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Fibromyalgia
References from 2001 to January 2007
(in order of descending date)
(1)
Alasehirli B, Demiryurek S, Arica E, Gursoy S, Demiryurek AT. No
evidence for an association between the Glu298Asp polymorphism
of the endothelial nitric oxide synthase gene and fibromyalgia
syndrome. Rheumatol Int 2007; 27(3):275-280.
Abstract: The objective of this study was to analyze the
genotype distributions and allele frequencies for the Glu298Asp
(G894T) polymorphism of the eNOS gene and the serum nitric oxide
level among the patients with fibromyalgia syndrome (FS).
Ninety-six fibromyalgia patients and 79 unrelated healthy
volunteer controls were included in the study. All patients and
controls were females. Genomic DNA from 96 patients meeting the
American College of Rheumatology 1990 criteria for FS and 79
healthy controls was analyzed by polymerase chain reaction. A
polymerase chain reaction-restriction fragment-length
polymorphism analysis of eNOS gene polymorphism was performed,
and the results of the patients with FS and healthy controls
were compared. Ozone-based chemiluminescence assay with Sievers
NO Analyzer was used to measure the serum nitric oxide levels.
Neither the frequencies of the Glu298Asp genotypes nor the serum
nitric oxide levels showed a significant difference between the
groups. These results suggested that FS of the Turkish
population seemed to develop without any alterations in eNOS
Glu298Asp genotype frequency and the serum nitric oxide level
(2)
Arshad A, Kong KO. Awareness and perceptions of fibromyalgia
syndrome: a survey of Malaysian and Singaporean rheumatologists.
Singapore Med J 2007; 48(1):25-30.
Abstract: Introduction: Fibromyalgia syndrome (FMS) is a common
but controversial condition. There appears to be different
levels of belief of its existence and awareness. We set out to
explore the variations of perceptions and awareness of this
condition among rheumatologists from Malaysia and Singapore.
Methods: 48 rheumatologists from Malaysia (28) and Singapore
(20) were approached to participate in this survey by answering
a specific questionnaire regarding their belief in FMS. 23
respondents from Malaysia and 20 from Singapore completed the
questionnaire. Results: 91 percent of Malaysian rheumatologists
and 95 percent of the Singaporean believe that FMS is a distinct
clinical entity and that this condition is considered an illness
rather than a disease. 87 percent and 90 percent of
rheumatologists from Malaysia and Singapore, respectively,
believe that FMS is a mixture of medical and psychological
illness. However, not many of those in the university setting
include FMS in their undergraduate teaching. 87 percent and 80
percent of the respondents from Malaysia and Singapore,
respectively, also ordered blood tests to exclude other serious
pathologies, and 100 percent of the respondents from both
countries also prescribed some form of drugs to their FMS
patients. Conclusion: This study confirmed that there was a
variation of perceptions and knowledge of FMS among
rheumatologists from Malaysia and Singapore. The majority of
rheumatologists recognise that FMS is a distinct clinical
entity, and is diagnosed by excluding other well-defined
clinical diseases through a combination of clinical evaluation
and screening tests
(3)
Bach GL, Clement DB. Efficacy of Farabloc as an analgesic in
primary fibromyalgia. Clin Rheumatol 2007; .
Abstract: The goal of our study was to determine the efficacy of
Farabloc, an electromagnetic shielding fabric compared to
placebo fabric when worn as a nightgown, as an analgesic in
patients hospitalized with fibromyalgia. In a rheumatologic and
rehabilitation hospital, we performed a phase 1, single-blind
study of patients using Farabloc (F) or placebo (P) gowns for 8
h per night during the 20-day hospitalization and a phase 2,
single-blind crossover study of patients using both F and P
gowns randomly and alternatively switching after 10 of 21 days
hospitalization (phase 1: 42 F, mean age 49.02 years, 35 female,
7 male; 84 P, mean age 48.08 years, 72 female, 12 males; phase
2: 25 F/P, P/F, or P/P, mean age 44.0 years, 24 female, 1 male).
The study involved randomly selected and blinded use of hospital
gown 8 h per night of either F or P fabric. The main outcome
measures were changes from admission or midpoint to discharge in
quantity of pain (QN), quality of pain (QL), and paracetamol use
(PU). In phase 1, all three variables significantly favored F
over P when using paired t test, two sample t test,
Mann-Whitney, and analysis of covariance tests. QN was reduced
(F = -2.03 -/+ 0.99*, P = 0.59 -/+ 0.71). QL was reduced (F =
-10.64 -/+ 5.69*, P = -2.54 -/+ 3.40). PU was reduced (F = 10.69
-/+ 6.68*, P = 26.12 -/+ 9.37). In phase 2, comparing midpoint
to discharge levels in the three variables again favored P/F
over F/P and P/P (>0.001): QN (P/F +16.00 -/+ 8.35* F/P -13.27
-/+ 11.40), QL (P/F +8.71 -/+ 4.75* F/P -6.55 -/+ 5.59), and PU
(F -9.29 -/+ 4.39* P -18.00 -/+ 5.27) (*p = <0.001). Patients
with fibromyalgia had less pain after sleeping in a gown made of
Farabloc than with a placebo fabric. This suggests that Farabloc,
an electromagnetic shielding fabric, has analgesic properties in
fibromyalgia. Reduced pain observation is consistent with
previous studies in phantom limb pain and delayed onset muscle
pain. Limitations of this study include single blind design,
small sample size, and in phase 2, a lack of washout period and
a F/F group
(4)
Buskila D, Sarzi-Puttini P, Ablin JN. The genetics of
fibromyalgia syndrome. Pharmacogenomics 2007; 8(1):67-74.
Abstract: Fibromyalgia syndrome (FMS) is a common chronic
widespread pain syndrome mainly affecting women. Although the
etiology of FMS is not completely understood, varieties of
neuroendocrine disturbances, as well as abnormalities of
autonomic function, have been implicated in its pathogenesis.
The exposure of a genetically predisposed individual to a host
of environmental stressors is presumed to lead to the
development of FMS. Fibromyalgia overlaps with several related
syndromes, collectively compromising the spectrum of the
functional somatic disorder. FMS is characterized by a strong
familial aggregation. Recent evidence suggests a role for
polymorphisms of genes in the serotoninergic, dopaminergic and
catecholaminergic systems in the etiopathogenesis of FMS. These
polymorphisms are not specific for FMS and are similarly
associated with additional comorbid conditions. The mode of
inheritance in FMS is unknown, but it is most probably
polygenic. Recognition of these gene polymorphisms may help to
better subgroup FMS patients and to guide a more rational
pharmacological approach. Future genetic studies conducted in
larger cohorts of FMS patients and matched control groups may
further illuminate the role of genetics in FMS
(5)
Crooks VA. Exploring the altered daily geographies and
lifeworlds of women living with fibromyalgia syndrome: A
mixed-method approach. Soc Sci Med 2007; 64(3):577-588.
Abstract: In this paper I employ data triangulation in order to
investigate the complex nature of the altered lifeworlds and
daily geographies of women living with fibromyalgia syndrome
(FMS). More specifically, I use the findings of in-depth
interviews and a standardized test (the Sickness Impact Profile
[SIP]) in a mixed-method approach to understanding how women's
lives change after the onset of FMS and how their changing
bodies and locations in society and space shape such altered
lifeworlds. These data were collected from 55 women living with
FMS in Ontario, Canada. The experiential evidence shared during
the interviews is used to qualify or explain certain phenomena
observed within the SIP dataset. I focus on four specific
experiences in the women's lives; these are the: (1) onset of
mental haziness and fatigue; (2) development of disrupted
sleep/sleep disorders; (3) removal from paid labour; and (4)
withdrawal from social and recreational activities. It is found
that changes in the women's bodies precipitated some of the most
significant life changes experienced, including altered
identities and diminished incomes, and that altered bodily
realities facilitated or denied access to socio-spatial life. At
the same time, the women's changing locations in society and
space also played a role in bringing about such changes
(6)
Dinler M, Kasikcioglu E, Akin A, Sayli O, Aksoy C, Oncel A et
al. Exercise capacity and oxygen recovery half times of skeletal
muscle in patients with fibromyalgia. Rheumatol Int 2007;
27(3):311-313.
(7)
Dooley DJ, Taylor CP, Donevan S, Feltner D. Ca(2+) channel
alpha(2)delta ligands: novel modulators of neurotransmission.
Trends Pharmacol Sci 2007; .
Abstract: The term 'Ca(2+) channel alpha(2)delta ligands' has
recently been applied to an evolving drug class that includes
gabapentin (Neurontin((R))) and pregabalin (Lyrica((R))), and
reflects significant progress over the past decade in
elucidating the mechanism of action of these drugs: a novel,
specific action at one of the subunits constituting
voltage-sensitive Ca(2+) channels. Binding of these ligands to
the alpha(2)delta subunit is considered to explain their
usefulness in treating several clinical disorders, including
epilepsy, pain from diabetic neuropathy, postherpetic neuralgia
and fibromyalgia, and generalized anxiety disorder. The evidence
indicates a relationship between alpha(2)delta subunit binding
and the modulation of processes that subserve neurotransmission.
This modulation is characterized by a reduction of the excessive
neurotransmitter release that is observed in certain
neurological and psychiatric disorders
(8)
Dreyer L, Mellemkjaer L, Kendall S, Jensen B, nneskiold-Samsoe
B, Bliddal H. Increased cancer risk in patients referred to
hospital with suspected fibromyalgia. J Rheumatol 2007;
34(1):201-206.
Abstract: OBJECTIVE: To analyze whether fibromyalgia (FM) and
FM-like symptoms are related to an increased incidence of
cancer. METHODS: We identified 1361 patients referred on
suspicion of FM in the period 1984-99 from hospital records.
Following the American College of Rheumatology (ACR) criteria,
patients were divided into subgroups with and without confirmed
FM. The cohort was followed to the end of 1999 and linked to the
files of the Danish Cancer Register. Site-specific standardized
incidence ratios (SIR) were calculated. RESULTS: We found no
association between FM and cancer in 1132 female patients with
confirmed FM at our institution (SIR 1.2, 95% CI 0.8-1.8). In
106 women referred for muscle pain and/or tenderness who did not
meet the criteria for FM, an increased overall SIR was observed
(SIR 2.5, 95% CI 1.2-4.6), with increased risk for breast cancer
(SIR 4.8, 95% CI 1.6-11.3) and lymphatic and hematological
cancers (SIR 10.6, 95% CI 1.2-38.2). There were 4 lung cancers
in 84 men with confirmed FM (SIR 12.6, 95% CI 3.4-32.4).
CONCLUSION: Neither confirmed FM nor those without confirmed FM
predicted cancer. An increased risk of breast cancer was found
among those who did not meet the ACR criteria for FM. These
patients should be investigated if they develop any new or
warning symptoms of malignancy, and treating physicians should
be vigilant with screening procedures such as mammography
(9)
Gahimer J, Wernicke J, Yalcin I, Ossanna MJ, Wulster-Radcliffe
M, Viktrup L. A retrospective pooled analysis of duloxetine
safety in 23 983 subjects. Curr Med Res Opin 2007;
23(1):175-184.
Abstract: OBJECTIVE: The safety and tolerability of duloxetine
for major depressive disorder (MDD), generalized anxiety
disorder (GAD), diabetic peripheral neuropathic pain (DPNP),
fibromyalgia, and lower urinary tract disorders (LUTD)
(including female stress urinary incontinence [SUI] and other
LUTDs) has been established in individual clinical studies. The
objective of this manuscript is to characterize the overall
safety profile of duloxetine, regardless of indication, based on
data from the duloxetine exposures integrated safety database.
RESEARCH DESIGN AND METHODS: The duloxetine exposures integrated
safety database was examined using pooled data from 23 983
patients randomized to receive duloxetine in 64 studies for MDD,
GAD, DPNP, fibromyalgia, or LUTDs. Evaluated aspects of drug
safety included treatment-emergent adverse events (TEAEs),
adverse events leading to discontinuation, serious adverse
events (SAEs), clinical laboratory tests, vital signs, and
electrocardiograms. RESULTS: Common TEAEs included nausea,
headache, dry mouth, insomnia, constipation, dizziness, fatigue,
somnolence, diarrhea, and hyperhidrosis. Most TEAEs emerged
early; the majority were mild to moderate in severity, and did
not worsen. Overall, discontinuation rates due to AEs were
20.0%. SAEs occurred at a rate of 3.5% and no single event was
predominant. Mean pulse increased by < 2 beats per minute. Mean
increases in systolic and diastolic blood pressure were < 1
mmHg. Mean alanine transaminase and aspartate transaminase
values increased by < 2 U/L. CONCLUSIONS: The safety profile for
the molecule from the overall duloxetine exposures integrated
safety database suggests that benign and common pharmacologic
side effects occur with duloxetine treatment. Because these
pooled analyses do not allow for statistical comparison to
placebo or active comparator, and include data from five
different studied indications, these data do not suggest
causality for AEs, nor are they necessarily generalizable to
each disease stated studied
(10)
Geisser ME, Gracely RH, Giesecke T, Petzke FW, Williams DA,
Clauw DJ. The association between experimental and clinical pain
measures among persons with fibromyalgia and chronic fatigue
syndrome. Eur J Pain 2007; 11(2):202-207.
Abstract: Evoked or experimental pain is often used as a model
for the study of clinical pain, yet there are little data
regarding the relationship between the two. In addition, there
are few data regarding the types of stimuli and stimulus
intensities that are most closely related to clinical pain. In
this study, 36 subjects with fibromyalgia (FM), chronic fatigue
syndrome (CFS), or both syndromes were administered measures of
clinical pain and underwent a dolorimetry evaluation. Subjects
also underwent experimental pain testing utilizing heat and
pressure stimulation. Stimulation levels evoking low, moderate
and high sensory intensity, and comparable levels of
unpleasantness, were determined for both types of stimuli using
random staircase methods. Clinical pain was assessed using
visual analogue ratings and the short form of the McGill Pain
Questionnaire (MPQ). Ratings of heat pain sensation were not
significantly associated with clinical pain ratings, with the
exception of unpleasantness ratings at high stimulus
intensities. Pain threshold and tolerance as assessed by
dolorimetry were significantly associated with average measures
of clinical pain. Both intensity and unpleasantness ratings of
pressure delivered using random staircase methods were
significantly associated with clinical pain at low, moderate and
high levels, and the strength of the association was greater at
increasingly noxious stimulus intensities. These findings
suggest that random pressure stimulation as an experimental pain
model in these populations more closely reflects the clinical
pain for these conditions. These findings merit consideration
when designing experimental studies of clinical pain associated
with FM and CFS
(11)
Guedj E, Taieb D, Cammilleri S, Lussato D, de LC, Niboyet J et
al. (99m)Tc-ECD brain perfusion SPECT in hyperalgesic
fibromyalgia. Eur J Nucl Med Mol Imaging 2007; 34(1):130-134.
Abstract: PURPOSE: Neuro-imaging studies with (99m)Tc-HMPAO
SPECT in fibromyalgia (FM) patients have reported only limited
subcortical hypoperfusion. (99m)Tc-ECD SPECT is known to provide
better evaluation of areas of high cerebral blood flow and
regional metabolic rate. We evaluated a homogeneous group of
hyperalgesic patients with FM using (99m)Tc-ECD SPECT. The aim
of this study was to investigate brain processing associated
with spontaneous pain in FM patients. METHODS: Eighteen
hyperalgesic FM women (mean age 49 years, range 25-63 years;
American College of Rheumatology criteria) and ten healthy women
matched for age were enrolled in the study. A voxel-by-voxel
group analysis was performed using SPM2 (p<0.05, corrected for
multiple comparisons). Visual Analogue Scale score for pain was
82+/-4 at the time of the SPECT study. RESULTS: Compared with
control subjects, we observed individual brain SPECT
abnormalities in FM patients, confirmed by SPM2 analysis, with
hyperperfusion of the somatosensory cortex and hypoperfusion of
the frontal, cingulate, medial temporal and cerebellar cortices.
CONCLUSION: In the present study, performed without noxious
stimuli in hyperalgesic FM patients, we found significant
hyperperfusion in regions of the brain known to be involved in
the sensory dimension of pain processing and significant
hypoperfusion in areas assumed to be associated with the
affective-attentional dimension. As current pharmacological and
non-pharmacological therapies act differently on the two
components of pain, we hypothesise that SPECT could be a
valuable and readily available tool to guide individual
therapeutic strategy and provide objective follow-up of pain
processing recovery under treatment
(12)
Gulec H, Sayar K. Reliability and validity of the Turkish form
of the Somatosensory Amplification Scale. Psychiatry Clin
Neurosci 2007; 61(1):25-30.
Abstract: In this study, the authors aimed to investigate the
reliability and validity of the Somatosensory Amplification
Scale (SSAS) that was developed by Barsky et al. in the Turkish
population. The study was carried out with 42 patients with
Fibromyalgia Syndrome and Asthma Diseases attending to
outpatient Physical Therapy and Rehabilitation and Chest
Diseases clinics and 86 healthy students from Karadeniz
Technical University. SSAS scores were normally distributed, and
had acceptable test-retest reliability (r: 0.73) and internal
consistency (alpha, 0.62-0.76). Item to scale correlations
varied from 0.10 to 0.72, and most were highly significant.
Whereas, one item (item 1) in the control group and one item
(item 2) in the patients group had low item-total score
correlation (r < 0.15). Criterion related validity of the SSAS
was shown with significant correlation between the Symptom
Interpretation Questionnaire, the Toronto Alexithymia Scale and
the Symptom Check List 90 Revised somatization subscale. The
validity analysis of the scale resulted in a very high
significant difference (P < 0.01) between the mean SSAS scores
of the control and patient's group. Test-retest, internal
reliability, and item-total score correlation, discriminating
power for specific groups and criterion related validity of the
SSAS show that the scale has acceptable reliability and validity
for the Turkish population
(13)
Hassett AL, Radvanski DC, Vaschillo EG, Vaschillo B, Sigal LH,
Karavidas MK et al. A Pilot Study of the Efficacy of Heart Rate
Variability (HRV) Biofeedback in Patients with Fibromyalgia.
Appl Psychophysiol Biofeedback 2007; .
Abstract: Fibromyalgia (FM) is a non-inflammatory rheumatologic
disorder characterized by musculoskeletal pain, fatigue,
depression, cognitive dysfunction and sleep disturbance.
Research suggests that autonomic dysfunction may account for
some of the symptomatology of FM. An open label trial of
biofeedback training was conducted to manipulate suboptimal
heart rate variability (HRV), a key marker of autonomic
dysfunction. Methods: Twelve women ages 18-60 with FM completed
10 weekly sessions of HRV biofeedback. They were taught to
breathe at their resonant frequency (RF) and asked to practice
twice daily. At sessions 1, 10 and 3-month follow-up,
physiological and questionnaire data were collected. Results:
There were clinically significant decreases in depression and
pain and improvement in functioning from Session 1 to a 3-month
follow-up. For depression, the improvement occurred by Session
10. HRV and blood pressure variability (BPV) increased during
biofeedback tasks. HRV increased from Sessions 1-10, while BPV
decreased from Session 1 to the 3 month follow-up. Conclusions:
These data suggest that HRV biofeedback may be a useful
treatment for FM, perhaps mediated by autonomic changes. While
HRV effects were immediate, blood pressure, baroreflex, and
therapeutic effects were delayed. This is consistent with data
on the relationship among stress, HPA axis activity, and brain
function
(14)
Hidalgo J, Rico-Villademoros F, Calandre EP. An open-label study
of quetiapine in the treatment of fibromyalgia. Prog
Neuropsychopharmacol Biol Psychiatry 2007; 31(1):71-77.
