disease on quality of life in long-standing acromegaly.

Miller A, Doll H, David J, Wass J.

Department of Rheumatology, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK. anne.miller@noc.anglox.nhs.uk

OBJECTIVE: To provide rheumatological assessment of patients with long-standing acromegaly and investigate the impact of musculoskeletal disease on quality of life. DESIGN: Cross-sectional observational study. METHODS: Fifty-eight patients diagnosed with acromegaly at least 5 years previously were interviewed and examined by a rheumatologist. Each patient completed the short form-36 (SF-36), arthritis impact measurement scales 2 (AIMS2) and acromegaly quality of life questionnaires (AcroQol). RESULTS: Fifty-two out of 58 (90%) reported musculoskeletal pain, with 29 (50%) reporting neck pain. Hip osteoarthritis was present in 49 (84%) and knee osteoarthritis in 20 (34%). Half the patients (52%) reported sleep disturbance, but only 2 (3.5%) had fibromyalgia. Ten (17.2%) had previously undergone carpal tunnel decompression. Fifty-one (88%) patients had consulted their general practioner and 31 (54%) complementary therapists. SF-36, AIMS2 and AcroQol scores were lower in patients with musculoskeletal pain. CONCLUSIONS: This study of musculoskeletal problems in patients with acromegaly reports systematic rheumatological examination, use of medical services and quality of life scores. Musculoskeletal problems should be routinely addressed in acromegaly by both endocrinologist and rheumatologist and a multidisciplinary approach taken to management.

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PMID: 18426816 [PubMed - indexed for MEDLINE]

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Illness experience in fibromyalgia syndrome: a metasynthesis of qualitative studies.

Sim J, Madden S.

Primary Care Musculoskeletal Research Centre, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom. j.sim@keele.ac.uk

There is growing interest in synthesizing qualitative research. Despite certain philosophical and methodological difficulties, such syntheses are potentially useful in enriching the insights of empirical qualitative work in a particular area. This paper reports an interpretive review of research into the subjective experience of fibromyalgia syndrome (FMS), utilizing principles of metasynthesis. Twenty-three separate studies were identified. Each study was evaluated using methodological criteria to provide a context for interpretation of substantive findings. Principal findings were extracted and synthesized under four broad categories: experience of symptoms, search for diagnosis, legitimacy, and coping. Our findings re-emphasised the point that pain in FMS is ambiguous and invisible, raising questions of credibility and legitimacy. People with a diagnosis of FMS appear to frame the experience of symptoms within the biomedical model, where FMS is viewed as an organic entity potentially identifiable through biomedical tests. The subjective meaning and perceived legitimacy of the diagnostic label appear to be important factors in the subjective experience of FMS. Coping strategies adopted can be subsumed under Mannerkorpi, K., Kroksmark, T., Ekdahl, C. [1999. How patients with fibromyalgia experience their symptoms in everyday life. Physiotherapy Research International, 4(2), 110-122.] notions of 'struggling', 'adapting', 'in despair' and 'giving up'. Most studies had at least one identified methodological shortcoming, though it is not straightforward to identify the significance of such shortcomings. We conclude that there is scope for further research into the subjective experience of FMS, and into the methodology of metasynthesis, especially in relation to methodological appraisal.

PMID: 18423826 [PubMed - in process]

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Case-control study of medical comorbidities in women with interstitial cystitis.

Clemens JQ, Meenan RT, O'Keeffe Rosetti MC, Kimes TA, Calhoun EA.

Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA. qclemens@umich.edu

PURPOSE: We used physician assigned diagnoses in an electronic medical record to assess comorbidities associated with interstitial cystitis. MATERIALS AND METHODS: A computer search of the administrative database at Kaiser Permanente Northwest, Portland, Oregon was performed for May 1, 1998 to April 30, 2003. All women with a medical record diagnosis of interstitial cystitis (ICD-9 code 595.1) were identified. These cases were then matched with 3 controls each based on age and duration in the health plan. The medical diagnoses (using ICD-9 codes restricted to 3 digits) assigned to these 2 groups were compared using the OR. RESULTS: A total of 239 cases and 717 matched controls were analyzed. There were 23 diagnoses that were significantly more common in cases than in controls (p < or = 0.005). Seven of these 23 diagnoses were other urological or gynecological codes used to describe pelvic symptoms. Additional specific conditions associated with interstitial cystitis were gastritis (OR 12.2), child abuse (OR 9.3), fibromyalgia (OR 3.0), anxiety disorder (OR 2.8), headache (OR 2.5), esophageal reflux (OR 2.2), unspecified back disorder (OR 2.2) and depression (OR 2.0). CONCLUSIONS: A diagnosis of interstitial cystitis was associated with multiple other unexplained physical symptoms and certain psychiatric conditions. Studies to explore the possible biological explanations for these associations are needed. Interstitial cystitis was also associated with a history of child abuse, although 96% of patients with IC did not have this diagnosis.