Abstract: The aim of this exploratory study was to
systematically assess the potential effectiveness and
tolerability of quetiapine, an atypical antipsychotic, for the
treatment of patients with fibromyalgia. This was a unicentre,
open-label study conducted in thirty-five outpatients, 18 years
or older, who met the ACR criteria for fibromyalgia and who had
not satisfactorily responded to their previous fibromyalgia
treatment. Quetiapine, flexibly dosed (25-100 mg/day), was added
to their original treatment regimen for 12 weeks. The primary
outcome measure was the mean change from baseline to endpoint in
the Fibromyalgia Impact Questionnaire (FIQ) total score.
Secondary efficacy measures included mean changes from baseline
to endpoint in the scores of the Clinical Global Impression
(CGI) of Severity scale, Pittsburgh Sleep Quality Index (PSQI),
Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI),
12-Item Short Form Health Survey (SF-12), and individual items
of the FIQ. Thirty (85.7%) patients (mean age 47+/-7.9, 93.3%
females) had a postbaseline evaluation and constituted the
intent-to-treat efficacy sample. Mean FIQ total score decreased
significantly by 10.2 points from a baseline of 63.2 to 53.0 at
study endpoint (p<0.001). A statistically significant reduction
was observed in FIQ stiffness and FIQ fatigue subscores but not
in FIQ pain subscore. Large effect sizes were observed for the
FIQ total (1.04), CGI-severity (1.00) and PSQI (1.07), while
moderate effect sizes (i.e.>/=0.50) were encountered in the FIQ
fatigue, FIQ stiffness and SF-12 mental component summary.
Quetiapine was safely administered and well tolerated. Despite
the lack of effect on pain, the significant and relevant
improvement in overall efficacy measures and quality of life
suggests that quetiapine may be a valuable drug for treatment of
patients with fibromyalgia that should be further tested in
double-blind, placebo-controlled trials
(15)
Hooper MM, Stellato TA, Hallowell PT, Seitz BA, Moskowitz RW.
Musculoskeletal findings in obese subjects before and after
weight loss following bariatric surgery. Int J Obes (Lond) 2007;
31(1):114-120.
Abstract: OBJECTIVE: To determine the point prevalence of
painful musculoskeletal (MSK) conditions in obese subjects
before and after weight loss following bariatric surgery.
DESIGN: Longitudinal, interventional, unblended.Subjects:Forty-eight
obese subjects (47 women, one man, mean age 44+/-9 years; mean
body mass index (BMI) 51+/-8 kg/m(2)) recruited from an academic
medical center bariatric surgery program. MEASUREMENTS: Comorbid
medical conditions; MSK findings; BMI; Western Ontario McMaster
Osteoarthritis Index (WOMAC) for pain, stiffness and function;
and SF-36 for quality of life. METHODS: Consecutive subjects
were recruited from the University Hospitals of Cleveland
Bariatric Surgery Program. Musculoskeletal signs and symptoms
and non-MSK comorbid conditions were documented at baseline and
at follow-up. Subjects completed the SF-36 and the WOMAC
questionnaires. Analyses were carried out for each MSK site,
fibromyalgia syndrome (FMS) and for the cumulative effect on the
spine, upper and lower extremities. The impact of change in
comorbid medical conditions, BMI, physical and mental health
domains of the SF-36 on the WOMAC pain subscale score was
evaluated. SF-36 outcomes were compared to normal published
controls. RESULTS: Forty-eight subjects were available for
baseline and a follow-up assessment 6-12 months after gastric
bypass surgery. They lost an average of 41+/-15 kg and the mean
BMI decreased from 51+/-8 to 36+/-7 kg/m(2). Baseline comorbid
medical conditions were present in 96% before surgery and 23%
after weight loss. There was an increased prevalence of painful
MSK conditions at baseline compared to general population
frequencies. Musculoskeletal complaints had been present in 100%
of obese subjects before, and 23% after weight loss. The
greatest improvements occurred in the cervical and lumbar spine,
the foot and in FMS (decreased by 90, 83, 83 and 92%,
respectively). Seventy-nine percent had upper extremity MSK
conditions before and 40% after weight loss. Before surgery,
100% had lower extremity MSK conditions and only 37% did after
weight loss. The WOMAC subscale and composite scores all
improved significantly, as did the SF-36((R)). Change in BMI was
the main factor impacting the WOMAC pain score. CONCLUSION:
There was a higher frequency of multiple MSK complaints,
including non-weight-bearing sites compared to historical
controls, before surgery, which decreased significantly at most
sites following weight loss and physical activity. These
benefits may improve further, as weight loss may continue for up
to 24 months. The benefits seen with weight loss indicate that
prevention and treatment of obesity can improve MSK health and
function
(16)
Hooten WM, Townsend CO, Sletten CD, Bruce BK, Rome JD. Treatment
outcomes after multidisciplinary pain rehabilitation with
analgesic medication withdrawal for patients with fibromyalgia.
Pain Med 2007; 8(1):8-16.
Abstract: Objective. This study of patients with a diagnosis of
fibromyalgia (FM) was conducted to test the hypothesis that
immediate posttreatment measures of psychosocial functioning,
health attributes, negative pain-related emotions, and
depressive symptoms improve significantly during
multidisciplinary pain rehabilitation while concurrently
withdrawing analgesic medications. Design. Prospective case
series. Setting. Multidisciplinary pain rehabilitation center at
a tertiary referral medical center. Patients. In total, 159
consecutive patients with a diagnosis of FM admitted to the pain
rehabilitation program from January 2002 to December 2003.
Interventions. A 3-week outpatient multidisciplinary pain
rehabilitation program based on a cognitive-behavioral model
that incorporates analgesic medication withdrawal. Outcome
Measures. Multidimensional Pain Inventory (MPI), Short Form-36
Health Status Questionnaire (SF-36), Coping Strategies
Questionnaire-Catastrophizing subscale (CSQ-C), and the Center
for Epidemiologic Studies-Depression scale (CES-D) were
administered at admission and dismissal and the mean differences
in scores were compared using paired t-tests. The number of
patients using opioid analgesics, nonsteroidal anti-inflammatory
drugs (NSAIDs), benzodiazepines, and muscle relaxants at
admission and dismissal were compared using chi-squared
analyses. Results. The difference in admission and dismissal
scores from the MPI, SF-36, CSQ-C, and CES-D demonstrated a
favorable response to treatment (P < 0.001). Compared with
admission, the number of patients using opioids (P < 0.001),
NSAIDs (P < 0.001), benzodiazepines (P < 0.001), and muscle
relaxants (P < 0.01) at program dismissal was significantly
reduced. Conclusion. The results of this study support the
hypothesis that immediate posttreatment measures of physical and
emotional functioning are favorable for patients with FM
following multidisciplinary pain rehabilitation that
incorporates withdrawal of analgesic medications
(17)
Ifergane G, Shelef I, Buskila D. Migraine and fibromyalgia
developing after a pontine haemorrhage.
Cephalalgia 2007; 27(2):191.
(18) Jespersen A, Dreyer L, Kendall S, Graven-Nielsen T,
rendt-Nielsen L, Bliddal H et al.
Computerized
cuff pressure algometry: A new method to assess deep-tissue
hypersensitivity in fibromyalgia. Pain 2007; .
Abstract: The aim of this study was to evaluate the use of
computerized cuff pressure algometry (CPA) in fibromyalgia (FM)
and to correlate deep-tissue sensitivity assessed by CPA with
other disease markers of FM. Forty-eight women with FM and 16
healthy age-matched women were included. A computer-controlled,
pneumatic tourniquet cuff was placed over the gastrocnemius
muscle. The cuff was inflated, and the subject rated the pain
intensity continuously on an electronic Visual Analogue Scale
(VAS). The subject stopped the inflation at the pressure-pain
tolerance and the corresponding VAS-score was determined
(pressure-pain limit). The pressure at which VAS firstly
exceeded 0 was defined as the pressure-pain threshold. Other
disease markers (FM only): Isokinetic knee muscle strength,
tenderpoint-count, myalgic score, Beck Depression Inventory, and
Fibromyalgia Impact Questionnaire. Student's T-test was used to
compare pressure-pain threshold and pressure-pain tolerance and
the Mann-Whitney test to compare pressure-pain limit. Pearson's
correlation was used to detect linear relationships.
Pressure-pain threshold and pressure-pain tolerance assessed by
CPA were significantly lower in FM compared to healthy controls.
There was no difference in pressure-pain limit. CPA-parameters
were significantly correlated to isokinetic muscle strength
where more hypersensitivity resulted in lower strength.
Pressure-pain threshold and pressure-pain tolerance assessed by
CPA were significantly lower in patients with FM indicating
muscle hyperalgesia. CPA was associated with knee muscle
strength but not with measures thought to be influenced by
psychological distress and mood
(19) Jones KD, Deodhar P, Lorentzen A, Bennett RM, Deodhar
AA.
Growth Hormone Perturbations in Fibromyalgia: A Review. Semin
Arthritis Rheum 2007; .
Abstract: OBJECTIVE: Fibromyalgia (FM) is a syndrome
characterized by chronic widespread pain, fatigue, disrupted
sleep, depression, and physical deconditioning. In this article,
we review the literature on the normal activity of the
hypothalamic-pituitary-growth hormone-insulin-like growth
factor-1 (HP-GH-IGF-1) axis and its perturbations in FM
subjects. METHODS: Studies included in this review were accessed
through an English language search of Cochrane Collaboration
Reviews. Keyword MeSH terms included "fibromyalgia," "growth
hormone" (GH), or "insulin-like growth factor-1" (IGF-1).
RESULTS: Twenty-six studies enrolling 2006 subjects were
reviewed. Overall, low levels of IGF-1 were found in a subgroup
of subjects. Growth hormone stimulation tests often revealed a
suboptimal response, which did not always correlate with IGF-1
levels. No consistent defects in pituitary function were found.
Of the 3 randomized placebo controlled studies, only 9 months of
daily injectable recombinant GH reduced FM symptoms and
normalized IGF-1. CONCLUSIONS: These studies suggest that
pituitary function is normal in FM and that reported changes in
the HP-GH-IGF-1 axis are most likely hypothalamic in origin. The
therapeutic efficacy of supplemental GH therapy in FM requires
further study before any solid recommendations can be made
(20)
Kadetoff D, Kosek E. The effects of static muscular contraction
on blood pressure, heart rate, pain ratings and pressure pain
thresholds in healthy individuals and patients with
fibromyalgia. Eur J Pain 2007; 11(1):39-47.
Abstract: Aberrations of cardiovascular regulation and
dysfunction of endogenous pain modulation have been reported in
fibromyalgia (FM) patients. This study aimed at investigating
the interactions between cardiovascular regulation and pain
perception during static muscle contractions. Seventeen FM
patients and 17 healthy controls performed a standardised static
contraction (m. quadriceps femoris dx) until exhaustion. Blood
pressure (BP), heart rate (HR), ratings of exertion/fatigue and
pain intensity as well as pressure pain thresholds (PPTs) (at m.
quadriceps dx and m. deltoideus dx) were assessed before, during
and 15 min following contraction. Systolic and diastolic BP
increased during contraction (p<0.001) and decreased following
contraction (p<0.001) in both groups alike. A significant
increase in HR was seen during contraction in FM patients
(p<0.001), but not in healthy controls (difference between
groups p<0.02). The rated exertion/fatigue and pain intensity
increased more during contraction and remained elevated longer
following contraction in the patient group. PPTs were lower in
patients compared to controls at both sites at all times
(p<0.001). No group differences in PPT changes over time were
found. In conclusion, no indication of an attenuated
cardiovascular response to exercise was found in our FM
patients. The more pronounced HR increase in patients during
contraction was most likely due to deconditioning. No exercise
related change in PPTs was seen in either group, most likely due
to insufficient exercise intensity, but the contraction induced
pain was more pronounced in the FM patients
(21)
Kim SH. Skin biopsy findings: Implications for the
pathophysiology of fibromyalgia. Med Hypotheses 2007; .
Abstract: The mechanisms responsible for symptom expression in
fibromyalgia (FM) are complex. The most consistently detected
objective abnormalities in FM involve pain-processing systems.
Up to recently, central nervous system was a primary focus of
investigations in FM. Although it is unlikely that FM occurs
because of primary disorders of the peripheral tissues, there
are still data to suggest that some abnormalities can be
detected in the periphery. With the recognition of abnormalities
in skin of some FM patients, it is now apparent that the role of
peripheral nerve endings in FM is much greater than previously
thought. The aim of this paper is to review literature
concerning the skin biopsy findings of FM patients and discuss
their potential relevance to FM. This paper suggests that
patients with FM represent a state of the dysfunction of
descending, antinociceptive pathways and low
hypothalamic-pituitary-adrenal function. This state is further
proposed to result in many skin biopsy findings associated with
the disorder, including increased N-methyl-d-aspartate receptors
subtype 2D expression, neurogenic inflammation and
characteristic electron microscopic findings. Future direction
of research would be identification of specific laboratory
markers such as skin biopsy for diagnostic and clinical
evaluation purposes in FM
(22)
Kivimaki M, Leino-Arjas P, Kaila-Kangas L, Virtanen M, Elovainio
M, Puttonen S et al. Increased absence due to sickness among
employees with fibromyalgia. Ann Rheum Dis 2007; 66(1):65-69.
Abstract: BACKGROUND: Little is known about the effect of
fibromyalgia on absence due to sickness in working populations.
OBJECTIVE: To examine the risk of absence due to sickness among
employees with fibromyalgia. METHODS: A prospective cohort study
with 1-year follow-up of recorded and certified absence due to
sickness after a survey of chronic diseases among 34 100 Finnish
public sector employees (27 360 women and 6740 men) aged 17-65
years at baseline in 2000-2. RESULTS: 20 224 days of absence due
to sickness for the 644 employees with fibromyalgia and 454 816
days for others were documented. Of those with fibromyalgia, 67%
had co-occurring chronic conditions such as osteoarthritis,
rheumatoid arthritis, depression or other psychiatric disorders.
Compared with employees with none of these chronic conditions,
the hazard ratio (HR) adjusted for age, sex and occupational
status was 1.85-fold (95% confidence interval (CI) 1.53 to 2.18)
for people with fibromyalgia alone and 2.63-fold (95% CI 2.34 to
2.96) for employees with fibromyalgia with coexisting
conditions. The excess rate of absence due to sickness was 61
episodes/100 person-years among people with fibromyalgia alone.
Among employees with musculoskeletal and psychiatric disorders,
secondary fibromyalgia was associated with a 1.4-1.5-fold
increase in risk of absence. CONCLUSION: Fibromyalgia is
associated with a substantially increased risk of medically
certified absence due to sickness that is not accounted for by
coexisting osteoarthritis, rheumatoid arthritis or psychiatric
disorders
(23)
Lakomek HJ, Lakomek M, Bosquet-Nahrwold K. [Fibromyalgia.
Diagnostics - Disease Approach - Therapy.]. Med Klin (Munich)
2007; 102(1):23-29.
Abstract: Fibromyalgia is a complex of symptoms predominantly
affecting females and consisting of widespread pain.Etiology and
pathogenesis are not sufficiently known yet, however, there is
the assumption that fibromyalgia is looked at as being an
illness with biological, psychological, and social aspects.
Therefore, the treatment of fibromyalgia calls for a multimodal
therapy approach.The importance of fibromyalgia has been
recognized within the German health system by creating the new
ICD code M79.70 and by assigning fibromyalgia its own
rheumatologic DRG (I79Z).In future research of fibromyalgia
special attention needs to be placed upon gender-specific
problems
(24)
Loevinger BL, Muller D, Alonso C, Coe CL. Metabolic syndrome in
women with chronic pain. Metabolism 2007; 56(1):87-93.
Abstract: Fibromyalgia is a prevalent syndrome characterized by
chronic pain, fatigue, and insomnia. Patients with fibromyalgia
commonly have an elevated body mass index and are physically
inactive, 2 major risk factors for metabolic syndrome. Yet
little is known about the relationship between chronic pain
conditions and metabolic disturbances. Our study evaluated the
risk for, and neuroendocrine correlates of, metabolic syndrome
in this patient population. Women with fibromyalgia (n = 109)
were compared with control healthy women (n = 46), all recruited
from the community. Metabolic syndrome was identified by using
criteria from the Adult Treatment Panel III with glycosylated
hemoglobin concentrations substituted for serum glucose.
Catecholamine and cortisol levels were determined from 12-hour
overnight urine collections. Women with fibromyalgia were 5.56
times more likely than healthy controls to have metabolic
syndrome (95% confidence interval, 1.25-24.74). Fibromyalgia was
associated with larger waist circumference (P = .04), higher
glycosylated hemoglobin (P = .01) and serum triglyceride (P <
.001) levels, and higher systolic (P = .003) and diastolic (P =
.002) blood pressure. Total and low-density lipoprotein
cholesterol were also significantly higher in women with
fibromyalgia (P = .001 and .02, respectively), although
high-density lipoprotein cholesterol was in the reference range.
These associations were not accounted for by age or body mass
index. Meeting criteria for more metabolic syndrome components
was related to higher urinary norepinephrine (NE)/epinephrine
and NE/cortisol ratios (P < .001 and P = .009, respectively).
Women with chronic pain from fibromyalgia are at an increased
risk for metabolic syndrome, which may be associated with
relatively elevated NE levels in conjunction with relatively
reduced epinephrine and cortisol secretion
(25)
Marotte H, Fontanges E, Bailly F, Zoulim F, Trepo C, Miossec P.
Etanercept treatment for three months is safe in patients with
rheumatological manifestations associated with hepatitis C
virus. Rheumatology (Oxford) 2007; 46(1):97-99.
Abstract: OBJECTIVE: The treatment of the rheumatological
manifestations associated with hepatitis C virus (HCV) remains
difficult. To examine the safety of anti-tumour necerosis
factor-alpha treatment, nine patients having rheumatological
manifestations associated with HCV were treated with etanercept
25 mg twice a week for 3 months. METHODS: Five patients had a
positive viral load at study entry (Group I), four were negative
(Group II). Clinical data recorded were: disease duration,
painful and swollen joint count, patient global and physician
global assessment, the number of 18 specified fibromyalgia
tender points and the Health Assessment Questionnaire score.
Laboratory studies included checking for the presence of
cryoglobulinaemia and transaminase levels. Quantitative HCV
viral RNA was performed by real-time polymerase chain reaction (PCR).
RESULTS: At 3 months, no patient was found to have evidence of
increased hepatic inflammation based on serial serum
transaminase levels. In the five patients from Group I with
detectable HCV RNA, no significant viral load increase was
observed. No reactivation was observed in the four patients from
Group II with undetectable HCV RNA. The effect on the clinical
rheumatological manifestations was more heterogeneous but
appears to be lower than that observed in rheumatoid arthritis.
CONCLUSION: In this phase II open short-term study, etanercept
appeared to be safe in patients with articular manifestations
associated with HCV
(26) Nilsen KB, Sand T, Westgaard RH, Stovner LJ, White LR,
Bang LR et al.
Autonomic
activation and pain in response to low-grade mental stress in
fibromyalgia and shoulder/neck pain patients. Eur J Pain 2007; .
Abstract: OBJECTIVE: Psychosocial stress is a risk factor for
musculoskeletal pain, but how stress affects musculoskeletal
pain is poorly understood. We wanted to examine the relationship
between low-grade autonomic activation and stress-related pain
in patients with fibromyalgia and localised chronic
shoulder/neck pain. METHODS: Twenty-three female patients with
fibromyalgia, 29 female patients with chronic shoulder-neck
pain, and 35 healthy women performed a stressful task lasting
60min. With a blinded study design, we recorded continuous blood
pressure, heart rate, finger skin blood flow and respiration
frequency before (10min), during (60min) and after (30min) the
stressful task. The physiological responses were compared with
subjective reports of pain. RESULTS: The increase in diastolic
blood pressure and heart rate in response to the stressful task
were smaller in fibromyalgia patients compared with the healthy
controls. Furthermore, fibromyalgia patients had reduced finger
skin blood flow at the end of the stressful task compared to
healthy controls. We also found an inverse relationship between
the heart rate response and development and recovery of the
stress-related pain in fibromyalgia patients. CONCLUSION: We
found abnormal cardiovascular responses to a 60min long
stressful task in fibromyalgia patients. Furthermore, we found a
negative association between the heart rate response and the
pain which developed during the stressful task in the
fibromyalgia group, possibly a result of reduced stress-induced
analgesia for fibromyalgia patients
(27) Onat AM, Ozturk MA, Ozcakar L, Ureten K, Kaymak SU,
Kiraz S et al.
Selective
serotonin reuptake inhibitors reduce the attack frequency in
familial mediterranean Fever. Tohoku J Exp Med 2007;
211(1):9-14.
Abstract: Familial Mediterranean Fever (FMF) is characterized by
recurrent acute attacks of fever and serositis, and colchicine
is the primary treatment. The pathogenesis of the disease has
not been fully understood. Resistance to colchicine remains to
be a problem in up to 30% of the patients and yet there seems to
be no alternative treatment. In this study our objective was to
investigate whether a selective serotonin re-uptake inhibitor
(SSRI) could affect the attack frequency and acute phase
response in FMF patients who were unresponsive to colchicine. We
retrospectively evaluated the hospital files of 11
colchicine-unresponsive FMF patients who had been treated with
SSRIs. According to the records and re-evaluation of the
patients, the total number of the FMF attacks was calculated
before and after the SSRI, adjunct to colchicine. The laboratory
values including erythrocyte sedimentation rate, C-reactive
protein, fibrinogen and white blood cell counts were also noted
before and after the SSRI treatment from their hospital files.
The mean attack frequency before adding SSRI to colchicine was
8.09 +/- 3.53 per 6 months, and at the end of this period there
was a great decline in the number of mean attack frequency (0.36
+/- 0.50 attacks per 6 months) (p < 0.001). Acute phase
reactants were significantly decreased after SSRI treatment (p <
0.001). All of the colchicine-unresponsive patients had
depression and 3 of those patients also had fibromyalgia. SSRIs
appear to be useful adjuncts in the management of FMF patients
who continue to have attacks despite regular colchicine
treatment
(28)
Pamuk ON, Cakir N. The frequency of thyroid antibodies in
fibromyalgia patients and their relationship with symptoms. Clin
Rheumatol 2007; 26(1):55-59.
Abstract: We determined the frequency of thyroid autoantibodies
in fibromyalgia (FM) patients and the relationship between FM
symptoms and these antibodies. Euthyroid 128 FM patients, 64
rheumatoid arthritis (RA) patients, and 64 healthy control
subjects were included in the study. The sociodemographic
features and the clinical features of FM patients were
determined. By using a visual analog scale, patients were
questioned about the severity of FM-related symptoms. All
patients were administered with Duke-Anxiety Depression
(Duke-AD) scale, the physical function items of the fibromyalgia
impact questionnaire scale. Thyroid autoimmunity was defined as
the presence of detectable antithyroglobulin (TgAb) and/or
antithyroid peroxidase (TPOAb) antibodies by the immunometric
methods. Patients with a connective tissue disorder, hypo- or
hyperthyroidism, and patients who had psychiatric treatment
within the last 6 months were not included into the study. The
frequencies of thyroid autoimmunity in FM (34.4%) and RA (29.7%)
patients were significantly higher than controls (18.8%)
(p<0.05). Twenty-six (20.3%) FM patients had positive TgAb and
31 (24.2%) had positive TPOAb. When patients with thyroid
autoimmunity were compared to others, it was seen that the mean
age, the percentage of postmenopausal patients, the frequency of
dryness of the mouth, and the percentage of patients with a
previous psychiatric treatment were higher in this group
(p<0.05). FM patients had thyroid autoimmunity similar to the
frequency in RA and higher than controls. Age and postmenopausal
status seemed to be associated with thyroid autoimmunity in FM
patients. The presence of thyroid autoimmunity had no
relationship with the depression scores of FM patients
(29)
Pieczenik SR, Neustadt J. Mitochondrial dysfunction and
molecular pathways of disease. Exp Mol Pathol 2007; .
Abstract: Since the first mitochondrial dysfunction was
described in the 1960s, the medicine has advanced in its
understanding the role mitochondria play in health, disease, and
aging. 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, have underlying
pathophysiological mechanisms in common, namely reactive oxygen
species (ROS) production, the accumulation of mitochondrial DNA
(mtDNA) damage, resulting in mitochondrial dysfunction.
Antioxidant therapies hold promise for improving mitochondrial
performance. Physicians seeking systematic treatments for their
patients might consider testing urinary organic acids to
determine how best to treat them. If in the next 50 years
advances in mitochondrial treatments match the immense increase
in knowledge about mitochondrial function that has occurred in
the last 50 years, mitochondrial diseases and dysfunction will
largely be a medical triumph
(30)
Sabayan B, Bagheri M, Borhani HA. Possible joint origin of
restless leg syndrome (RLS) and migraine. Med Hypotheses 2007; .
Abstract: Sleep disorders have been described in migraine
patients. Among sleep disorders RLS has been reported in up to
one-third of migraineurs. Adverse effects of anti migraine
therapy by dopamine antagonists can not fully explain this
association. Therefore we present the hypothesis that RLS and
migraine may have a joint origin. The hypothesis is supported
by: (1) the same genetic origin for migraine without aura and
RLS in single Italian family on chromosome 14q21; this gene
codes survival motor neuron-interacting protein 1 (SIP1) which
can play role in both diseases. (2) Correlation of both RLS and
migraine with fibromyalgia. (3) Alteration of cortical
excitability in both migraine and RLS
(31) Su SY, Chen JJ, Lai CC, Chen CM, Tsai FJ.
The
association between fibromyalgia and polymorphism of monoamine
oxidase A and interleukin-4. Clin Rheumatol 2007; 26(1):12-16.
Abstract: Because fibromyalgia (FM) is often comorbid with
anxiety, and monoamine oxidase A (MAOA) was reported to be
associated with anxiety, we determine if there is MAOA gene
polymorphism associated with FM patients. Moreover, interleukin
4 (IL-4) was found to be an important cytokine participating in
the immunologic pathway of T-helper 2 (Th-2) cells, in this
study, we search if the genetic polymorphism of IL-4 intron3
could be demonstrated in FM patients. The genotype of sixty-two
FM patients was compared with that of control subjects. The
polymorphism of IL-4 intron3 variable number of tandem repeats
(VNTR) was demonstrated by performing the genomic polymerase
chain reaction (PCR) and analyzing the length of PCR product.
Furthermore, the MAOA 941 G to T polymorphism was also
determined by PCR-RFLP (restriction fragment length
polymorphism) analysis. The MAOA 941 position genotype
polymorphism between FM and control subjects was found neither
statistically different in male (p=0.60) or female (p=0.52), nor
total allelic frequency (p=0.52). Similarly, the difference of
IL-4 intron3 polymorphism between FM and control was neither
existing in genotype (p=0.06), nor allele frequency (p=0.07).
The result suggests either the genetic linkage between FM and
anxiety or that between FM and immunologic diseases are weak.
Accordingly, the MAOA 941 position and IL-4 intron3
polymorphisms are not susceptible markers to predict FM
(32)
Veerapen K, Wigley RD, Valkenburg H. Musculoskeletal pain in
Malaysia: a COPCORD survey. J Rheumatol 2007; 34(1):207-213.
Abstract: OBJECTIVE: To assess the nature and extent of
rheumatic complaints in a semirural area in a multiracial
(Malay, Indian, Chinese) community in Malaysia using the
Community Oriented Program for the Control of Rheumatic Diseases
(COPCORD) protocol initiated by ILAR and the WHO. METHODS: All
members of a community of 2700 persons over the age of 15 years
were offered a questionnaire based interview in Phase 1 of the
study. Those with rheumatic complaints (pain in the last 1 week)
were invited for a physical examination by a rheumatologist in
Phase 2. RESULTS: In total, 2594 (96%) persons agreed to a
questionnaire based interview. Of those interviewed, 21.1% had a
current rheumatic complaint. The pain rate was higher in women
(23.8%) than in men (17.8%). Chinese men had the lowest
age-standardized pain rate (9.9%), while Indian women had the
highest rate (28.4%). In the study population, 14.4% complained
of pain in the joints and/or musculoskeletal pain and 11.6% had
low back pain. The knee was responsible for 64.8% of all
complaints pertaining to the joints, and more than half those
examined with knee pain had clinical evidence of osteoarthritis
(OA). The complaint rate increased with age, up to 53.4% in the
group age > 65 years. The major disability encountered was the
inability to squat (3.1%). Fibromyalgia, soft tissue lesions,
and localized OA of the knees were the main clinical diagnoses.
Inflammatory arthritis was uncommon. Both Western and
traditional sources of healthcare were used, often together.
Self-medication was common (58.8%). CONCLUSION: Knee and back
pain are the main rheumatic complaints in Malaysia, with
complaint rates differing according to race and gender
(33)
Williams DA, Gracely RH. Biology and therapy of fibromyalgia.
Functional magnetic resonance imaging findings in fibromyalgia.
Arthritis Res Ther 2007; 8(6):224.
Abstract: ABSTRACT: Techniques in neuroimaging such as
functional magnetic resonance imaging (fMRI) have helped to
provide insights into the role of supraspinal mechanisms in pain
perception. This review focuses on studies that have applied
fMRI in an attempt to gain a better understanding of the
mechanisms involved in the processing of pain associated with
fibromyalgia. This article provides an overview of the
nociceptive system as it functions normally, reviews functional
brain imaging methods, and integrates the existing literature
utilizing fMRI to study central pain mechanisms in fibromyalgia
(34)
Wingenfeld K, Wagner D, Schmidt I, Meinlschmidt G, Hellhammer
DH, Heim C. The low-dose dexamethasone suppression test in
fibromyalgia. J Psychosom Res 2007; 62(1):85-91.
Abstract: OBJECTIVE: Fibromyalgia syndrome (FMS) has been
associated with decreased cortisol secretion. Patients with
posttraumatic stress disorder (PTSD) exhibit similar
hypocortisolism in the context of increased negative feedback
sensitivity of the hypothalamic-pituitary-adrenal (HPA) axis.
Because trauma and PTSD have been associated with fibromyalgia,
we evaluated whether patients with fibromyalgia demonstrate
increased HPA feedback sensitivity. METHOD: Baseline blood
samples were obtained at 0800 h, and 0.5 mg of dexamethasone was
administered to 15 female patients with FMS and 20 normal
controls at 2300 h. Adrenocorticotropin (ACTH), cortisol, and
dexamethasone levels were measured at 0800 h after dexamethasone
intake. RESULTS: There were no group differences in mean ACTH or
cortisol levels or in ACTH/cortisol ratio at baseline. After
dexamethasone intake, patients with FMS exhibited more
pronounced suppression of cortisol but not of ACTH, as well as
increased ACTH/cortisol ratios compared with controls. Percent
cortisol suppression was associated with pain and fatigue, while
ACTH/cortisol ratio and dexamethasone availability were
associated with stress and anxiety measures. CONCLUSION: Our
results suggest increased sensitivity to glucocorticoid
feedback, manifested at the adrenal level, in FMS
(35)
Wood PB, Patterson JC, Sunderland JJ, Tainter KH, Glabus MF,
Lilien DL. Reduced presynaptic dopamine activity in fibromyalgia
syndrome demonstrated with positron emission tomography: a pilot
study. J Pain 2007; 8(1):51-58.
Abstract: Although the pathophysiology underlying the pain of
fibromyalgia syndrome (FMS) remains unknown, a variety of
clinical and investigational findings suggests a dysregulation
of dopaminergic neurotransmission. We therefore investigated
presynaptic dopaminergic function in 6 female FMS patients in
comparison to 8 age- and gender-matched controls as assessed by
positron emission tomography with 6-[(18)F]fluoro-L-DOPA as a
tracer. Semiquantitative analysis revealed reductions in
6-[(18)F]fluoro-L-DOPA uptake in several brain regions,
indicating a disruption of presynaptic dopamine activity wherein
dopamine plays a putative role in natural analgesia. Although
the small sample size makes these findings preliminary, it
appears that FMS might be characterized by a disruption of
dopaminergic neurotransmission. PERSPECTIVE: An association
between FMS and reduced dopamine metabolism within the pain
neuromatrix provides important insights into the pathophysiology
of this mysterious disorder
(36) Zijlstra TR, Taal E, van de Laar MA, Rasker JJ.
Validation of
a Dutch translation of the fibromyalgia impact questionnaire.
Rheumatology (Oxford) 2007; 46(1):131-134.
Abstract: OBJECTIVES: To validate a Dutch translation of the
fibromyalgia impact questionnaire (FIQ). Materials and METHODS:
Data were taken from two randomized clinical trials on Spa
treatment and venlafaxine in fibromyalgia (FM). Participants
completed the Dutch FIQ and a set of validated questionnaires
for general health (RAND-36), depression (Beck depression
inventory, BDI), pain (McGill pain questionnaire, MPQ) and
fatigue (checklist individual strength, CIS). Internal
consistency within the FIQ item 'physical functioning' was
studied using Cronbach's alpha. Test-retest reliability was
studied with intra-class-correlation (ICC) in a subsample of 76
control subjects over a 3 month period without specific
intervention. Construct validity was evaluated by correlating
the FIQ to other questionnaires. Sensitivity to change was
studied using standardized response means (SRM). RESULTS: The
study sample consisted of 213 women and 11 men (mean age 47 yrs,
mean disease duration 11 yrs). Cronbach's alpha for the item
'physical functioning' was 0.91, indicating high internal
consistency. Test-retest reliability was acceptable, with ICC
ranging from 0.45 for 'morning tiredness' to 0.71 for 'physical
function'. FIQ correlated significantly with the RAND-36, with
Spearman's rho ranging from -0.60 to -0.70 for items measuring
the same concept. Similar patterns of correlation were seen with
MPQ, BDI and CIS. Sensitivity to change was sufficient, with SRM
after Spa treatment ranging from 0.3 for 'work days missed' to
0.9 for 'days felt good'. Similar SRM were found in the
venlafaxine trial for patients reporting general improvement.
CONCLUSION: The Dutch FIQ is a valid instrument for measuring
health status in FM, showing sufficient reliability, construct
validity and responsiveness
(37)
Study finds acupuncture improves fibromyalgia symptoms. Mayo
Clin Womens Healthsource 2006; 10(12):3.
(38)
Duloxetine: new indication. Depression and diabetic neuropathy:
too many adverse effects. Prescrire Int 2006; 15(85):168-172.
Abstract: (1) Several classes of antidepressants are available.
The main difference between these classes is in their short-term
pharmacological effects, leading to different patterns of
adverse effects. Some antidepressants, especially tricyclics,
have positive risk-benefit balances in the treatment of diabetic
neuropathy. (2) Duloxetine, a compound chemically related to
fluoxetine, appears to have a short-term mechanism of action
similar to that of venlafaxine. In the European Union,
duloxetine was first approved for female urinary stress
incontinence. Another brand of duloxetine has since been
marketed for depression and neuropathic pain in diabetic
patients. (3) Duloxetine at a dose of 60 mg once a day showed
moderate efficacy in 2 placebo-controlled trials. At this dose,
however, there are no other comparative trials. It is therefore
not possible to know whether duloxetine is as effective as other
antidepressants. (4) Two placebo-controlled trials involving
patients with pain due to diabetic neuropathy concluded that a
dose of 60 mg/day had efficacy, although of doubtful clinical
relevance. In the absence of comparative trials, however, we do
not know if this efficacy is even equivalent to that of a
tricyclic antidepressant used as an analgesic. (5) In
fibromyalgia, a controversial clinical diagnosis, two
double-blind placebo-controlled trials involving 207 and 354
patients failed to prove that duloxetine had tangible analgesic
efficacy. It is therefore appropriate that this use is not
mentioned in the "Indications" section of the summary of product
characteristics (SPC). (6) The assessment of duloxetine in
depression and neuropathic pain confirms existing data on its
gastrointestinal, neuropsychological and hepatic adverse
effects. In these trials, duloxetine increased blood pressure in
a dose-dependent manner. (7) Duloxetine is metabolized by
cytochrome P450 isoenzymes CYP 1A2 and CYP 2D6, creating an
important risk of interactions with other drugs. (8) In
practice, duloxetine currently has no place in the treatment of
depression or diabetic neuropathy. Its efficacy has not yet been
demonstrated to be even equivalent to that of other available
drugs, and it has too many adverse effects, given this degree of
uncertainty
(39)
Duloxetine effective for fibromyalgia in some women. J Fam Pract
2006; 55(5):382.
(40)
New recommendations for fibromyalgia relief. Heated pool
therapy, certain medications among new treatments. Health News
2006; 12(11):8-9.
(41)
Ablin JN, Shoenfeld Y, Buskila D. Fibromyalgia, infection and
vaccination: Two more parts in the etiological puzzle. J
Autoimmun 2006; 27(3):145-152.
Abstract: As the pathogenesis of fibromyalgia continues to raise
debate, multiple putative triggers have been implicated. The
current review summarizes the available data linking
fibromyalgia to either infection or vaccination. Multiple
infectious agents have been associated with the development of
either full-blown fibromyalgia (e.g. hepatits C), or with
symptom complexes extensively overlapping with that syndrome
(e.g. chronic Lyme disease). The cases of Lyme disease,
mycoplasma, hepatits C and HIV are detailed. Despite the
described associations, no evidence is available demonstrating
the utility of antibiotic or anti-viral treatment in the
management of fibromyalgia. Possible mechanistic links between
fibromyalgia and HIV are reviewed. Associations have been
described between various vaccinations and symptom complexes
including fibromyalgia and chronic fatigue syndrome. The case of
Gulf War syndrome, a functional multisystem entity sharing many
clinical characteristics with fibromyalgia is discussed, with
emphasis on the possibility of association with administration
of multiple vaccinations during deployment in the Persian Gulf
and the interaction with stress and trauma. Based on this
example a model is proposed, wherein vaccinations function as
co-triggers for the development of functional disorders
including fibromyalgia, in conjunction with additional
contributing factors
(42)
Ablin JN, Cohen H, Buskila D. Mechanisms of Disease: genetics of
fibromyalgia. Nat Clin Pract Rheumatol 2006; 2(12):671-678.
Abstract: Fibromyalgia is characterized by widespread pain and
tenderness, and has a significant familial component. The
etiology of fibromyalgia remains unclear, but genetic factors
seem to have a significant role, and are influenced by
environmental factors. Research over the past two decades has
demonstrated that genetic polymorphisms in the serotoninergic,
dopaminergic and catecholaminergic systems of pain transmission
and processing are involved in the etiology of fibromyalgia, but
additional candidates continue to emerge. Fibromyalgia is
thought to belong to the group of affective spectrum disorders,
which include related psychiatric and medical disorders. As the
concept of affective spectrum disorders continues to evolve,
progress in the understanding of the genetic basis of related
functional disorders, such as irritable bowel syndrome and
post-traumatic-stress disorder, is aiding our understanding of
the genetic basis of fibromyalgia
(43)
Ablin JN, Buskila D. The genetics of fibromyalgia--closing
Osler's backdoor. Isr Med Assoc J 2006; 8(6):428-429.
(44)
Alegre C, Vidal-Coll C. [Cell phone devices and fibromyalgia].
Med Clin (Barc ) 2006; 126(13):514.
(45)
Altindag O, Celik H. Total antioxidant capacity and the severity
of the pain in patients with fibromyalgia. Redox Rep 2006;
11(3):131-135.
Abstract: The purpose of the study was to determine the
oxidative and antioxidative status of plasma in patients with
fibromyalgia. Total antioxidant capacity (TAC) of plasma was
significantly lower in patients with fibromyalgia (n = 20) than
in healthy controls (n = 20) [1.5 (SD 0.3) and 1.9 (SD 0.3) mmol
Trolox equiv./l, P = 0.001]. In contrast, the total peroxide
level of plasma was significantly higher in patients than in
healthy controls [37.4 (SD 6.7) and 33.0 (SD 2.7) micromol
H2O2/l; P = 0.01]. The oxidative stress index (OSI) level was
significantly higher in patients with fibromyalgia than in
healthy controls [2.5 (SD 1.0) and 1.8 (SD 0.4); P = 0.007]. A
significant negative correlation between visual analogue scale
(VAS) and TAC level was determined (r = -0.79, P < 0.001). The
present results indicate that patients with fibromyalgia are
exposed to oxidative stress and this increased oxidative stress
may play a role in the etiopathogenesis of the disease.