PMID: 18423759 [PubMed - indexed for MEDLINE]

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Misdiagnosis of serotonin syndrome as fibromyalgia and the role of physical therapists.

Alnwick GM.

Genesis Rehabilitation Services, Gorham Outpatient Clinic, 4 Woodbound Rd, Gorham, NH 03581, USA. galnwick@ne.rr.com

BACKGROUND AND PURPOSE: With increased use of serotonergic medications, a condition triggered by serotonin excess within the brain and spinal cord has emerged and may be gaining prevalence. The purposes of this case report are to describe how to identify serotonin syndrome in a patient who is taking citalopram (a selective serotonin reuptake inhibitor) on the basis of signs and symptoms and to promote the ability of physical therapists to recognize such signs and symptoms. CASE DESCRIPTION: The patient was a 42-year-old woman referred for physical therapy with a diagnosis of fibromyalgia. The physical therapist recognized that the patient's symptoms did not resemble those of fibromyalgia and recommended referral to a neurologist for further diagnostic testing. OUTCOMES: The patient was referred to a neurologist, who diagnosed serotonin syndrome related to the use of citalopram. The patient was weaned off citalopram and made a successful recovery, with scores on the Oswestry Disability Index decreasing from 70% to 28% at discharge from the physical therapy treatment and to 0% at the 6-month follow-up. The patient has since returned to her prior activity level, which includes skiing, motorcycle riding, and working at her consulting firm. DISCUSSION: This case report demonstrates how careful evaluation by the physical therapist indicated that signs and symptoms were not consistent with fibromyalgia, and further medical evaluation revealed the actual diagnosis of serotonin syndrome.

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PMID: 18420814 [PubMed - indexed for MEDLINE]

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Chronic fatigue syndrome in male Gulf war veterans and civilians: a further test of the single syndrome hypothesis.

Ciccone DS, Weissman L, Natelson BH.

UMDNJ-New Jersey Medical School, USA. donald.ciccone@va.gov

Different modes of fatigue onset in male Gulf War veterans versus male civilians raise the possibility that chronic fatigue syndrome (CFS) may not be a single disease entity. We addressed this issue by comparing 45 male veterans with CFS to 84 male civilians who satisfied identical case criteria. All were evaluated for fibromyalgia (FM), multiple chemical sensitivity and psychiatric comorbidity. CFS was more likely to present in a sudden flu-like manner in civilians than veterans (p < .01) and comorbid FM was more prevalent in civilians (p < .01). These findings question the assumption that all patients with CFS suffer from the same underlying disorder.

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PMID: 18420761 [PubMed - indexed for MEDLINE]

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The effects of unmitigated communion and life events among women with fibromyalgia syndrome.

Nagurney AJ.

Department of Psychology, Texas State University-San Marcos, USA. an18@txstate.edu

This study examined the effects of the personality trait of unmitigated communion (UC) within the context of positive and negative relationship events. Ninety-one women diagnosed with fibromyalgia syndrome completed initial measures of UC as well as weekly measures of positive and negative relationship events and positive and negative affect. Positive events were related to positive affect while negative events were related to negative affect. Negative and positive affect were also predicted from the interaction of UC and negative events. These results suggest the interrelationships among UC and relationship events can combine in meaningful ways to predict psychological well-being.

Publication Types:
PMID: 18420760 [PubMed - indexed for MEDLINE]

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Electronic support groups, patient-consumers, and medicalization: the case of contested illness.

Barker KK.