Supplementation of antioxidant vitamins such as vitamins C and E
to the therapy may be indicated
(46)
Ambalavanar R, Moutanni A, Dessem D. Inflammation of
craniofacial muscle induces widespread mechanical allodynia.
Neurosci Lett 2006; 399(3):249-254.
Abstract: The modulation of behavioral responses evoked by local
and distant nociceptive stimuli following a discrete somatic
injection of complete Freund's adjuvant (CFA) was examined in
rats. Inflammation of one craniofacial muscle evoked mechanical
allodynia not only in the region of inflammation but also
secondary mechanical allodynia in the contralateral head,
ipsilateral hindpaw, and contralateral hindpaw. In contrast to
this, CFA-induced inflammation of either the hindpaw or
gastrocnemius muscle evoked mechanical allodynia restricted to
the hindlimb region. The widespread modulation of nocifensive
behavior evoked by inflammation of deep craniofacial tissue
found in this study resembles the widespread deep tissue pain
reported in fibromyalgia, whiplash injury and some
temporomandibular disorders and thus may provide insight into
the mechanisms of these musculoskeletal pathologies
(47)
Amital D, Fostick L, Polliack ML, Segev S, Zohar J, Rubinow A et
al. Posttraumatic stress disorder, tenderness, and fibromyalgia
syndrome: are they different entities? J Psychosom Res 2006;
61(5):663-669.
Abstract: OBJECTIVES: Many features of fibromyalgia syndrome
(FMS) resemble those of posttraumatic stress disorder (PTSD).
The goal of this study was to investigate the comorbidity of FMS
and PTSD in a cohort of men following an intensive, initial,
defined traumatic event. METHODS: One hundred twenty-four males
(55 patients with PTSD, 20 patients with major depression, and
49 controls) were evaluated for the presence of FMS. The major
traumatic events in all PTSD patients were combat-related. Each
individual completed questionnaires characterizing his disease,
disabilities, and quality of life. RESULTS: Forty-nine percent
of PTSD patients, compared to 5% of major depression patients
and none of normal controls, fulfilled the American College of
Rheumatology criteria for FMS (P<.0001). Significant
correlations were detected between tender points and measured
parameters in the PTSD group. CONCLUSIONS: In male patients,
PTSD is highly associated with FMS. The degree and impact of
these disorders are also highly related
(48)
Amital D, Vishne T, Rubinow A, Levine J. Observed effects of
creatine monohydrate in a patient with depression and
fibromyalgia. Am J Psychiatry 2006; 163(10):1840-1841.
(49)
Angst F, Brioschi R, Main CJ, Lehmann S, Aeschlimann A.
Interdisciplinary rehabilitation in fibromyalgia and chronic
back pain: a prospective outcome study. J Pain 2006;
7(11):807-815.
Abstract: This study aimed to examine short-term and mid-term
course of health, biopsychosocial functional ability, and coping
performance of patients with fibromyalgia (FM) or chronic back
pain (BP) after participation in a standardized 4-week
inpatient, interdisciplinary pain rehabilitation program. In a
prospective cohort study, assessments were made by using a set
of standardized, well-tested self-rating instruments and other
parameters before and after the intervention up to the 6-month
follow-up with standardized effect sizes (ES) and comparison to
population norms. The effects of improvements in health and
coping domains on pain reduction were examined by linear
regression modeling. The health of the 65 FM and the 60 BP
patients at baseline was far worse than expected from the norms.
Improvements included ES up to 1.09 for pain, physical role
performance, and mental/affective health dimensions and 0.50 in
coping at discharge from the clinic. At the 6-month follow-up,
all effects were consistently lower but still up to ES = 0.75.
Improvements of FM and BP were equal at discharge but slightly
better for the FM's mood scales at the 6-month follow-up.
Physical and social function, mood, and coping were
significantly associated with pain reduction. PERSPECTIVE:
Inpatient, structured interdisciplinary rehabilitation covering
elements of cognitive and operant behavioral therapy, graded
activity exercise, and adapted drug therapy revealed moderate to
large short-term and mid-term improvements in physical and
mental health and in the major coping dimensions as captured by
comprehensive and specific assessment
(50)
Ardic F, Ozgen M, Aybek H, Rota S, Cubukcu D, Gokgoz A. Effects
of balneotherapy on serum IL-1, PGE(2 )and LTB (4) levels in
fibromyalgia patients. Rheumatol Int 2006; .
Abstract: The purpose of this study was to investigate the
clinical effects of balneotherapy in the treatment of
Fibromyalgia Syndrome (FMS) and to determine if balneotherapy
influences serum levels of inflammation markers, IL-1, PGE(2
)and LTB(4). 24 primary fibromyalgia female patients diagnosed
according to American College of Rheumatology criteria were
included to the study. Their ages ranged between 33 and 55
years. FMS patients were randomly assigned in two groups as,
group 1 (n = 12) and group 2 (n = 12). Group 1 received 20-min
bathing, once in a day for five days per week. Patients
participated in the study for 3 weeks (total of 15 sessions) in
Denizli. Group 2 did not receive balneotherapy. FMS patients
were evaluated by tenderness measurements (tender point count
and algometry), Visual Analogue Scale, Beck's Depression Index,
Fibromyalgia Impact Questionnaire. Ten healthy women recruited
group three as the controls. Serum PGE(2), LTB(4) and IL1-alpha
levels were measured in all three groups. The biochemical
measurements and clinical assessments were performed before and
at the end of general period of therapy. Statistically
significant alterations in algometric score, Visual Analogue
score, Beck's Depression Index and PGE(2) levels (P < 0.001),
numbers of tender points (P < 0.01) and Fibromyalgia Impact
Questionnaire score (P < 0.05) were found after the
balneotherapy between group 1 and 2. Mean PGE(2) level of FMS
patients were higher compared to healthy control group (P <
0.0001) and decreased after the treatment period, only in group
1 (P < 0.05). As in the group 2 and 3, detectable IL-1 and
LTB(4) measurements were insufficient, statistical analysis was
performed, only in group 1. After balneotherapy IL-1 and LTB(4)
significantly decreased in group 1 (P < 0.05). In conclusion,
balneotherapy is an effective choice of treatment in patients
with FMS relieving the clinical symptoms, and possibly
influencing the inflammatory mediators
(51)
Arguelles LM, Afari N, Buchwald DS, Clauw DJ, Furner S, Goldberg
J. A twin study of posttraumatic stress disorder symptoms and
chronic widespread pain. Pain 2006; 124(1-2):150-157.
Abstract: Previous studies of the association between
posttraumatic stress disorder (PTSD) and chronic widespread pain
(CWP) or fibromyalgia have not examined the role of familial or
genetic factors. The goals of this study were to determine if
symptoms of PTSD are related to CWP in a genetically informative
community-based sample of twin pairs, and if so, to ascertain if
the association is due to familial or genetic factors. Data were
obtained from the University of Washington Twin Registry, which
contains 1042 monozygotic and 828 dizygotic twin pairs. To
assess the symptoms of PTSD, we used questions from the Impact
of Events Scale (IES). IES scores were partitioned into
terciles. CWP was defined as pain located in 3 body regions
lasting at least 1 week during the past 3 months. Random-effects
regression models, adjusted for demographic features and
depression, examined the relationship between IES and CWP. IES
scores were strongly associated with CWP (P<0.0001). Compared to
those in the lowest IES tercile, twins in the highest tercile
were 3.5 times more likely to report CWP. Although IES scores
were associated with CWP more strongly among dizygotic than
among monozygotic twins, this difference was not significant.
Our findings suggest that PTSD symptoms, as measured by IES, are
strongly linked to CWP, but this association is not explained by
a common familial or genetic vulnerability to both conditions.
Future research is needed to understand the temporal association
of PTSD and CWP, as well as the physiological underpinnings of
this relationship
(52)
Armstrong DJ, Meenagh GK, Bickle I, Lee AS, Curran ES, Finch MB.
Vitamin D deficiency is associated with anxiety and depression
in fibromyalgia. Clin Rheumatol 2006; %19;.
Abstract: Fibromyalgia is a complex problem in which symptoms of
anxiety and depression feature prominently. Low levels of
vitamin D have been frequently reported in fibromyalgia, but no
relationship was demonstrated with anxiety and depression.
Seventy-five Caucasian patients who fulfilled the ACR criteria
for fibromyalgia had serum vitamin D levels measured and
completed the Fibromyalgia Impact Questionnaire (FIQ) and
Hospital Anxiety and Depression Score (HADS). Deficient levels
of vitamin D was found in 13.3% of the patients, while 56.0% had
insufficient levels and 30.7% had normal levels. Patients with
vitamin D deficiency (<25 nmol/l) had higher HADS [median, IQR,
31.0 (23.8-36.8] than patients with insufficient levels [25-50
nmol/l; HADS 22.5 (17.0-26.0)] or than patients with normal
levels [50 nmol/l or greater; HADS 23.5 (19.0-27.5);
Kruskal-Wallis ANOVA on ranks p<0.05]. There was no relationship
with global measures of disease impact or musculoskeletal
symptoms. Vitamin D deficiency is common in fibromyalgia and
occurs more frequently in patients with anxiety and depression.
The nature and direction of the causal relationship remains
unclear, but there are definite implications for long-term bone
health
(53)
Arnold LD, Bachmann GA, Rosen R, Kelly S, Rhoads GG. Vulvodynia:
Characteristics and Associations With Comorbidities and Quality
of Life. Obstet Gynecol 2006; 107(3):617-624.
Abstract: OBJECTIVE: This case-control survey compared health
history and health care use of women with vulvodynia with a
control group reporting absence of gynecologic pain. METHODS:
Women with a clinically assessed diagnosis of vulvodynia and
asymptomatic controls were matched for age and mailed a
confidential survey that evaluated demographics, health history,
use of the health care system, and history of vulvodynia.
Participants were all current or former ambulatory patients
within a university health care system. RESULTS: Of the 512
questionnaires mailed to valid addresses, 70% (n = 91) of cases
and 72% (n = 275) of controls responded, with 77 cases and 208
controls meeting eligibility criteria. Women with vulvodynia
reported a substantial negative impact on quality of life, with
42% feeling out of control of their lives and 60% feeling out of
control of their bodies. Forty-one percent indicated a severe
impact on their sexual lives. When comorbidities were evaluated
individually and adjusted for age, fibromyalgia (odds ratio
3.84, 95% confidence interval 1.54-9.55) and irritable bowel
syndrome (odds ratio 3.11, 95% confidence interval 1.60-6.05)
were significantly associated with vulvodynia. On a multivariate
level, vulvodynia was correlated with a history of chronic yeast
vaginitis and urinary tract infections. CONCLUSION: This survey
highlights the psychological distress associated with vulvodynia
and underscores the need for prospective studies to investigate
the relationship between chronic bladder and vaginal infections
as etiologies for this condition. As well, the association of
vulvodynia with other comorbid conditions, such as fibromyalgia
and irritable bowel syndrome, needs to be further evaluated.
LEVEL OF EVIDENCE: II-2
(54)
Arnold LM. Biology and therapy of fibromyalgia. New therapies in
fibromyalgia. Arthritis Res Ther 2006; 8(4):212.
Abstract: Fibromyalgia is a chronic, musculoskeletal pain
condition that predominately affects women. Although
fibromyalgia is common and associated with substantial morbidity
and disability, there are no US Food and Drug
Administration-approved treatments. However, progress has been
made in identifying pharmacological and non-pharmacological
treatments for fibromyalgia. Recent pharmacological treatment
studies have focused on selective serotonin and norepinephrine
reuptake inhibitors, which enhance serotonin and norepinephrine
neurotransmission in the descending pain pathways and lack many
of the adverse side effects associated with tricyclic
medications. Promising results have also been reported for
medications that bind to the alpha2delta subunit of
voltage-gated calcium channels, resulting in decreased calcium
influx at nerve terminals and subsequent reduction in the
release of several neurotransmitters thought to play a role in
pain processing. There is also evidence to support exercise,
cognitive behavioral therapy, education, and social support in
the management of fibromyalgia. It is likely that many patients
would benefit from combinations of pharmacological and
non-pharmacological treatments, but more study is needed
(55)
Arnold LM, Hudson JI, Keck PE, Auchenbach MB, Javaras KN, Hess
EV. Comorbidity of fibromyalgia and psychiatric disorders. J
Clin Psychiatry 2006; 67(8):1219-1225.
Abstract: OBJECTIVE: To assess the co-occurrence of fibromyalgia
with psychiatric disorders in participants of a fibromyalgia
family study. METHOD: Patients (probands) with fibromyalgia,
control probands with rheumatoid arthritis, and first-degree
relatives of both groups completed a structured clinical
interview and tender point examination. The co-occurrence odds
ratio (OR) (the odds of a lifetime comorbid DSM-IV disorder in
an individual with fibromyalgia divided by the odds of a
lifetime comorbid disorder in an individual without
fibromyalgia, adjusted for age and sex) was calculated;
observations were weighted by the inverse probability of
selection, based on the fibromyalgia status of the pro-band; and
standard errors were adjusted for the correlation of
observations within families. The study was conducted from
September 1999 to April 2002. RESULTS: We evaluated 78
fibromyalgia pro-bands and 146 of their relatives, and 40
rheumatoid arthritis probands and 72 of their relatives. Among
the relatives of both proband groups, we identified 30 cases of
fibromyalgia, bringing the total number of individuals with
fibromyalgia to 108, compared with 228 without fibromyalgia. The
co-occurrence ORs for specific disorders in individuals with
versus those without fibromyalgia were as follows: bipolar
disorder: 153 (95% CI = 26 to 902, p < .001); major depressive
disorder: 2.7 (95% CI = 1.2 to 6.0, p = .013); any anxiety
disorder: 6.7 (95% CI = 2.3 to 20, p < .001); any eating
disorder: 2.4 (95% CI = 0.36 to 17, p = .36); and any substance
use disorder: 3.3 (95% CI = 1.1 to 10, p = .040). CONCLUSIONS:
There is substantial lifetime psychiatric comorbidity in
individuals with fibromyalgia. These results have important
clinical and theoretical implications, including the possibility
that fibromyalgia might share underlying pathophysiologic links
with some psychiatric disorders
(56)
Assis MR, Silva LE, Alves AM, Pessanha AP, Valim V, Feldman D et
al. A randomized controlled trial of deep water running:
clinical effectiveness of aquatic exercise to treat
fibromyalgia. Arthritis Rheum 2006; 55(1):57-65.
Abstract: OBJECTIVE: To compare the clinical effectiveness of
aerobic exercise in the water with walking/jogging for women
with fibromyalgia (FM). METHODS: Sixty sedentary women with FM,
ages 18-60 years, were randomly assigned to either deep water
running (DWR) or land-based exercises (LBE). Patients were
trained for 15 weeks at their anaerobic threshold. Visual analog
scale of pain, Fibromyalgia Impact Questionnaire (FIQ), Beck
Depression Inventory, Short Form 36 Health Survey (SF-36), and a
patient's global assessment of response to therapy (PGART) were
measured at baseline, week 8, and week 15. Statistical analysis
included all patients. RESULTS: Four patients dropped out from
each group. Both groups improved significantly at week 15
compared with baseline, with an average 36% reduction in pain
intensity. For PGART, 40% of the DWR group and 30% of the LBE
group answered "much better" at posttreatment. FIQ total score
and FIQ depression improvements in the DWR group were faster
(week 8) than the LBE group and kept improving (week 15; P <
0.05). Only the DWR group showed improvements in SF-36 role
emotional (P = 0.006). No significant between-group differences
were observed for peak oxygen uptake and other outcomes.
CONCLUSION: DWR is a safe exercise that has been shown to be as
effective as LBE regarding pain. However, it has been shown to
bring more advantages related to emotional aspects. Aerobic gain
was similar for both groups, regardless of symptom improvement.
Therefore, DWR could be studied as an exercise option for
patients with FM who have problems adapting to LBE or lower
limbs limitations
(57)
Auvinet B, Bileckot R, Alix AS, Chaleil D, Barrey E. Gait
disorders in patients with fibromyalgia. Joint Bone Spine 2006;
73(5):543-546.
Abstract: OBJECTIVES: The objective of this study was to compare
gait in patients with fibromyalgia and in matched controls.
METHODS: Measurements must be obtained in patients with
fibromyalgia, as the evaluation scales for this disorder are
semi-quantitative. We used a patented gait analysis system
(Locometrix Centaure Metrix, France) developed by the French
National Institute for Agricultural Research. Relaxed walking
was evaluated in 14 women (mean age 50+/-5 years; mean height
162+/-5 cm; and mean body weight 68+/-13 kg) meeting American
College of Rheumatology criteria for fibromyalgia and in 14
controls matched on sex, age, height, and body weight. RESULTS:
Gait during stable walking was severely altered in the patients.
Walking speed was significantly diminished (P<0.001) as a result
of reductions in stride length (P<0.001) and cycle frequency
(P<0.001). The resulting bradykinesia (P<0.001) was the best
factor for separating the two groups. Regularity was affected in
the patients (P<0.01); this variable is interesting because it
is independent of age and sex in healthy, active adults.
CONCLUSION: Measuring the variables that characterize relaxed
walking provides useful quantitative data in patients with
fibromyalgia
(58)
Aydin G, Basar MM, Keles I, Ergun G, Orkun S, Batislam E.
Relationship between sexual dysfunction and psychiatric status
in premenopausal women with fibromyalgia. Urology 2006;
67(1):156-161.
Abstract: OBJECTIVES: To evaluate the possible relationship
between the sexual and psychiatric status of premenopausal
female patients with fibromyalgia compared with healthy
controls. METHODS: A total of 48 female patients with
fibromyalgia and 38 age-matched healthy controls were enrolled
in the study. All the subjects were asked to complete the Female
Sexual Function Index (FSFI) for sexual status and the
State-Trait Anxiety Inventory (STAI) and Beck Depression
Inventory (BDI) for psychiatric assessment. Serum biochemical
analysis was done, and the serum hormonal levels were analyzed.
RESULTS: The mean BDI score for patients was significantly
greater than the score for the controls (P = 0.017) and the mean
FSFI score was significantly lower than the score for the
controls (P = 0.001). According to the FSFI data, female sexual
dysfunction was found in 26 patients (54.2%) with fibromyalgia
and only 6 controls (15.8%), a significant difference (Pearson
chi-square = 14.46, P = 0.000). When the subscores of each
domain of FSFI were evaluated, the most common sexual problem
was diminished desire in patients (n = 30, 62.5%) and controls
(n = 11, 28.9%). In the correlation analysis, the FSFI score
showed a significant negative correlation with the BDI (r =
-0.337, P = 0.002) and STAI (r = -0.413, P = 0.004) scores. No
significant correlation was revealed between the FSFI and BDI or
FSFI and STAI scores in the controls. CONCLUSIONS: Depression is
one of the emotional disorders commonly encountered in women
with fibromyalgia, most possibly leading to sexual dysfunction.
Thus, sexual dysfunction related to impaired psychiatric status
should be considered a common problem in premenopausal women
with fibromyalgia
(59)
Baker K, Barkhuizen A. Pharmacologic treatment of fibromyalgia.
Curr Psychiatry Rep 2006; 8(6):464-469.
Abstract: Fibromyalgia is a syndrome of widespread pain,
non-restorative sleep, disturbed mood, and fatigue. Optimal
treatment involves a multidisciplinary approach with a team of
health care providers using pharmacologic and nonpharmacologic
treatment. Because of the heterogeneity of the illness,
management should be individualized for the patient.