Department of Sociology, Oregon State University, Corvallis, OR 97331, USA. kristin.barker@oregonstate.edu

This article illustrates the role electronic support groups play in consumer-driven medicalization. The analysis is based on an observational study of a year in the life of an electronic support group for sufferers of the contested illness fibromyalgia syndrome. The analysis builds on and extends scholarship concerning the growing influence of lay expertise in the context of medical uncertainty by showing how the dominant beliefs and routine practices of this electronic community simultaneously (and paradoxically) challenge the expertise of physicians and encourage the expansion of medicine's jurisdiction. Drawing on their shared embodied expertise, participants confirm the medical character of their problem and its remedy, and they empower each other to search for physicians who will recognize and treat their condition accordingly. Physician compliance is introduced as a useful concept for understanding the relationship between lay expertise, patient-consumer demand, and contemporary (and future) instances of medicalization.

Publication Types:
PMID: 18418983 [PubMed - indexed for MEDLINE]

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Fibromyalgia: understanding a mysterious ailment.

[No authors listed]

PMID: 18418944 [PubMed - indexed for MEDLINE]

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The association of anti-CCP antibodies with disease activity in rheumatoid arthritis.

Serdaroglu M, Cakirbay H, Deger O, Cengiz S, Kul S.

Physical Therapy and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey. drmunser@yahoo.com

Antibodies to citrullinated proteins have been described in patients with rheumatoid arthritis (RA) and these appear to be the most specific markers of the disease. Our objective was to determine the frequency of antibodies to cyclic citrullinated peptides (CCPs) in patients with RA and the association of anti-CCP antibodies with disease activity, radiological erosions and HLA DR genotype. Forty patients with RA and 38 patients with fibromyalgia were included in this study. Serum samples were collected from both patient groups with RA and fibromyalgia. Anti-CCP was measured by the corresponding enzyme-linked immunosorbent assay. Additionally, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), disease activity score (DAS), visual analog scala (VAS), HLA genotype and radiographic information were determined in patients with RA. The rate of sensitivity and specificity of anti-CCP reactivity for the diagnosis RA were measured (sensitivity 50%, specificity 100%). There is no significant difference between anti-CCP (+) and anti-CCP (-) RA patients for DAS28, VAS, ESR, CRP, disease duration, HLA genotype, and radiological assessment of hand. However, there was a significant difference between anti-CCP (+) and anti-CCP (-) RA patients for RF and the radiological assessment of left and right wrists (respectively, P < 0.05, P = 0.04, P = 0.01). There was no significant correlation between anti-CCP antibody and ESR, CRP, VAS, DAS 28 or radiological assessment. A small but significant correlation was found between RF and anti-CCP antibody (P = 0.02, r = 0.35).

PMID: 18418600 [PubMed - in process]

PMCID: PMC2493537


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[Functional digestive disorders and fibromyalgia]

[Article in Spanish]

Garc’a MD.

Fibromyalgia is a syndrome characterized by generalized chronic pain, with mainly musculoeskeletal and excess tenderness in certain areas of the body of unknown origin. Patients with fibromyalgia are often affected by additional pain symptoms, mostly funtional disorders. People with fibromyalgia experience migraines as well as symptoms of irritable bowel syndrome (IBS). Others digestive functional disorders have not been yet associated with fibromyalgia. We enclosed preliminary results of a study including all functional disorders according to Rome II criteria. We conclude that these disorders are more prevalent in patients with fibromyalgia and not only the IBS. These functional disorders are also associated with some emotional factors. All these factors make that quality of life in those patients were not good.

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PMID: 18416034 [PubMed - indexed for MEDLINE]

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[Descending facilitation in chronic stress and chronic pain state]

[Article in Japanese]

Senba E, Imbe H, Okamoto K.

Department of Anatomy & Neurobiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509 Japan. esenba@wakayama-med.ac.jp