Pharmacologic treatment should address issues of pain control,
sleep disturbance, fatigue, and any underlying coexisting mood
disorder. Nonpharmacologic treatment should include patient
education, a regular exercise and stretching program, and
cognitive behavioral therapy. All of these are essential to
improving functional capacity and quality of life. This review
provides general guidelines in initiating a successful
pharmacologic treatment program for patients with fibromyalgia
(60)
Bathaii SM, Tabaddor K. Characteristics and incidence of
fibromyalgia in patients who receive worker's compensation. Am J
Orthop 2006; 35(10):473-475.
Abstract: The aim of our study was to investigate the incidence
of fibromyalgia syndrome (FMS) in patients with work-related
injuries, the potential risk factors for and causes of FMS, and
the disabilities associated with FMS
(61)
Bazzichi L, Giannaccini G, Betti L, Italiani P, Fabbrini L,
Defeo F et al. Peripheral benzodiazepine receptors on platelets
of fibromyalgic patients. Clin Biochem 2006; 39(9):867-872.
Abstract: OBJECTIVE: The aim of the present study was to analyze
if alterations of peripheral-type benzodiazepine receptor (PBR)
characteristics occurred in platelet membranes of patients
affected by primary fibromyalgia (FM). DESIGN AND METHODS:
Platelets were obtained from 30 patients with FM. Evaluation of
kinetic parameters of PBR was performed using [(3)H] PK11195 as
specific radioligand compared with 16 healthy volunteers.
RESULTS: The results showed a significant increase of PBR
binding sites value in platelet membranes from FM patients
(B(max) was 5366+/-188 fmol/mg vs. controls, 4193+/-341 fmol/mg,
mean+/-SEM) (**p<0.01) but not for affinity value (K(d) was
4.90+/-0.39 nM vs. controls, 4.74+/-0.39 nM, mean+/-SEM)
(p>0.05). Symptom severity scores (pain and tiredness) were
positively correlated with B(max). CONCLUSIONS: Our results
showed an up-regulation of PBR in platelets of FM patients, and
this seems to be related to the severity of fibromyalgic
symptoms
(62)
Bazzichi L, Giannaccini G, Betti L, Mascia G, Fabbrini L,
Italiani P et al. Alteration of serotonin transporter density
and activity in fibromyalgia. Arthritis Res Ther 2006; 8(4):R99.
Abstract: The aim of the study was to evaluate the kinetic
parameters of a specific serotonin transporter (SERT) and
serotonin uptake in a mentally healthy subset of patients with
fibromyalgia. Platelets were obtained from 40 patients and 38
healthy controls. SERT expression and functionality were
evaluated through the measurement of [3H]paroxetine binding and
the [3H]serotonin uptake itself. The values of maximal membrane
binding capacity (Bmax) were statistically lower in the patients
than in the healthy volunteers, whereas the dissociation
constant (Kd) did not show any statistically significant
variations. Moreover, a decrease in the maximal uptake rate of
SERT (Vmax) was demonstrated in the platelets of patients,
whereas the Michaelis constant (Km) did not show any
statistically significant variations. Symptom severity score
(tiredness, tender points index and Fibromyalgia Impact
Questionnaire) were negatively correlated with Bmax and with
Vmax, and positively correlated with Km. A change in SERT seems
to occur in fibromyalgic patients, and it seems to be related to
the severity of fibromyalgic symptoms
(63)
Becker-Merok A, Kalaaji M, Haugbro K, Nikolaisen C, Nilsen K,
Rekvig OP et al. Alpha-actinin-binding antibodies in relation to
systemic lupus erythematosus and lupus nephritis. Arthritis Res
Ther 2006; 8(6):R162.
Abstract: This study investigated the overall clinical impact of
anti-alpha-actinin antibodies in patients with pre-selected
autoimmune diseases and in a random group of anti-nuclear
antibody (ANA)-positive individuals. The relation of
anti-alpha-actinin antibodies with lupus nephritis and
anti-double-stranded DNA (anti-dsDNA) antibodies represented a
particular focus for the study. Using a cross-sectional design,
the presence of antibodies to alpha-actinin was studied in
selected groups, classified according to the relevant American
College of Rheumatology classification criteria for systemic
lupus erythematosus (SLE) (n = 99), rheumatoid arthritis (RA) (n
= 68), Wegener's granulomatosis (WG) (n = 85), and fibromyalgia
(FM) (n = 29), and in a random group of ANA-positive individuals
(n = 142). Renal disease was defined as (increased) proteinuria
with haematuria or presence of cellular casts. Sera from SLE,
RA, and Sjogren's syndrome (SS) patients had significantly
higher levels of anti-alpha-actinin antibodies than the other
patient groups. Using the geometric mean (+/- 2 standard
deviations) in FM patients as the upper cutoff, 20% of SLE
patients, 12% of RA patients, 4% of SS patients, and none of the
WG patients were positive for anti-alpha-actinin antibodies.
Within the SLE cohort, anti-alpha-actinin antibody levels were
higher in patients with renal flares (p = 0.02) and correlated
independently with anti-dsDNA antibody levels by enzyme-linked
immunosorbent assay (p < 0.007) but not with other disease
features. In the random ANA group, 14 individuals had
anti-alpha-actinin antibodies. Of these, 36% had SLE, while 64%
suffered from other, mostly autoimmune, disorders. Antibodies
binding to alpha-actinin were detected in 20% of SLE patients
but were not specific for SLE. They correlate with anti-dsDNA
antibody levels, implying in vitro cross-reactivity of
anti-dsDNA antibodies, which may explain the observed
association with renal disease in SLE
(64)
Bennett R, Nelson D. Cognitive behavioral therapy for
fibromyalgia. Nat Clin Pract Rheumatol 2006; 2(8):416-424.
Abstract: Cognitive behavioral therapy (CBT) techniques offer
short-term, goal-oriented psychotherapy. In this respect, it
differs from classical psychoanalysis in emphasizing changes in
thought patterns and behaviors rather than providing 'deep
insight'. Importantly, the beneficial effects of CBT can be
achieved in 10-20 sessions, compared with the many years
required for classical psychoanalysis. Although CBT is often
done on a one-to-one basis, it also lends itself to a group
therapeutic setting. CBT was initially used in the treatment of
mood disorders, but its use has subsequently been expanded to
include various other medical conditions, including chronic pain
states. Over the past 18 years, several chronic pain treatment
programs have used CBT techniques in the management of
fibromyalgia. In this review, the results from 13 programs using
CBT, alone or in combination with other treatment modalities,
are analyzed. In most studies, CBT provided worthwhile
improvements in pain-related behavior, self-efficacy, coping
strategies and overall physical function. Sustained improvements
in pain were most evident when individualized CBT was used to
treat patients with juvenile fibromyalgia. The current data
indicate that CBT, as a single treatment modality, does not
offer any distinct advantage over well-planned group programs of
education or exercise, or both. Its role in the management of
fibromyalgia patients needs further research
(65)
Bergeson J, Eickhoff A. Mayo Clinic office visit. Fibromyalgia
management. An interview with Jody Bergeson, R.N., and Andrea
Eickhoff, R.N. Mayo Clin Womens Healthsource 2006; 10(8):7-8.
(66) Bieber C, Muller KG, Blumenstiel K, Schneider A, Richter
A, Wilke S et al.
Long-term
effects of a shared decision-making intervention on
physician-patient interaction and outcome in fibromyalgia. A
qualitative and quantitative 1 year follow-up of a randomized
controlled trial. Patient Educ Couns 2006; 63(3):357-366.
Abstract: OBJECTIVE: Fibromyalgia syndrome (FMS) patients and
their doctors frequently complain on interaction difficulties.
We investigated the effects of a shared decision-making (SDM)
intervention on physician-patient interaction and health
outcome. METHODS: Sixty-seven FMS patients of an outpatient
university setting that had been included in a randomized
controlled trial were followed up. They were either treated in
an SDM group or in an information group. Both groups saw a
computer based information tool on FMS, but only the SDM group
was treated by doctors which underwent a special SDM
communication training. A comparison group of 44 FMS patients
receiving treatment as usual was recruited in rheumatological
practices. We assessed patients and their doctors using a
combined qualitative and quantitative approach. Patients and
doctors were followed-up after 3 months (T2) and after 1 year
(T3). RESULTS: The significantly best quality of
physician-patient interaction was reported by patients and
doctors of the SDM group, followed by the information group.
Coping had more often improved in the SDM group than in the
information group. However directly health related outcome
variables had not improved in any of the groups at T3.
CONCLUSION: An SDM intervention can lead to an improved
physician-patient relationship from the patients' and from the
doctors' perspective. PRACTICE IMPLICATIONS: It should be
considered to include SDM in standard care for FMS patients
(67)
Birtane M, Uzunca K, Tastekin N, Tuna H. The evaluation of
quality of life in fibromyalgia syndrome: a comparison with
rheumatoid arthritis by using SF-36 Health Survey. Clin
Rheumatol 2006; .
Abstract: Musculoskeletal disorders are the most common causes
of deterioration in quality of life (QOL). We in this study
aimed to assess (1) the impact of fibromyalgia syndrome (FS) on
QOL comparing with that of rheumatoid arthritis (RA) patients
and control subjects and (2) the impact of these two
musculoskeletal disorders on various components of QOL using
SF-36 Health Survey. Thirty-five patients with RA, 30 patients
with FS, and 30 voluntary control subjects were included in the
study. The groups were comparable in terms of demographic
characteristics. QOL was evaluated by using Short-Form (SF)-36
Health Survey in all study participants, and Fibromyalgia Impact
Questionnaire (FIQ), which is a specific health-status
instrument for FS, was used in FS patients. Physical
functioning, physical role, social functioning, bodily pain,
general health, vitality, emotional role, and mental health
scores were significantly lower in RA and FS patients than in
control subjects (p<0.05). The between-groups comparisons
revealed that FS patients had significantly lower mental health
scores than RA patients (49.87 vs 62.51, respectively),
(p<0.001). Total FIQ score correlated significantly with
physical functioning, physical role, and bodily pain in FS
patients. All parameters of SF-36 Health Survey except for
social functioning correlated significantly with some of the
variables of FIQ. FS has a negative impact on QOL, like RA.
Furthermore, mental health was more severely affected in FS
patients when compared with RA patients
(68)
Blasco CL, Mallo CM, Mencia PA, Franch BJ, Casaus SP, Pena RJ et
al. Clinical profiles in fibromyalgia patients of the community
mental health center: a predictive index of psychopathological
severity. Actas Esp Psiquiatr 2006; 34(2):112-122.
Abstract: INTRODUCTION: In recent years we have seen an
increasing demand for mental health care in patients with
fibromyalgia and psychiatric symptoms, although it is not clear
if the symptoms are primary or secondary to the presence of the
syndrome. This fact has led mental health providers to think
that there would be some psychological factors influencing the
vulnerability of suffering this painful syndrome, because its
etiology is quite non-specific. Bradley et al. (1978) identified
different psychopathological profiles within chronic pain
syndromes with the MMPI, which were subsequently adapted by
Yunus et al. (1991) for fibromyalgia. This present work studied
the clinical profile in patients with fibromyalgia. METHOD:
Sample: 75 patients with fibromyalgia from the community mental
health center and 55 healthy subjects. Tools: STAI-E/R, BDI,
MMPI-2, MMPI-2 personality disorders, MMPI-2 PSY-5. Statistical
analysis: descriptive statistics and mean comparison (Student's
t test). Confirmatory cluster analysis. Discriminative analysis
of subgroups. RESULTS: Two different patterns were obtained:
group A (32 %) with a typical chronic pain profile (CP) and
group B (68 %) with a psychological maladjustment profile (PM).
With the discriminative analysis, we obtained the coefficients
of the discriminative canonical functions that maximize the
differences between both groups. CONCLUSIONS: We confirmed
Bradley's classification, obtaining two different
psychopathological patterns in the fibromyalgia syndrome sample
we studied. We obtained an index of psychopathological profile
in fibromyalgia, which would form a new scale, from MMPI-2 for
discriminating psychopathological severity in fibromyalgia
(69)
Blehm R. Physical therapy and other nonpharmacologic approaches
to fibromyalgia management. Curr Pain Headache Rep 2006;
10(5):333-338.
Abstract: Fibromyalgia is a vague and changing syndrome that
comprises many symptoms. Due to the confounding nature of
fibromyalgia syndrome, there has been much debate about which
interventions and therapies should be considered as viable
treatment options. Opinions continue to shift in publication and
research circles, with little documentation to show good,
long-term outcomes. Several studies have shown promise, with
initial improvement in symptoms, but in many cases, these
improvements were not lasting or the patients were then unable
to continue/replicate the program on their own. In this article,
some of the more recently published findings regarding the
efficacy of exercise are explored, specifically physical therapy
and other nonpharmacologic interventions, for managing
fibromyalgia syndrome
(70)
Bonifazi M, Suman AL, Cambiaggi C, Felici A, Grasso G, Lodi L et
al. Changes in salivary cortisol and corticosteroid
receptor-alpha mRNA expression following a 3-week
multidisciplinary treatment program in patients with
fibromyalgia. Psychoneuroendocrinology 2006; 31(9):1076-1086.
Abstract: The aim of the present study was to investigate the
effects of a 3-week residential multidisciplinary
non-pharmacological treatment program (including individually
prescribed aerobic exercise and cognitive-behavioral therapy) on
fibromyalgia symptoms and hypothalamic-pituitary-adrenal (HPA)
axis function. Salivary and venous blood samples were collected
from 12 female patients with fibromyalgia (age: 25-58) the day
before and the day after the treatment period: saliva, eight
times (every two hours from 0800 to 2200 h); venous blood, at
0800 h. Peripheral blood mononuclear cells (PBMC) were separated
and analyzed for glucocorticoid receptor-alpha (GR-alpha) mRNA
expression by semi-quantitative RT-PCR, while the salivary
cortisol concentration was determined by RIA. At the same time,
pain and aerobic capacity were evaluated. Aerobic capacity
improved at the end of the treatment program. The slope of the
regression of salivary cortisol values on sampling time was
steeper in all patients after treatment, indicating that the
cortisol decline was more rapid. Concomitantly, the area under
the cortisol curve "with respect to increase" (AUC(i)) was
higher and there was a significant increase in GR-alpha mRNA
expression in PBMC. The number of positive tender points,
present pain, pain area and CES-D score were significantly
reduced after the treatment, while the pressure pain threshold
increased at most of the tender points. Our findings suggest
that one of the active mechanisms underlying the effects of our
treatment is an improvement of HPA axis function, consisting in
increased resiliency and sensitivity of the stress system
probably related to stimulation of GR-alpha synthesis by the
components of the treatment
(71)
Boocock MG, McNair PJ, Larmer PJ, Armstrong B, Collier J,
Simmonds M et al. Interventions for the prevention and
management of neck/upper extremity musculoskeletal conditions: a
systematic review. Occup Environ Med 2006; .
Abstract: Whether considered from medical, social or economic
perspectives, the cost of musculoskeletal injuries suffered in
the workplace is substantial and there is a need to identify the
most efficacious interventions for their effective prevention,
management and rehabilitation. Previous reviews have highlighted
the limited number of studies that focus on upper extremity
intervention programmes. The aim of the current study was to
evaluate the findings of primary, secondary and/or tertiary
intervention studies for neck/upper extremity conditions
undertaken between 1999 and 2004 and compare these results with
those of previous reviews. Relevant studies were retrieved
through the use of a systematic approach to literature searching
and evaluated using a standardised tool. Evidence was then
classified according to a 'pattern of evidence' approach.
Studies were categorised into subgroups depending on the type of
INTERVENTION: mechanical exposure interventions; production
systems/organisational culture interventions; and modifier
interventions. Thirty one intervention studies met the inclusion
criteria. The findings provided evidence to support the use of
some mechanical and modifier interventions as approaches for
preventing and managing neck/upper extremity musculoskeletal
conditions and fibromyalgia. Evidence to support the benefits of
production systems/organisational culture interventions was
found to be lacking. This review identified no one single or
multidimensional strategy for intervention that was considered
effective across occupational settings. There is limited
information to support the establishment of evidence-based
guidelines applicable to a number of industrial sectors
(72)
Borg-Stein J, Wilkins A. Soft tissue determinants of low back
pain. Curr Pain Headache Rep 2006; 10(5):339-344.
Abstract: Low back pain is one of the complaints most commonly
seen in the clinical setting. Correctly or incorrectly, these
patients are often given the diagnosis of fibromyalgia,
myofascial pain syndrome, disk herniation, or some other label.
It is important to recognize the soft tissue causes of low back
pain and understand how they can be most appropriately diagnosed
and managed. Nonligamentous disorders of the low back region may
occur in isolation or in combination with underlying discogenic,
ligamentous, and facet-mediated causes of pain. Therefore, in
order to fully evaluate and treat a patient with low back pain,
it is necessary to consider and address these soft tissue
conditions. This paper reviews soft tissue causes of low back
pain and discusses how they are most appropriately diagnosed and
managed
(73)
Borg-Stein J. Treatment of fibromyalgia, myofascial pain, and
related disorders. Phys Med Rehabil Clin N Am 2006;
17(2):491-510, viii.
Abstract: Chronic muscle pain is a common complaint among
patients who seek care for musculoskeletal disorders. A spectrum
of clinical presentations exists, ranging from focal or regional
complaints that usually represent myofascial pain syndromes to
more wide spread pain that may meet criteria for a diagnosis of
fibromyalgia. This article addresses the epidemiology,
pathophysiology, and clinical management of myofascial pain
syndrome and fibromyalgia. These conditions are challenging to
treat and require physiatrists to be aware of the wide range of
pharmacologic, rehabilitative,and psychosocial interventions
that can be helpful
(74) Brautbar A, Elstein D, Pines B, Krienen N, Hemmer J,
Buskila D et al.
Fibromyalgia
and Gaucher's disease. QJM 2006; 99(2):103-107.
Abstract: BACKGROUND: Patients with symptomatic Gaucher's
disease sometimes have non-specific symptoms (such as general
malaise with widespread musculoskeletal pains) that respond
poorly to enzyme replacement treatment. These may indicate
fibromyalgia syndrome; if so, other therapeutic options might be
more appropriate. AIM: To identify patients with Gaucher's
disease for whom fibromyalgia-specific therapy may be
therapeutic. DESIGN: Questionnaire-based survey. METHODS: Adult
patients (n = 109) with non-neuronopathic Gaucher's disease and
adult healthy controls (n = 108) completed health-related
questionnaires including the Fibromyalgia Impact Questionnaire,
and underwent testing with a dolorimeter to ascertain
sensitivity at 22 tender points. RESULTS: Six patients, but no
controls, met the criteria for fibromyalgia. Patients with
fibromyalgia had a significantly greater incidence of
co-morbidities (p = 0.014) relative to other patients with
Gaucher's disease; four suffered from bone involvement and were
receiving enzyme therapy, but two were untreated. DISCUSSION:
The presence of fibromyalgia-specific trigger points may result
from multiple aetiologies, or may be an independently-sorting
predisposition. Our findings cannot distinguish between these
possibilities, but if fibromyalgia were the cause, enzyme
replacement therapy would be expensive and inappropriate
(75)
Bronner G. [Female sexual function and chronic disease].
Harefuah 2006; 145(2):114-116.