The spino-thalamic tract consists of two systems; the lateral system terminates in the somato-sensory cortex, and participates in the sensory discrimination of pain, and the medial system terminates in the anterior cingulated cortex (ACC) and insular cortex (IC) to mediate affective components of pain. Persistent pain induces plastic changes in cortical neurons, especially in the ACC and IC. Activation of these neurons is transmitted to the periaqueductal gray and rostroventromedial medulla (RVM) (descending pain control system). This system has long been considered to exert descending inhibition, but recent studies revealed that it also causes facilitation in certain pathological conditions. A variety of stressful stimuli have been shown to affect pain sensitivity. We demonstrated that chronic restraint stress induced thermal hyperalgesia in rats, in which phosphorylated ERK and levels of tryptophan hydroxylase, a key enzyme of 5-HT production, were increased in the RVM. 5HT released from the bulbospinal neurons may exert facilitatory effects on spinal nociceptive processing probably through 5HT3 receptors. Patients suffering chronic pain originating from deep tissues, such as temporo-mandibular disorder, fibromyalgia, or low back pain, often complain of pain and tenderness in various parts of the body. We injected complete Freund's adjuvant into a temporo-mandibular joint of rats unilaterally, and then injected 5% formalin into the ipsilateral or contralateral masseter muscle 2 weeks later. Pain-related behavior and neuronal activation in the spinal trigeminal nucleus were enhanced on both sides compared to those in non-inflammatory controls. Systemic enhancement of pain and hyperalgesia induced by unilateral joint inflammation may have been caused by the central sensitization and descending facilitation.

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PMID: 18411707 [PubMed - indexed for MEDLINE]

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Chronic pain may change the structure of the brain.

May A.

Department of Systems Neuroscience, University of Hamburg Eppendorf (UKE), Martinistrasse 52, D-20246 Hamburg, Germany. a.may@uke.uni-hamburg.de

Recently, local morphologic alterations of the brain in areas ascribable to the transmission of pain were detected in patients suffering from phantom pain, chronic back pain, irritable bowl syndrome, fibromyalgia and two types of frequent headaches. These alterations were different for each pain syndrome, but overlapped in the cingulate cortex, the orbitofrontal cortex, the insula and dorsal pons. These regions function as multi-integrative structures during the experience and the anticipation of pain. As it seems that chronic pain patients have a common "brain signature" in areas known to be involved in pain regulation, the question arises whether these changes are the cause or the consequence of chronic pain. The author suggests that the gray matter change observed in chronic pain patients are the consequence of frequent nociceptive input and should thus be reversible when pain is adequately treated.

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PMID: 18410991 [PubMed - in process]

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Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine.

Trivedi MH, Desaiah D, Ossanna MJ, Pritchett YL, Brannan SK, Detke MJ.

Mood Disorders Program and Clinic, University of Texas Southwestern Medical School, Dallas, TX 75235-9119, USA. Madhukar.Trivedi@UTSouthwestern.edu

Most antidepressants in clinical use are believed to function by enhancing neurotransmission of serotonin [5-hydroxytryptamine (5-HT)] and/or norepinephrine (NE) via inhibition of neurotransmitter reuptake. Agents that affect reuptake of both 5-HT and NE (serotonin-norepinephrine reuptake inhibitors) have been postulated to offer greater efficacy for the treatment of major depressive disorder (MDD). These dual-acting agents also display a broader spectrum of action, including efficacy for MDD and associated painful physical symptoms, diabetic peripheral neuropathic pain, generalized anxiety disorder, and fibromyalgia syndrome. Substantial preclinical evidence shows that duloxetine, an approved drug for the treatment of MDD, generalized anxiety disorder, and the management of diabetic peripheral neuropathic pain, inhibits reuptake of both 5-HT and NE. This paper reviews clinical and neurochemical evidence of duloxetine's effects on 5-HT and NE reuptake inhibition. The clinical evidence supporting duloxetine's effects on NE reuptake inhibition includes indirect measures such as altered excretion of NE metabolites, cardiovascular effects, and treatment-emergent adverse event profiles similar to those for other drugs believed to act through the inhibition of NE reuptake. In summary, the data presented in this report provide clinical evidence of a mechanism for duloxetine involving both 5-HT and NE reuptake inhibition in humans and are consistent with preclinical evidence for 5-HT/NE reuptake inhibition.

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PMID: 18408530 [PubMed - indexed for MEDLINE]

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Pharmacological treatments of fibromyalgia: do complex conditions need complex therapies?

Lawson K.

Biomedical Research Centre, Sheffield Hallam University, Faculty of Health and Wellbeing, City Campus, Sheffield S1 1WB, UK. K.Lawson@shu.ac.uk

Fibromyalgia (FM) is a chronic pain condition, with auxiliary symptoms, such as sleep disturbances and fatigue. Although many of the mechanisms of action targeted by the drugs used to treat FM have been focused to the management of single symptoms, drugs (e.g. pregabalin, duloxetine) have now been identified that demonstrate a multidimensional effect. However, such drugs often fail to demonstrate acceptable efficacy in the majority of the patient population. Thus, the mechanisms of action of the drugs studied as treatments for FM are either identifying subgroups within the pathophysiology of the condition or suggesting that a mechanism of action that will offer universal efficacy has, as yet, to be identified.

PMID: 18405846 [PubMed - in process]

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[Contentious diseases--a medico-social phenomenon from an insurance medicine perspective]

[Article in German]

Regenauer A.

Kompetenzzentrum Medical Research & Underwriting, MŸnchener RŸckversicherunga-Gesellschaft.

A group of illnesses that are difficult to assess objectively, comprising such conditions as fibromyalgia, chronic fatigue syndrome, attention-deficit hyperactivity disorder, whiplash injury, and last but not least a multitude of somatoform disorders, has become a growing concern to Western health care systems and insurance industries. Thus far, the medical literature has failed to provide informative overviews of this group, which at first glance admittedly seems to be rather heterogeneous. If at all, the disorders have been grouped together under the term ,,controversial illnesses" to differentiate them from other diseases. The insurance industry - and claims departments, in particular - are increasingly having to deal with this rapidly growing phenomenon, which affects not only life business, but also health, worker's compensation and motor third-party liability. When paying compensation and settling claims, insurers are often left with a feeling that the illness may have been ,,imaginary" or aggravated. Is there a common basis for this new disorder mega-trend - independent of the recognition of the conditions by medical associations? This article aims at providing an overview of the common characteristics of the group of disorders, including a description of the key physical, psychological and social aspects. In particular, it is intended to deepen insurers' understanding of the risks arising from social change. The article also examines the disorder prevalence in Western societies and the possible causes of the significant increase.

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PMID: 18405228 [PubMed - indexed for MEDLINE]

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An increased prevalence of fibromyalgia in iron deficiency anemia and thalassemia minor and associated factors.

Pamuk GE, Pamuk ON, Set T, Harmandar O, Yesil N.

Department of Hematology, Trakya University Medical Faculty, Edirne, Turkey, gepamuk@yahoo.com.

In this study, we evaluated the prevalence of fibromyalgia (FM) in iron deficiency anemia (IDA) and thalassemia minor (TM) patients and associated factors. In addition, we investigated the prevalence of IDA in outpatients with fibromyalgia, and its effect on clinical findings. The study included 205 IDA, 40 TM patients and 100 healthy controls. FM was diagnosed according to 1990 ACR criteria. Whole blood count, biochemical tests, and serum iron parameters were determined. Pain, fatigue, and FM Impact Questionnaire (FIQ) functional item scores were assessed in FM subjects. In addition, the prevalence of IDA in FM patients diagnosed at the Rheumatology Outpatient Clinic was determined. The prevalences of FM in IDA (17.6%) and TM (20%) groups were higher than in controls (6%; p values 0.006 and 0.025, respectively). When IDA patients with FM were compared to those without FM, it was seen that a higher percentage were females, married, and a higher percentage had history of pica (all p values < 0.05). Serum hemoglobin and iron parameters did not differ between IDA patients with and without FM. IDA was detected in 48 (24.5%) of 196 FM patients. FM patients without IDA had higher sleep disturbance scores (p = 0.012) and longer duration of FM (p = 0.045). FM was a common finding in patients with IDA and TM. FM was associated with female sex and history of pica in IDA patients, and not associated with serum hemoglobin and selected iron parameters. The presence of FM in TM had no association with any of the above-mentioned parameters.

PMID: 18404239 [PubMed - in process]

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Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?

Russo EB.

GW Pharmaceuticals, 2235 Wylie Avenue, Missoula, MT 59802, USA. erusso@montanadsl.net