Abstract: Female sexual dysfunction (FSD) is a multifactorial
set of conditions associated with multiple anatomical,
physiological, biological, medical and psychological factors
that can have major impact on self-esteem, quality of life, mood
and relationships. Studies indicate that FSD is commonly seen in
women who report a low level of satisfaction with partner
relationship and in women with male partners who have erectile
dysfunction. This complexity of FSD is augmented by the presence
of chronic disease. Negative sexual effects are widely reported
in studies of women with chronic diseases (such as metabolic
syndrome, diabetes mellitus, chronic kidney disease, cancer,
spinal cord injury, lupus, rheumatic diseases, Parkinson's
disease, fibromyalgia and chronic pain) as compared to a general
healthy female population. Physical problems, emotional problems
and partnership difficulties arising from disease-related stress
contribute to less active and less enjoyable sex life. Chronic
pain, fatigue, low self-esteem as well as use of medications
might reduce sexual function. These effects of chronic diseases
on female sexual function still remain largely unstudied. The
study by Manor and Zohar published in this issue of Harefuah
draws our attention to the sexual dysfunction of women with
breast cancer and examines their needs for information regarding
their sexual function. In the absence of definite treatment
evidence, psychological counseling, improved vaginal
lubrication, low dose of hormonal therapy can be used to relieve
FSD. Physicians must consider integrating diagnosis of their
female patients' sexual needs and dysfunction, especially women
with chronic diseases. Patients' education and counseling may
contribute to a better quality of life in spite of their chronic
disease
(76)
Burckhardt CS. Multidisciplinary approaches for management of
fibromyalgia. Curr Pharm Des 2006; 12(1):59-66.
Abstract: Multidisciplinary approaches to fibromyalgia syndrome
(FMS) treatment are advocated for treating the complex symptoms
and problems confronting many patients. Exercise and
cognitive-behavioral strategies together with patient education
commonly comprise the multidisciplinary approach to treatment in
clinical trials. A review of the research literature suggests
that they are effective for decreasing pain and FMS impact and
increasing self-efficacy and physical functioning. Limitations
of the current evidence base include a lack of studies that
include medication treatment as part of the multidisciplinary
approach as well as lack of attention to the diversity of
patient psychosocial issues that may interfere with treatment
effectiveness. The review recommends that further randomized
clinical trials be carried out with subgroups of patients using
standardized outcome measurements, adequate treatment length and
sufficient length of follow-up to be able to observe and
document changes in patient symptoms and behaviors over time
(77)
Buskila D, Sarzi-Puttini P. Biology and therapy of fibromyalgia.
Genetic aspects of fibromyalgia syndrome. Arthritis Res Ther
2006; 8(5):218.
Abstract: Genetic and environmental factors may play a role in
the etiopathology of fibromyalgia syndrome (FMS) and other
related syndromes. There is a high aggregation of FMS in
families of FMS patients. The mode of inheritance is unknown but
it is most probably polygenic. There is evidence that
polymorphisms of genes in the serotoninergic, dopaminergic and
catecholaminergic systems play a role in the etiology of FMS.
These polymorphisms are not specific for FMS and are associated
with other functional somatic disorders and depression. Future
genetic studies in the field of FMS and related conditions
should be conducted in larger cohorts of patients and ethnically
matched control groups
(78)
Cabyoglu MT, Ergene N, Tan U. The mechanism of acupuncture and
clinical applications. Int J Neurosci 2006; 116(2):115-125.
Abstract: This study presents the result of the studies
explaining the effects of acupuncture on various systems and
symptoms. It has been determined that endomorphin-1, beta
endorphin, encephalin, and serotonin levels increase in plasma
and brain tissue through acupuncture application. It has been
observed that the increases of endomorphin-1, beta endorphin,
encephalin, serotonin, and dopamine cause analgesia, sedation,
and recovery in motor functions. They also have immunomodulator
effects on the immune system and lipolithic effects on
metabolism. Because of these effects, acupuncture is used in the
treatment of pain syndrome illnesses such as migraine,
fibromyalgia, osteoarthritis, and trigeminal neuralgia; of
gastrointestinal disorders such as disturbance at
gastrointestinal motility and gastritis; of psychological
illnesses such as depression, anxiety, and panic attack; and in
rehabilitation from hemiplegia and obesity
(79)
Cacace E, Ruggiero V, Anedda C, Denotti A, Minerba L, Perpignano
G. [Quality of life and associated clinical distress in
fibromyalgia]. Reumatismo 2006; 58(3):226-229.
Abstract: OBJECTIVES: Fibromyalgia (FM) is a syndrome
characterized by chronic, diffuse musculoskeletal pain and by a
low pain threshold at specific anatomical points (tender
points). Numerous other conditions (Irritable bowel syndrome,
tension-type headache, migraine headaches, etc.) may overlap
with FM. Aim of this study was to evaluate the quality of life
and associated clinical distress in patients with FM. METHODS:
53 females affected by primary fibromyalgia and 40 healthy
females were examined were examined by an experienced
rheumatologist and interviewed using the Fibromyalgia Impact
Questionnaire (FIQ). Clinical monitoring included Visual
Analogue Scale for pain and pain pressure threshold
measurements. RESULTS: Mean FIQ scores were 66.39+/-14.94 in FM
patients and 13.15+/-5.37 in control subjects and the difference
was statistically significant. Among associated clinical
distress higher frequencies have been found for paraesthesia
(87%), sleep disturbance (72%), tension type headache (70%),
oto-vestibule syndrome (72%) and irritable colon (60%). An
R.O.C. bend was developed in the presence of paraesthesias and
oto-vestibule syndromes at the same time. This allowed us to
identify a FIQ cut off value of 66.85 so FM patients were
divided into 2 groups according to their FIQ scores: severe
degree and mild or slight degree. CONCLUSIONS: Based on our
data, it would appear possible to use a FIQ value equal to or
higher than 66.85 for the clinical picture of FM to be
classified as severe
(80)
Calandre EP, Hidalgo J, Rico-Villademoros F. Use of ziprasidone
in patients with fibromyalgia: a case series. Rheumatol Int
2006; .
Abstract: Atypical antipsychotics may be useful in chronic pain
treatment. The objective of the present study was to assess the
effect of ziprasidone in fibromyalgia management. Ziprasidone
was administered to 32 fibromyalgia patients at a dose of 20
mg/day, subsequently adjusted according to clinical response and
tolerability. Fibromyalgia Impact Questionnaire (FIQ),
Pittsburgh Sleep Quality Index (PSQI), a Clinical Global
Impression improvement scale (CGIi), and a scale evaluating the
severity of fibromyalgia symptoms were administered at 4 week
intervals for 12 weeks. Drug adverse reactions were recorded.
Ten patients withdrew from the study. The CGIi showed 32% of
responders. FIQ and PSQI scores showed a non-statistically
significant decrease. The conditions of stiffness, anxiety and
sadness improved significantly. Most frequent side effects
included sleep disturbances, headache, tremor, and rigidity.
Although ziprasidone does not seem an especially useful adjunct
drug in fibromyalgia, it could be tried on patients who are
markedly anxious and/or depressed
(81)
Caldarella MP, Giamberardino MA, Sacco F, Affaitati G, Milano A,
Lerza R et al. Sensitivity disturbances in patients with
irritable bowel syndrome and fibromyalgia. Am J Gastroenterol
2006; 101(12):2782-2789.
Abstract: BACKGROUND: Although visceral hypersensitivity is a
common feature among patients with irritable bowel syndrome
(IBS), studies on somatic sensitivity have given controversial
results. AIM: To assess visceral sensitivity in response to
isotonic rectal distensions and somatic sensitivity at different
layers of the body wall (skin, subcutis, and muscle) in patients
with IBS and fibromyalgia (FM), within and outside the area of
abdominal pain referral. MATERIALS AND METHODS: We studied 10
patients with IBS, 5 patients with FM, 9 patients with IBS+FM,
and 9 healthy controls. Rectal distensions were performed by
increasing tension at 4 g steps up to 64 g or discomfort. Pain
thresholds to electrical stimulation were measured within and
outside the areas of abdominal pain referral. RESULTS: Patients
with IBS and IBS+FM demonstrated rectal hypersensitivity in
comparison to controls. The threshold of discomfort was 44 +/- 5
g in IBS and 36 +/- 5 in IBS+FM patients, while patients with FM
and healthy controls tolerated all distensions without
discomfort. In the areas of pain referral, pain thresholds of
all three tissues of the body wall were lower than normal in all
patients groups (p < 0.001). In control areas, the pain
thresholds were normal in skin, and lower than normal in
subcutis and muscle in IBS (p < 0.001). FM and IBS+FM
demonstrated somatic hypersensitivity at all sites (p < 0.001 vs
healthy). CONCLUSION: Our observations seem to indicate that,
although sharing a common hypersensitivity background, multiple
mechanisms may modulate perceptual somatic and visceral
responses in patients with IBS and FM
(82)
Callejas-Rubio JL, Lopez-Perez L, Navarro-Pelayo F,
Ortego-Centeno N. [More on therapeutic options in
fibromyalgia.]. Med Clin (Barc ) 2006; 127(2):76-77.
(83)
Carrillo-de-la-Pena MT, Vallet M, Perez MI, Gomez-Perretta C.
Intensity dependence of auditory-evoked cortical potentials in
fibromyalgia patients: a test of the generalized hypervigilance
hypothesis. J Pain 2006; 7(7):480-487.
Abstract: On the basis of recent evidence concerning the
amplification of incoming stimulation in fibromyalgia (FM)
patients, it has been proposed that a generalized hypervigilance
of painful and nonpainful sensations may be at the root of this
disorder. So far, research into this issue has been
inconclusive, possibly owing to the lack of agreement as to the
operational definition of "generalized hypervigilance" and to
the lack of robust objective measures characterizing the sensory
style of FM patients. In this study, we recorded auditory-evoked
potentials (AEPs) elicited by tones of increasing intensity (60,
70, 80, 90, and 105 dB) in 27 female FM patients and 25 healthy
controls. Fibromyalgia patients presented shorter N1 and P2
latencies and a stronger intensity dependence of their AEPs.
Both results suggest that FM patients may be hypervigilant to
sensory stimuli, especially when very loud tones are used. The
most noteworthy difference between patients and control subjects
is at the highest stimulus intensity, for which far more
patients maintained increased N1-P2 amplitudes in relation to
the 90-dB tones. The larger AEP amplitudes to the 105-dB tones
suggest that defects in an inhibitory system protecting against
overstimulation may be a crucial factor in the pathophysiology
of FM. Because a stronger loudness dependence of AEPs has been
related to weak serotonergic transmission, it is hypothesized
that for many FM patients deficient inhibition of the response
to noxious and intense auditory stimuli may be due to a
serotonergic deficit. PERSPECTIVE: The study of auditory-evoked
potentials in response to tones of increasing intensity in FM
patients may help to clarify the pathophysiology of this
disorder, especially regarding the role of inhibition deficits
involving serotonergic dysfunction, and may be a useful tool to
guide the pharmacologic treatment of FM patients
(84)
Carta MG, Cardia C, Mannu F, Intilla G, Hardoy MC, Anedda C et
al. The high frequency of manic symptoms in fibromyalgia does
influence the choice of treatment? Clin Pract Epidemol Ment
Health 2006; %19;2:36.:36.
Abstract: ABSTRACT: BACKGROUND: Mood disorders were found
associated with fibromyalgia (FM) and clinical studies have
revealed the efficacy of antidepressant drugs in the treatment
of FM. However no specific instruments to identify manic
symptoms were used. OBJECTIVES: To assess the frequency of
anxiety and mood disorders (particularly bipolar disorders and
manic symptoms) in a consecutive sample of women affected by FM
using standardized diagnostic tools and to compare the
prevalence of these disorders with that observed in a sample of
healthy controls from the general population. METHODS: Cases:
consecutive series of women (N = 37, mean age 50.1 +/- 21.0)
attending a Rheumatology outpatient Unit at the University of
Cagliari. Controls: 148 women, drawn from the data bank of an
epidemiological study matched for sex and age with controls
according to a randomisation "after blocks" method. The Italian
version of the Composite International Diagnostic Interview
Simplified were carried out by physicians. Psychiatric diagnosis
was formulated according to DSM-IV criteria. The Italian version
of the Mood Disorder Questionnaire (MDQ) was administered to
identify manic symptoms and bipolar disorders. Diagnosis of FM
were carried out by rheumatologist according to the criteria of
American College of Rheumatology. RESULTS: Subjects with FM
showed a higher comorbidity with Generalised Anxiety Disorder,
Panic Disorder and Major Depressive Disorder than controls. The
study showed a high frequency of manic symptoms (MDQ positive)
in the sample of fibromyalgic patients (59%), approximately
double that found in the control sample (P < 0.001). DISCUSSION:
Clinical studies have shown the efficacy of antidepressants,
especially tricyclic antidepressants, in the treatment of FM.
The clinical difficulty in identifying hypomanic episodes is
well known particularly where previous and not present episodes
are concerned as in depressive patients. These data would
suggest further studies on the subject are needed and more
caution also in prescribing antidepressants in a population
apparently at high risk for bipolar disorders
(85)
Castel A, Perez M, Sala J, Padrol A, Rull M. Effect of hypnotic
suggestion on fibromyalgic pain: Comparison between hypnosis and
relaxation. Eur J Pain 2006; .
Abstract: The main aims of this experimental study are: (1) to
compare the relative effects of analgesia suggestions and
relaxation suggestions on clinical pain, and (2) to compare the
relative effect of relaxation suggestions when they are
presented as "hypnosis" and as "relaxation training". Forty-five
patients with fibromyalgia were randomly assigned to one of the
following experimental conditions: (a) hypnosis with relaxation
suggestions; (b) hypnosis with analgesia suggestions; (c)
relaxation. Before and after the experimental session, the pain
intensity was measured using a visual analogue scale (VAS) and
the sensory and affective dimensions were measured with the
McGill Pain Questionnaire. The results showed: (1) that hypnosis
followed by analgesia suggestions has a greater effect on the
intensity of pain and on the sensory dimension of pain than
hypnosis followed by relaxation suggestions; (2) that the effect
of hypnosis followed by relaxation suggestions is not greater
than relaxation. We discuss the implications of the study on our
understanding of the importance of suggestions used in hypnosis
and of the differences and similarities between hypnotic
relaxation and relaxation training
(86)
Cayea D, Perera S, Weiner DK. Chronic low back pain in older
adults: What physicians know, what they think they know, and
what they should be taught. J Am Geriatr Soc 2006;
54(11):1772-1777.
Abstract: Chronic low back pain (CLBP) is a common and
debilitating problem in older adults. Little exists in the
literature about primary care physicians' (PCPs') knowledge of
and confidence in managing this problem. A self-administered
survey was mailed to PCPs in western Pennsylvania to measure
knowledge of the evaluation and treatment of common contributors
to CLBP in older adults, confidence in diagnosing these
contributors through physical examination, and the association
between confidence levels and knowledge. The survey combined
items with an ordinal scale on which PCPs ranked their
confidence in detecting various contributors to CLBP (e.g.,
fibromyalgia) using physical examination and patient vignettes
followed by multiple choice questions designed to assess
knowledge. One hundred fifty-three of 634 surveys were returned
(24.1%). Overall, the majority of PCPs did not feel "very
confident" in their ability to diagnose any of the contributors
of CLBP listed (most items <40%). PCPs felt most confident in
detecting scoliosis and least confident detecting myofascial
pain of the piriformis muscle. There was a wide range in the
number of respondents answering all questions related to a
particular topic correctly (3.9% for sacroiliac joint syndrome
to 70.4% for hip osteoarthritis). There was no relationship
between knowledge scores and confidence ratings (P > .05 for all
comparisons). The results point to a need for more PCP education
about CLBP in older adults. It also suggests that accurate needs
assessment should not rely on physician confidence ratings alone
(87)
Chandler HK, Ciccone DS, Raphael KG. Localization of pain and
self-reported rape in a female community sample. Pain Med 2006;
7(4):344-352.
Abstract: OBJECTIVE: Studies suggest that rape increases risk of
medically unexplained pain in women. At present it is not clear
whether rape is associated with pain at specific locations or at
multiple locations. In this study we tested the hypothesis that
rape was associated with a preferential increase in risk of
pelvic pain that was not explained by pain at other sites.
DESIGN: We relied on an existing community study that
oversampled women with fibromyalgia and major depression.
Localization was assessed by asking about pain at four sites:
pelvic region; jaw/face; headache; and lower back. Three groups
were identified using a structured telephone interview: Abuse
Only (sexual/physical abuse excluding rape); Rape+Abuse (rape in
addition to other sexual/physical abuse); and No Abuse. RESULTS:
Compared with the No Abuse group, the Rape+Abuse group was eight
times more likely to have pelvic pain and 3.7 times more likely
to have jaw/face pain after we controlled for the effect of
widespread pain. Rape was not associated with lower back pain or
headache. The Abuse Only group did not show a preferential
increase in risk of pain at any of the four locations that were
assessed. After controlling for pain at other locations, we
found that the Rape + Abuse group was 10 times more likely to
report pelvic pain than the No Abuse group (P<0.005).
DISCUSSION: In accord with the localization hypothesis,
self-reported rape was uniquely associated with pelvic pain.
Future efforts to account for pain in the aftermath of rape must
specify a mechanism that can simultaneously cause widespread
pain as well as increase risk of localized pain
(88)
Chen KW, Hassett AL, Hou F, Staller J, Lichtbroun AS. A pilot
study of external qigong therapy for patients with fibromyalgia.
J Altern Complement Med 2006; 12(9):851-856.
Abstract: OBJECTIVES: Although qigong is an important part of
Traditional Chinese medicine (TCM) based on a philosophy similar
to acupuncture, few studies of qigong exist in the Western
medicine literature. To evaluate qigong therapy as a modality in
treating chronic pain conditions such as fibromyalgia syndrome
(FMS), we report a pilot trial of 10 women with severe FMS who
experienced significant improvement after external qigong
therapy (EQT). DESIGN: Ten patients with FMS completed five to
seven sessions of EQT over 3 weeks with pre- and posttreatment
assessment and a 3-month follow-up. Each treatment lasted
approximately 40 minutes. OUTCOME MEASURES: Tender point count
(TPC) and Fibromyalgia Impact Questionnaire (FIQ) were the
primary measures. McGill Pain Questionnaire (MPQ), Beck
Depression Inventory (BDI), anxiety, and self-efficacy were the
secondary outcomes. RESULTS: Subjects demonstrated improvement
in functioning, pain, and other symptoms. The mean TPC was
reduced from 136.6 to 59.5 after EQT treatment; mean MPQ
decreased from 27.0 to 7.2; mean FIQ from 70.1 to 37.3; and mean
BDI from 24.3 to 8.3 (all p < 0.01). Many subjects reported
reductions in other FMS symptoms, and two reported they were
completely symptom-free. Results from the 3-month follow-up
indicated some slight rebound from the post-treatment measures,
but still much better than those observed at baseline.
CONCLUSIONS: Treatment with EQT resulting in complete recovery
for some FMS patients suggests that TCM may be very effective
for treating pain and the multiplicity of symptoms associated
with FMS. Larger controlled trials of this promising
intervention are urgently needed
(89)
Chou CT. The clinical application of etanercept in Chinese
patients with rheumatic diseases. Mod Rheumatol 2006;
16(4):206-213.
Abstract: Over a 2-year period, to evaluate the efficacy and
safety of biologic agents, etanercept (25 mg twice per week,
s.c.) was used to treat 57 rheumatoid arthritis (RA) patients, 9
ankylosing spondylitis (AS) patients, 6 psoriatic arthritis
(PSA) patients, and 4 juvenile rheumatoid arthritis (JRA)
patients. In addition to inflammatory arthritis, I have used
this tumor necrosis factor (TNF) blocker in other rheumatic
diseases including idiopathic thrombocytopenic purpura (ITP),
Behcet's disease with intractable oral ulcer, fibromyalgia
syndrome, and systemic lupus erythematosis with intractable
pleural effusion and acute lumbar disc herniation. For RA, after
6 months of etanercept treatment, all the parameters including
number of swollen joints, number of tender joints, disease
activity score, erythrocyte sedimentation rate, C-reactive
protein, and global health status were rapidly improved (P <
0.001 or P < 0.0001). The anticyclic citrullinated peptide
(anti-CCP) antibody and rheumatoid factor also significantly
declined. For spondyloarthropathy, it also gave a similar effect
as to RA. Both Bath Ankylosing Spondylitis Disease Activity
Index and Bath Ankylosing Spondylitis Functional Index also
improved. One of the two cases with Behcet's disease with
intractable oral ulcer had a long-term remission after
etanercept. The other Behcet's disease patient with oral ulcer
and another with ITP obtained a good response temporarily. The
short-term use of etanercept (<3 months) did not bring a
significant effect for cases of fibromyalgia syndrome, pleural
effusion, and lumbar disc herniation. In conclusion, a dramatic
and rapid clinical response in different kinds of arthritis
patients can be achieved by etanercept. Moreover, the TNF-alpha
inhibitor also can treat other severe rheumatic-related
symptoms. In general, except for a few cases with infection and
two cases with malignancy, etanercept was safe in our arthritis
patients. We need to study a larger number of patients in order
to better understand the efficacy and safety of etanercept
(90)
Choy E. Comparing methods for the diagnosis of fibromyalgia. Nat
Clin Pract Rheumatol 2006; 2(5):244-245.
(91)
Citak-Karakaya I, Akbayrak T, Demirturk F, Ekici G, Bakar Y.
Short and long-term results of connective tissue manipulation
and combined ultrasound therapy in patients with fibromyalgia. J
Manipulative Physiol Ther 2006; 29(7):524-528.
Abstract: OBJECTIVE: The aim of the study was to evaluate the
short-term and 1-year follow-up results of connective tissue
manipulation and combined ultrasound (US) therapy (US and
high-voltage pulsed galvanic stimulation) in terms of pain,
complaint of nonrestorative sleep, and impact on the functional
activities in patients with fibromyalgia (FM). METHODS: This is
an observational prospective cohort study of 20 female patients
with FM. Intensity of pain, complaint of nonrestorative sleep,
and impact of FM on functional activities were evaluated by
visual analogue scales. All evaluations were performed before
and after 20 sessions of treatment, which included connective
tissue manipulation of the back daily, for a total of 20
sessions, and combined US therapy of the upper back region every
other session. One-year follow-up evaluations were performed on
14 subjects. Friedman test was used to analyze time-dependent
changes. RESULTS: Statistical analyses revealed that pain
intensity, impact of FM on functional activities, and complaints
of nonrestorative sleep improved after the treatment program (P
< .05). CONCLUSION: Methods used in this study seemed to be
helpful in improving pain intensity, complaints of
nonrestorative sleep, and impact on functional activities in
patients with FM
(92)
Clayton AH, West SG. Combination therapy in fibromyalgia. Curr
Pharm Des 2006; 12(1):11-16.
Abstract: Fibromyalgia is an enigmatic medical condition whose
specific etiology remains undiscovered but currently plagues
five million Americans. Research indicates that the origin of
the disease is most likely multifactorial. Treatment should
therefore be tailored accordingly. Thus, it is often necessary
to combine different options in order to achieve the maximum
benefit in patients suffering from fibromyalgia
(93)
Clemens JQ, Brown SO, Kozloff L, Calhoun EA. Predictors of
symptom severity in patients with chronic prostatitis and
interstitial cystitis. J Urol 2006; 175(3 Pt 1):963-966.
Abstract: PURPOSE: Numerous studies have been performed to
identify potential risk factors for CP/CPPS and IC. However, few
studies have been done to identify predictors of disease
severity. MATERIALS AND METHODS: A total of 174 men with CP/CPPS
and 111 women with IC completed questionnaires to quantify
symptom severity and identify demographic, medical and
psychosocial characteristics. Symptom severity was assessed with
the National Institutes of Health CPSI in men, and the
O'Leary-Sant ICSI and problem index in women. Univariate and
multivariate analyses were performed to identify characteristics
predictive of worse symptoms. RESULTS: The mean National
Institutes of Health CPSI score in men was 15.32, and the mean
O'Leary-Sant ICSI and problem index in women was 19.17. The most
commonly reported comorbidities were allergies, sinusitis,
erectile dysfunction and irritable bowel syndrome in men, and
allergies, urinary incontinence, sinusitis and irritable bowel
syndrome in women. In the 2 sexes self-reported urinary
frequency and urgency, worse depression scores and lower
education level were independent predictors of worse symptom
severity. In men additional independent predictors were
self-reported pelvic pain, fibromyalgia and previous heart
attack, and in women an additional independent predictor was
postmenopausal status. CONCLUSIONS: There are several common
medical conditions associated with urological pelvic pain
syndromes in men and women. Few of them were predictive of
symptoms severity in this analysis. Self-reported pelvic pain
symptoms, education and depression severity were the factors
most strongly predictive of symptom severity in patients with
CP/CPPS and IC
(94)
Cogan J, Camus M, Saucier JF, Arsenault P, Demers J. A new
application of sound resonance technology therapy for the
treatment of fibromyalgia: a retrospective analysis. Complement
Ther Clin Pract 2006; 12(3):206-212.
Abstract: OBJECTIVE: Chart review to evaluate the effectiveness
of a three-phase sound resonance technology therapy (SRTT)
protocol for the treatment of fibromyalgia. RESULTS: Initial FIQ
scores of 159 consecutive patients ranged from 24 to 80
(mean=58). After Phase 1, ( approximately 1 month into the
protocol), FIQ scores had decreased on average by 26 points
(n=128, 95% CI 23-30, p<.001). After phase 3 of the protocol 53
patients completed an FIQ questionnaire and the mean decrease in
FIQ score was 38 points (95% CI 32-44, p=.004). CONCLUSIONS:
This retrospective analysis suggests considerable and rapid
relief of the symptoms of fibromyalgia following the use of the
three-phase SRTT treatment protocol, which appears to be
maintained over several years. Although these results are not
conclusive they are remarkable as no other therapy reported in
the scientific literature seems as efficacious for fibromyalgia.
A follow-up study using an RCT design is warranted
(95)
Cohen H, Jotkowitz A, Buskila D, Pelles-Avraham S, Kaplan Z,
Neumann L et al. Post-traumatic stress disorder and other
co-morbidities in a sample population of patients with irritable
bowel syndrome. Eur J Intern Med 2006; 17(8):567-571.
Abstract: BACKGROUND: High rates of psychiatric co-morbidity
have been reported in patients with irritable bowel syndrome
(IBS) and high rates of post-traumatic stress disorder (PTSD)
have been reported in fibromyalgia, a disorder also associated
with IBS. The primary aim of this study was to assess the
frequency of PTSD in IBS patients. METHODS: Sixty-four patients
who fulfilled the Rome II diagnostic criteria for IBS were asked
to complete questionnaires measuring the prevalence and severity
of symptoms of PTSD and psychological distress. RESULTS:
Although 86% of IBS patients reported a traumatic life
experience, only 7.8% met the diagnostic criteria for PTSD. High
rates of somatization, obsessive-compulsive behavior,
interpersonal sensitivity, and anxiety symptoms were seen among
the IBS patients. CONCLUSIONS: The results show a lower than
expected prevalence of PTSD among IBS patients, which is similar
to that of the general population. Thus, we did not find that
PTSD is over-represented in a sample population of IBS patients
(96)
Cohen SP, Verdolin MH, Chang AS, Kurihara C, Morlando BJ, Mao J.
The intravenous ketamine test predicts subsequent response to an
oral dextromethorphan treatment regimen in fibromyalgia
patients. J Pain 2006; 7(6):391-398.
Abstract: Fibromyalgia (FM) is a challenging pain syndrome for
which no reliable pharmacologic treatment exists. Recent
clinical studies suggest that N-methyl-D-aspartate receptors
might play a role in the pathogenesis of this disorder. To
determine whether an intravenous (IV) ketamine test predicts the
response to a therapeutic trial with an oral
N-methyl-D-aspartate receptor antagonist, we performed a
low-dose (0.1 mg/kg) IV ketamine infusion on 34 consecutive
patients with FM, which was subsequently followed by an oral
dextromethorphan (DX) treatment regimen. As per previous
guidelines, the cutoff value for a positive response to the IV
ketamine test was designated to be 67% pain relief, and a
positive response to DX treatment was 50% pain reduction at 4-
to 6-week follow-up visits. The degree of correlation between
pain relief with ketamine and DX was highly significant (Pearson
correlation coefficient, 0.66; P < .001). Ten patients responded
positively to both ketamine and DX, 19 responded to neither
drug, 3 had a positive response to ketamine but not DX, and 2
obtained good pain relief with DX but not ketamine. The
sensitivity of the IV ketamine test was 83%, the specificity was
86%, the positive predictive value was 77%, and the negative
predictive value was 91%. An association was also found between
the development of side effects to the two treatments.
PERSPECTIVE: The response to an IV ketamine infusion was found
to predict the subsequent response to an oral dextromethorphan
treatment regimen in fibromyalgia patients, with an observed
agreement of 83%. Considering the refractory nature of
fibromyalgia to conventional pain treatments, the IV ketamine
test might enhance patient care by saving time and reducing
unnecessary treatment trials
(97)
Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA. Migraine,
fibromyalgia, and depression among people with IBS: a prevalence
study. BMC Gastroenterol 2006; 6:26.:26.
Abstract: BACKGROUND: Case descriptions suggest IBS patients are
more likely to have other disorders, including migraine,
fibromyalgia, and depression. We sought to examine the
prevalence of these conditions in cohorts of people with and
without IBS. METHODS: The source of data was a large U.S. health
plan from January 1, 1996 though June 30, 2002. We identified
all people with a medical claim associated with an ICD-9 code
for IBS. A non-IBS cohort was a random sample of people with an
ICD-9 code for routine medical care. In the cohorts, we
identified all claims for migraine, depression, and
fibromyalgia. We estimated the prevalence odds ratios (PORs) of
each of the three conditions using the Mantel-Haenszel method.
We conducted quantitative sensitivity analyses to quantify the
impact of residual confounding and in differential outcome
identification. RESULTS: We identified 97,593 people in the IBS
cohort, and a random sample of 27,402 people to compose the
non-IBS comparison cohort. With adjustment, there was a 60%
higher odds in the IBS cohort of having any one of the three
disorders relative to the comparison cohort (POR 1.6, 95% CI 1.5
- 1.7). There was a 40% higher odds of depression in the IBS
cohort (POR 1.4, 95% CI 1.3 - 1.4). The PORs for fibromyalgia
and migraine were similar (POR for fibromyalgia 1.8, 95% CI 1.7
- 1.9; POR for migraine 1.6, 95% CI 1.4 - 1.7). Differential
prevalence of an unmeasured confounder, or imperfect sensitivity
or specificity of outcome detection would have impacted the
observed results. CONCLUSION: People in the IBS cohort had a 40%
to 80% higher prevalence odds of migraine, fibromyalgia, and
depression
(98)
Colladdo A, de SP. [Fibromyalgia: understanding the disease and
its social implications]. Rev Esp Anestesiol Reanim 2006;
53(1):1-3.
(99)
Cook DB, Nagelkirk PR, Poluri A, Mores J, Natelson BH. The
influence of aerobic fitness and fibromyalgia on
cardiorespiratory and perceptual responses to exercise in
patients with chronic fatigue syndrome. Arthritis Rheum 2006;
54(10):3351-3362.
Abstract: OBJECTIVE: To investigate cardiorespiratory and
perceptual responses to exercise in patients with chronic
fatigue syndrome (CFS), accounting for comorbid fibromyalgia
(FM) and controlling for aerobic fitness. METHODS: Twenty-nine
patients with CFS only, 23 patients with CFS plus FM, and 32
controls completed an incremental bicycle test to exhaustion.
Cardiorespiratory and perceptual responses were measured.
Results were determined for the entire sample and for 18
subjects from each group matched for peak oxygen consumption.
RESULTS: In the overall sample, there were no significant
differences in cardiorespiratory parameters between the CFS only
group and the controls. However, the CFS plus FM group exhibited
lower ventilation, lower end-tidal CO2, and higher ventilatory
equivalent of carbon dioxide compared with controls, and slower
increases in heart rate compared with both patients with CFS
only and controls. Peak oxygen consumption, ventilation, and
workload were lower in the CFS plus FM group. Subjects in both
the CFS only group and the CFS plus FM group rated exercise as
more effortful than did controls. Patients with CFS plus FM
rated exercise as significantly more painful than did patients
with CFS only or controls. In the subgroups matched for aerobic
fitness, there were no significant differences among the groups
for any measured cardiorespiratory response, but perceptual
differences in the CFS plus FM group remained. CONCLUSION: With
matching for aerobic fitness, cardiorespiratory responses to
exercise in patients with CFS only and CFS plus FM are not
different from those in sedentary healthy subjects. While CFS
patients with comorbid FM perceive exercise as more effortful
and painful than do controls, those with CFS alone do not. These
results suggest that aerobic fitness and a concurrent diagnosis
of FM are likely explanations for currently conflicting data and
challenge ideas implicating metabolic disease in the
pathogenesis of CFS
(100)
Cruz BA, Catalan-Soares B, Proietti F. Higher prevalence of
fibromyalgia in patients infected with human T cell lymphotropic
virus type I. J Rheumatol 2006; 33(11):2300-2303.
Abstract: OBJECTIVE:. Inflammatory rheumatic conditions
including rheumatoid arthritis and Sjogren's syndrome have been
reported in individuals infected with human T cell lymphotropic
virus type I (HTLV-I). Other chronic lymphotropic virus
infections such as hepatitis C and human immunodeficiency virus
are associated with fibromyalgia (FM). There are no reports
about the association between HTLV-I infection and FM. We
evaluated the association between FM and HTLV-I infection.
METHODS: We conducted a case-control study with prevalent cases.
Ex-blood donation candidates with HTLV-I infection from a blood
bank cohort, and healthy blood donors as a control group, were
submitted to rheumatologic evaluation to compare the prevalence
of FM. The following covariables were also evaluated: other
rheumatic diseases, age, sex, personal income, level of
education, and depression. RESULTS: One hundred individuals with
HTLV-I infection and 62 non-infected blood donors were studied.
Thirty-eight (38%) HTLV-I infected individuals and 3 (4.8%)
individuals from the control group presented the diagnosis of FM
(OR 12.05, 95% CI 3.53-41.17). Other rheumatic diseases were
also more prevalent in the infected group (37% vs 12.9%; OR
3.80, 95% CI 1.63-8.86). In multivariate analysis adjusted by
the covariables, the association between HTLV-I and FM was
statistically significant (OR 9.14, 95% CI 2.42-34.52).
CONCLUSION: Our study shows a greater prevalence of FM in HTLV-I
infected individuals, suggesting that FM may be associated with
this viral infection
(101)
cuna-Castroviejo D, Escames G, Reiter RJ. Melatonin therapy in
fibromyalgia. J Pineal Res 2006; 40(1):98-99.
(102)
Cunningham MM, Jillings C. Individuals' descriptions of living
with fibromyalgia. Clin Nurs Res 2006; 15(4):258-273.
Abstract: Fibromyalgia (FM) is a chronic pain syndrome with no
known etiology, cure, prognosis, or clear diagnostic criteria.
This interpretive descriptive study was focused on the
experience of living with FM. Using a constant comparative
inductive analytic method, the researcher collected and analyzed
data from in-depth, semistructured interviews with eight
participants. This study's findings offer insights into the
experience of living with and managing FM and identify social,
policy, and health care issues that profoundly affect those
suffering from it. Participants believe that people with FM
would benefit if more health care professionals, as well as
family and friends, would validate their condition and provide
them with better support. More research could clarify ways in
which health care providers may provide more effective
interventions, appropriate care, and ongoing support for those
affected with FM
(103) Da CD, Dritsa M, Bernatsky S, Pineau C, Menard HA,
Dasgupta K et al.
Dimensions of
fatigue in systemic lupus erythematosus: relationship to disease
status and behavioral and psychosocial factors. J Rheumatol
2006; 33(7):1282-1288.
Abstract: OBJECTIVE: To characterize the experience of fatigue
in patients with systemic lupus erythematosus (SLE) using a
multidimensional assessment and to delineate contributors to
physical and mental dimensions of fatigue. METHODS: Fatigue in
130 women with SLE was assessed using the Multidimensional
Fatigue Inventory (MFI-20). Participants completed standardized
questionnaires assessing sleep quality, depressed mood, social
support, and leisure-time physical activity. A clinical
examination determined disease activity, cumulative damage, and
whether patients fulfilled American College of Rheumatology
criteria for fibromyalgia (FM). A series of hierarchical
multiple regressions were computed to identify contributors to
physical and mental fatigue. RESULTS: Patients scored high on
all 5 MFI-20 fatigue dimensions, with general fatigue and
physical fatigue having the highest scores. A hierarchical
multiple regression showed that greater disease damage and
disease activity, the presence of FM, depressed mood, sleep
disturbance, and less participation in leisure-time physical
activity contributed to higher physical fatigue scores. The
results of the second model found depressed mood to be the
strongest determinant of mental fatigue. Disease-related
variables were not associated with mental fatigue. CONCLUSION:
Fatigue in SLE is multidimensional and multidetermined, with
physical and mental aspects likely having different etiologies.
A multidimensional assessment of fatigue in SLE is needed to
tailor and optimize interventions aimed at alleviating fatigue
(104)
Dadabhoy D, Clauw DJ. Therapy Insight: fibromyalgia--a different
type of pain needing a different type of treatment. Nat Clin
Pract Rheumatol 2006; 2(7):364-372.
Abstract: In the past decade, we have made tremendous progress
in our understanding of fibromyalgia, which is now recognized as
one of many 'central' pain syndromes that are common in the
general population. Specific genes that might confer an
increased risk of developing fibromyalgia syndrome are beginning
to be identified and the environment (in this case exposure to
stressors) might also have a significant effect on triggering
the expression of symptoms. After developing the syndrome, the
hallmark aberration noted in individuals with fibromyalgia is
augmented central pain processing. Insights from research
suggest that fibromyalgia and related syndromes require a
multimodal management program that is different from the
standard used to treat peripheral pain (i.e. acute or
inflammatory pain). Instead of the nonsteroidal
anti-inflammatory drugs and opioids commonly used in the
treatment of peripheral pain, the recommended drugs for central
pain conditions are neuroactive compounds that downregulate
sensory processing. The most efficacious compounds that are
currently available include the tricyclic drugs and mixed
reuptake inhibitors that simultaneously increase serotonin and
norepinephrine concentrations in the central nervous system.
Other compounds that increase levels of single monoamines
(serotonin, norepinephrine or dopamine), and anticonvulsants
also show efficacy in this condition. In addition to these
pharmacologic therapies, which are useful in improving symptoms,
nonpharmacologic therapies such as exercise and cognitive
behavioral therapy are useful treatments for restoring function
to an individual with fibromyalgia
(105)
Dahan V, Kimoff RJ, Petrof BJ, Benedetti A, Diorio D, Trojan DA.
Sleep-disordered breathing in fatigued postpoliomyelitis clinic
patients. Arch Phys Med Rehabil 2006; 87(10):1352-1356.
Abstract: OBJECTIVE: To determine the frequency, predictive
factors, and symptoms predictive of sleep-disordered breathing
(SDB) in fatigued postpoliomyelitis clinic patients. DESIGN:
Cross-sectional, retrospective chart review. SETTING:
University-affiliated hospital postpolio clinic. PARTICIPANTS:
Postpolio clinic charts (N=590) were reviewed. Ninety-eight
patients were included, and 492 patients were not included,
primarily because of the lack of a polysomnogram. INTERVENTIONS:
Not applicable. MAIN OUTCOME MEASURE: The Apnea-Hypopnea Index
(AHI) calculated as the total number of sleep-related breathing
events/total sleep time. RESULTS: The frequency of SDB defined
by an AHI score of 5 or more was 65% and by an AHI score of 10
or more was 50%. Obstructive hypopnea was the predominant form,
occurring in 86%. Age, sex, age at acute polio, time since
polio, weakness and respiratory difficulties at acute polio,
bulbar involvement at acute polio and at evaluation, body mass
index, pulmonary function measures, alcohol use, sedative drug
use, smoking, fibromyalgia, kyphoscoliosis, and scoliosis and
ear-nose-throat surgery were not predictive of SDB (AHI scores >
or =5 and > or =10). Snoring was more common in subjects with
SDB (AHI score > or =5 and > or =10). Some pulmonary function
measures correlated with oxygen saturation during sleep in SDB
(AHI scores > or =5). CONCLUSIONS: SDB was very common in
fatigued postpoliomyelitis clinic patients referred for sleep
evaluation. Obstructive hypopnea was the most frequent type. In
this preliminary study, snoring tended to predict SDB
(106)
de Sa Pinto AL, de Barros Holanda PM, Radu AS, Villares SM, Lima
FR. Musculoskeletal findings in obese children. J Paediatr Child
Health 2006; 42(6):341-344.