OBJECTIVES: This study examines the concept of clinical endocannabinoid deficiency (CECD), and the prospect that it could underlie the pathophysiology of migraine, fibromyalgia, irritable bowel syndrome, and other functional conditions alleviated by clinical cannabis. METHODS: Available literature was reviewed, and literature searches pursued via the National Library of Medicine database and other resources. RESULTS: Migraine has numerous relationships to endocannabinoid function. Anandamide (AEA) potentiates 5-HT1A and inhibits 5-HT2A receptors supporting therapeutic efficacy in acute and preventive migraine treatment. Cannabinoids also demonstrate dopamine-blocking and anti-inflammatory effects. AEA is tonically active in the periaqueductal gray matter, a migraine generator. THC modulates glutamatergic neurotransmission via NMDA receptors. Fibromyalgia is now conceived as a central sensitization state with secondary hyperalgesia. Cannabinoids have similarly demonstrated the ability to block spinal, peripheral and gastrointestinal mechanisms that promote pain in headache, fibromyalgia, IBS and related disorders. The past and potential clinical utility of cannabis-based medicines in their treatment is discussed, as are further suggestions for experimental investigation of CECD via CSF examination and neuro-imaging. CONCLUSION: Migraine, fibromyalgia, IBS and related conditions display common clinical, biochemical and pathophysiological patterns that suggest an underlying clinical endocannabinoid deficiency that may be suitably treated with cannabinoid medicines.

PMID: 18404144 [PubMed]

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The effect of laparoscopic Roux-en-Y gastric bypass on fibromyalgia.

Saber AA, Boros MJ, Mancl T, Elgamal MH, Song S, Wisadrattanapong T.

Department of Surgery, Michigan State University/Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo, MI 49008, USA. saber@kcms.msu.edu

BACKGROUND: Fibromyalgia is a chronic debilitating disorder affecting 3-5% of the US population. Treatment of this disorder is a challenge. The incidental finding of improvement of fibromyalgia following laparoscopic Roux-en-Y gastric bypass stimulated us to study this phenomenon. METHODS: A retrospective chart review of patients with fibromyalgia who underwent laparoscopic Roux-en-Y gastric bypass. RESULTS: Postoperative decrease in median of BMI from 49.4 to 29.7 was significant (p value = 0.0010). This was associated with statistically significant improvement in median of pain score (p value = 0.0010) and median points of tenderness (p value = 0.0010). CONCLUSION: Significant weight loss following laparoscopic Roux-en-Y gastric bypass is associated with resolution or improvement of fibromyalgia. Consequently, the bariatric surgeon should be a member of the multidisciplinary team approach for treating fibromyalgia.

PMID: 18401670 [PubMed - indexed for MEDLINE]

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Fibromyalgia relapse evaluation and efficacy for durability of meaningful relief (FREEDOM): a 6-month, double-blind, placebo-controlled trial with pregabalin.

Crofford LJ, Mease PJ, Simpson SL, Young JP Jr, Martin SA, Haig GM, Sharma U.

University of Kentucky, Internal Medicine, Room J-503 Kentucky Clinic, 740 S. Limestone Street, Lexington, KY 40536-0284, USA. lcrofford@uky.edu

This was a multicenter, double-blind (DB), placebo-controlled, randomized discontinuation trial to evaluate the efficacy of pregabalin monotherapy for durability of effect on fibromyalgia (FM) pain. The trial included a 6-week open-label (OL) pregabalin-treatment period followed by 26-week DB treatment with placebo or pregabalin. Adults with FM and 40-mm score on 100-mm pain visual analog scale (VAS) were eligible. During OL weeks 1-3, patients received escalating dosages of pregabalin to determine their optimal dosages. During OL weeks 4-6, patients received their optimal fixed dosages (300, 450, 600mg/d). To be randomized, patients must have had 50% decrease in pain VAS and a self-rating of "much" or "very much" improved on Patient Global Impression of Change (PGIC) at the end of OL. Double-blind treatment was with placebo or the patient's optimal fixed dosage of pregabalin. Primary outcome was time to loss of therapeutic response (LTR), defined as <30% reduction in pain (from OL baseline) or worsening of FM. A total of 1051 patients entered OL; 287 were randomized to placebo, 279 to pregabalin. Time to LTR was longer for pregabalin versus placebo (P<.0001). Kaplan-Meier estimates of time-to-event showed half the placebo group had LTR by Day 19; half the pregabalin group still had not lost response by trial end. At the end of DB, 174 (61%) placebo patients met LTR criteria versus 90 (32%) pregabalin patients. Pregabalin was well tolerated, though 178 (17%) discontinued during OL for treatment-related adverse events (AE), and more pregabalin than placebo patients discontinued for AEs during DB. In those who respond, pregabalin demonstrated durability of effect for relieving FM pain.

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PMID: 18400400 [PubMed - indexed for MEDLINE]


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