Abstract: AIM: A cross-sectional study was conducted to explore
osteoarticular alterations in obese children. METHODS:
Twenty-five boys and 24 girls (mean age: 10.8+/-2.07 years) with
a body mass index (BMI) above the 95th percentile were compared
with 28 boys and 19 girls (controls, mean age: 10.4+/-2.3 years)
with a BMI below the 80th percentile. RESULTS: A higher
frequency of at least one osteoarticular manifestation was
observed in obese patients (55%) compared with the control group
(23%) (P=0.001). A statistically significant association was
also found between obesity and lower back pain, genu valgum,
genu recurvatum and tight quadriceps. Fibromyalgia tender points
(=11) were present at similar frequency in both groups (obese:
3/38 (9%) vs. control: 1/48 (2%)). CONCLUSION: The present data
suggest that obesity has a negative impact on osteoarticular
health by promoting biomechanical changes in the lumbar spine
and lower extremities
(107) Degotardi PJ, Klass ES, Rosenberg BS, Fox DG, Gallelli
KA, Gottlieb BS.
Development
and evaluation of a cognitive-behavioral intervention for
juvenile fibromyalgia. J Pediatr Psychol 2006; 31(7):714-723.
Abstract: OBJECTIVE: To describe the development and test the
efficacy of a cognitive-behavioral intervention (CBT) for
juvenile fibromyalgia. METHOD: Sixty-seven children with
fibromyalgia and their parents were recruited to participate in
an 8-week intervention that included modules of pain management,
psychoeducation, sleep hygiene, and activities of daily living.
Children were taught techniques of cognitive restructuring,
thought stopping, distraction, relaxation, and self-reward.
Additionally, they kept daily pain and sleep diaries. Children
completed questionnaires of pre- and post-treatment measuring
physical status and psychological functioning. RESULTS:
Following CBT, children reported significant reductions (p <
.006) in pain, somatic symptoms, anxiety, and fatigue, as well
as improvements in sleep quality. Additionally, children
reported improved functional ability and had fewer school
absences. CONCLUSION: Children with fibromyalgia can be taught
CBT strategies that help them effectively manage this chronic
and disabling musculoskeletal pain disorder
(108) Dobkin PL, Da CD, Abrahamowicz M, Dritsa M, Du BR,
Fitzcharles MA et al.
Adherence
during an individualized home based 12-week exercise program in
women with fibromyalgia. J Rheumatol 2006; 33(2):333-341.
Abstract: OBJECTIVE: Treatment recommendations for fibromyalgia
(FM) include regular physical exercise. In this prospective
study we examined predictors for adherence to stretching and
aerobic exercises in women provided with an individualized home
based program. METHODS: Thirty-nine women kept exercise diaries
for 12 weeks. RESULTS: For both types of exercise, women who
were less physically fit at baseline engaged in more exercise
during the program. Yet for stretching, more lower body pain at
baseline predicted engaging in less stretching exercise over
time, whereas for aerobic exercise, more baseline upper body
pain predicted more exercise over time. As time passed,
participants with higher baseline physical fitness and/or older
age were reducing their aerobic exercise practice at
significantly faster rates, as were those women with higher
baseline stress. CONCLUSION: Given that adequate levels of
adherence were limited to about half of the participants for
both types of exercise, steps to reduce barriers to exercise
(e.g., stress) need to be taken when prescribing exercise in the
treatment of FM
(109)
Dobkin PL, De CM, Abrahamowicz M, Baron M, Bernatsky S.
Predictors of health status in women with fibromyalgia: a
prospective study. Int J Behav Med 2006; 13(2):101-108.
Abstract: Although cross-sectional studies have identified
correlates of dysfunction in fibromyalgia (FM) patients (e.g.,
psychological distress and pain), predictors of health status
have not been previously investigated using a longitudinal
research design. We gathered data from 156 women who met
American College of Rheumatology criteria for primary FM
recruited from both tertiary care and community settings.
Stepwise multiple linear regression analysis indicated that
poorer health status (p < .0001) and more comorbidity (p =
.0089) at baseline were predictors of poorer health status 6
months later. After controlling for these covariates,
psychological distress contributed significantly to the model (p
= .01). There was a trend indicating that palliative coping
styles (i.e., self-care, energy conservation) altered the impact
of pain on 6-month health status (p = .06). These findings
highlight the need for multidisciplinary interventions that
target psychological distress, coping, and comorbidity in
patients with FM
(110)
Dobkin PL, Sita A, Sewitch MJ. Predictors of adherence to
treatment in women with fibromyalgia. Clin J Pain 2006;
22(3):286-294.
Abstract: OBJECTIVES: The goal of this study was to identify
predictors of general and medication adherence in women with
fibromyalgia (FM). METHODS: Participants were 142 women
recruited from tertiary care hospitals or the community and 10
rheumatologists. Participants' demographic, clinical, and
psychosocial characteristics, as well as patient-physician
discordance, were assessed at the index visit. Adherence was
assessed 6 months later. Multivariable generalized estimating
equations were used to identify predictors of general adherence
and adherence to medication. RESULTS: The average age of
participants was 50.9 years (SD=10.2) and the median duration of
FM was 32 months. Participants reported extensive use of health
services and medications. The mean score for general adherence
was 61.0 (SD=22.4; range 0-100) and 52.9% of the cohort reported
at least one form of behavior reflecting nonadherence to
medications. More general adherence was significantly predicted
by lower patient-physician discordance on patient well-being and
lower patient psychological distress. Medication adherence was
significantly predicted by higher affective pain and lower
patient psychological distress. CONCLUSIONS: Adherence is
influenced by both clinical (patient-physician discordance and
pain) and psychological (distress) factors in women with FM.
Improvements in these domains may improve adherence in FM
(111)
Edwards RR, Bingham CO, III, Bathon J, Haythornthwaite JA.
Catastrophizing and pain in arthritis, fibromyalgia, and other
rheumatic diseases. Arthritis Rheum 2006; 55(2):325-332.
Abstract: OBJECTIVE: Pain is among the most frequently reported,
bothersome, and disabling symptoms described by patients with
osteoarthritis, rheumatoid arthritis, fibromyalgia, and other
musculoskeletal conditions. This review describes a growing body
of literature relating catastrophizing, a set of cognitive and
emotional processes encompassing magnification of pain-related
stimuli, feelings of helplessness, and a generally pessimistic
orientation, to the experience of pain and pain-related sequelae
across several rheumatic diseases. METHODS: We reviewed
published articles in which pain-related catastrophizing was
assessed in the context of one or more rheumatic conditions.
Because much of the available information on catastrophizing is
derived from the more general chronic pain literature, seminal
studies in other disease states were also considered. RESULTS:
Catastrophizing is positively related, in both cross-sectional
and prospective studies across different musculoskeletal
conditions, to the reported severity of pain, affective
distress, muscle and joint tenderness, pain-related disability,
poor outcomes of pain treatment, and, potentially, to
inflammatory disease activity. Moreover, these associations
generally persist after controlling for symptoms of depression.
There appear to be multiple mechanisms by which catastrophizing
exerts its harmful effects, from maladaptive influences on the
social environment to direct amplification of the central
nervous system's processing of pain. CONCLUSION: Catastrophizing
is a critically important variable in understanding the
experience of pain in rheumatologic disorders as well as other
chronic pain conditions. Pain-related catastrophizing may be an
important target for both psychosocial and pharmacologic
treatment of pain
(112)
Egle UT, Van HB. [Fibromyalgia: a stress induced pain illness?].
Schmerz 2006; 20(2):99-100.
(113)
Eksioglu E, Yazar D, Bal A, Usan HD, Cakci A. Effects of Stanger
bath therapy on fibromyalgia. Clin Rheumatol 2006; .
Abstract: The purpose of this study was to assess the
effectiveness of Stanger bath on the treatment of fibromyalgia
(FM). Fifty women with FM were randomly divided into two groups.
The first group (n=25) was treated with amitriptyline, 10 mg/day
for 8 weeks, and Stanger bath, 20 min daily for ten sessions.
The second group (n=25) only had amitriptyline, 10 mg/day for 8
weeks. In the first group the assessment parameters were
measured before (t1), at the end (t2), and 2 months after the
hydrotherapy (t3). In the second group these parameters were
examined before (T1) and 2 months after the treatment (T2).
Patients were evaluated by number of tender points and
Fibromyalgia Impact Questionnaire (FIQ) scores. There was
significant improvement in number of tender points between t1
and t2 (P<0.01) and t1 and t3 (P<0.001) in the Stanger bath
group. In addition, there was significant improvement in FIQ
scores between t1 and t2 (P<0.001) and t1 and t3 (P<0.01) in the
Stanger bath group. In the second group we observed significant
improvement in FIQ scores and tender point numbers between T1
and T2 (P=0.00). We did not find any difference between groups
in tender point number percent change (p=0.074). However, we
observed statistically significant improvement in percent change
of FIQ scores in Stanger bath group (-30+/-16.7) when compared
to group 2 (-19.3+/-13) (p=0.016). We conclude that Stanger bath
therapy when combined with amitriptyline has a long lasting
effect and better outcome in FM patients
(114)
El-Hage W, Lamy C, Goupille P, Gaillard P, Camus V.
[Fibromyalgia: a disease of psychic trauma?]. Presse Med 2006;
35(11 Pt 2):1683-1689.
Abstract: Chronic unexplained pain may be a somatic
manifestation of psychological distress - often untreated
distress. The association between psychic trauma, posttraumatic
symptoms, psychic dissociation, and somatoform disorders is
currently well documented. When examining a patient with chronic
pain syndrome, it is important to consider its psychic dimension
early on and to look for a history of psychic trauma. This can
help avoid prolonged chronic effects and the emergence of
psychiatric comorbidity. There is currently no consensual
medication strategy for treatment of unexplained chronic pain
syndrome. Multidisciplinary outpatient management is necessary
in these complex cases, which require simultaneous medical and
psychiatric referrals
(115)
El MA, Tellal S, Achemlal L, Nouijai A, Ghazi M, Mounach A et
al. Bone turnover and hormonal perturbations in patients with
fibromyalgia. Clin Exp Rheumatol 2006; 24(4):428-431.
Abstract: OBJECTIVE: Studies of bone turnover in fibromyalgia
(FM) have, to date, shown conflicting results. Although most
patients with FM are women, only a few investigations have paid
attention to the changes of sex hormones in FM. Moreover, FM is
often viewed as a stress related disorder, and abnormalities of
the hypothalamic-pituitary-adrenal (HPA) axis have been found in
FM. The aim of the study was to assess bone turnover using serum
osteocalcin and CTx in patients with FM and study correlation
between bone turnover parameters and parathormon and hormones of
the HPA axis. METHODS: A total of 81 subjects participated in
this study: 41 healthy volunteers and 40 patients with FM. Serum
osteocalcin, crosslaps (C-telopeptide: CTx), parathyroid hormone
(PTH), testosterone, estrogen, prolactin, FSH, and LH were
measured. The mean age of the study population was 49.5 (7.6)
years (32-69) and the mean disease duration was 8.1 (12.0) years
(4.5-30.7). RESULTS: No difference between patients and controls
were observed in serum calcium, phosphorus, creatinine, albumin,
osteocalcin, testosterone, and urinary calcium. Patients had
lower serum levels of CTx, estrogen, PTH and prolactin than
controls and higher serum levels of LH and FSH with a
significant statistical difference. No significant statistical
correlation was observed between intensity of pain and fatigue
and bone turnover parameters and PTH or hormones of the HPA
axis. CONCLUSION: Our study showed that patients with FM had low
bone resorption and normal bone formation compared to a control
group. This was not related to several hormonal perturbations
observed in these patients and may reflect functional impairment
as suggested in previous studies
(116)
Elvin A, Siosteen AK, Nilsson A, Kosek E. Decreased muscle blood
flow in fibromyalgia patients during standardised muscle
exercise: a contrast media enhanced colour Doppler study. Eur J
Pain 2006; 10(2):137-144.
Abstract: The aim of the study was to investigate if contrast
enhanced ultrasound (US) imaging of muscular blood flow during
and following exercise could detect alterations in vascularity
in fibromyalgia (FM) patients. Ten FM patients and 10 matched
controls were examined with US during standardised static and
directly following static and dynamic muscular contractions of
the infraspinatus muscle. Doppler ultrasound evaluation was
performed before and after the administration of ultrasound
contrast media. The FM patients had lower magnitude of muscle
vascularity following dynamic (p<0.001) and during (p<0.002)
static exercise compared to controls. The immediate flow
response to muscular activity was not only of a lower magnitude,
but also of a shorter duration in FM patients following dynamic
exercise (p<0.001) and during static exercise (p<0.01). There
were no statistically significant group differences in blood
flow intensity or duration following static contraction. In
conclusion, contrast enhanced US was found useful to study
real-time muscle blood flow changes during and following
standardised, low-intensity exercise in FM patients and healthy
controls. Our results support the suggestion that muscle
ischemia can contribute to pain in FM, possibly by maintaining
the central nervous changes such as central
sensitisation/disinhibition. US with contrast can be a new
valuable approach to assess muscle perfusion in pain patients
during standardised exercise
(117) Erkal MZ, Wilde J, Bilgin Y, Akinci A, Demir E, Bodeker
RH et al.
High
prevalence of vitamin D deficiency, secondary
hyperparathyroidism and generalized bone pain in Turkish
immigrants in Germany: identification of risk factors.
Osteoporos Int 2006; 17(8):1133-1140.
Abstract: INTRODUCTION: The aim of the study was to determine
the prevalence of vitamin D deficiency, secondary
hyperparathyroidism (sHPT), generalized bone pain and predictors
of vitamin D deficiency in a cohort of 994 healthy adult urban
residents (589 males, 405 females; age range: 16-69 years)
consisting of 101 Germans, 327 Turkish residents of Turkey and
566 Turkish immigrants living in Germany. METHODS: The mean (+/-
standard deviation) for 25-hydroxyvitamin D [25(OH)D] and
biointact parathyroid hormone (BioPTH) for the German men and
women was 68.4 nmol/l and 26.7 pg/ml, respectively. Turkish
residents of Turkey had a mean 25(OH)D and BioPTH of 40.6 nmol/l
and 27.5 pg/ml, respectively, whereas Turkish residents of
Germany had a 25(OH)D of 38.1 nmol/l and a BioPTH of 35.6 pg/ml.
RESULTS: Vitamin D insufficiency was common among Turkish
nationals independent of whether they lived in Turkey or
Germany; 75% had 25(OH)D levels of <50 nmol/l. Turkish females
had a higher prevalence of 25(OH)D deficiency (<25 nmol/l) than
Turkish males: 30 and 19% of Turkish females living in Germany
and Turkey were severely vitamin D deficient compared to 8% and
6% of Turkish males living in Germany and Turkey, respectively.
With respect to BioPTH levels, 31% of Turkish females and 21% of
Turkish males had elevated BioPTH levels in contrast to only 15%
of females and 4% of males living in Turkey. Unconditional
logistic regression analysis identified the most important
predictors for low 25(OH)D levels as sex, body mass index, lack
of sun exposure and living at a higher latitude. Additionally,
wearing a scarf and number of children were found to be an
independent risk factor for vitamin D deficiency in Turkish
women living in Turkey and Germany. A strong correlation between
low 25(OH)D levels and higher rates and longer duration of
generalized bone and/or muscle aches and pains (often diagnosed
as fibromyalgia) was observed. CONCLUSION: Secondary
hyperparathyroidism and vitamin D deficiency was found to be
common among Turkish immigrants living in Germany, especially in
veiled women. Therefore, the monitoring of vitamin D
status--i.e. 25(OH)D and PTH--in Turkish immigrants is warranted
and once a deficiency is identified, it should be appropriately
treated
(118)
Farajidavar A, Gharibzadeh S, Towhidkhah F, Saeb S. A cybernetic
view on wind-up. Med Hypotheses 2006; 67(2):304-306.
Abstract: Wind-up is described traditionally as a frequency
dependent increase in the excitability of spinal cord neurons,
evoked by electrical stimulation of afferent C-fibers. Different
kinds of wind-up have been reported, but wind-up of Abeta fibers
in hyperalgesic states has gained little attention. In this
paper, we present a cybernetic view on Abeta fiber wind-up and
consider the involved molecular mechanisms as feedback and
feedforward processes. Furthermore, our previous hypothesis, the
sprouting phenomenon, is included in this view. Considering the
proposed model, wind-up in hyperalgesic states might leave out
in three different ways: (1) blocking the NMDA receptors by
increasing extracellular Mg2+, 2) blocking the receptors and
channels that contribute to Ca2+ inward current, and 3) blocking
the Abeta fibers by local anesthetics. It seems that wind-up may
be inhibited more effectively by using these three blocking
mechanisms simultaneously, because in this case, the feedback
process (main controller), the feedforward process (trigger),
and Abeta stimulation (trigger) would be inhibited concurrently.
Wind up may aggravate the pain in clinical hyperalgesic
situations such as post-surgical states, some neuropathic pains,
fibromyalgia syndrome, and post-herpetic neuralgia. Surely,
clinical studies are needed to validate the effectiveness of our
abovementioned suggestions in relieving such clinical pains
(119)
Fengler RK, Jacobs JW, Bac M, van Wijck AJ, van Meeteren NL.
Action potential simulation (APS) in patients with fibromyalgia
syndrome (FMS): a controlled single subject experimental design.
Clin Rheumatol 2006; .
Abstract: OBJECTIVES: Action potential simulation (APS) is
becoming a popular method of pain reduction. Nevertheless,
little is known about the efficacy of this relatively new
treatment. The aim of this study was to investigate whether APS
helps to reduce pain, improves patients' perception of daily
functioning and social participation in patients with
fibromyalgia syndrome (FMS). MATERIALS AND METHODS: Ten patients
with FMS according to the American College of Rheumatology (ACR)
criteria entered this double blind crossover single-case study.
In a period of 20 weeks, the patients underwent two treatment
periods of 4 weeks, one with verum and one with placebo, at
random, in a double blind fashion. Outcome measures were
evaluated on a weekly basis. Primary outcome measure was pain
measured with the Fibromyalgia Impact Questionnaire (FIQ)
questions 4 and 5, the number of tender points and the total
tender point pain intensity score. Both visual inspection and
statistical analysis were done to analyse the data from this
single-subject design. RESULTS: Performing visual inspection and
statistical analysis, no positive results of the APS treatment
were found in this study. Remarkable is the fact that placebo
APS had significantly better results than verum APS.
CONCLUSIONS: In this single-case study with ten patients (all
female), APS was not a helpful method to reduce pain, to improve
patients' perception of daily functioning and social
participation in patients with FMS
(120)
Ferreira JJ, Couto M, Costa J, Coelho M, Rosa MM, Sampaio C.
[Botulinum toxin for the treatment of pain syndromes]. Acta
Reumatol Port 2006; 31(1):49-62.
Abstract: Although botulinum toxin (BoNT) is being used for
therapeutic purposes for more than 20 years, the list of
potential new indications continues to increase and includes
various pain syndromes. The pain relief experienced by patients
with dystonia and spasticity from intramuscular BoNT injections
suggested that other chronic skeletal-muscles pain conditions
may also benefit. BoNT inhibits the release of acetylcholine at
the neuromuscular junction thereby reducing striatal muscle
contractions and the proposed analgesic property was initially
attributed to muscular relaxation. A specific analgesic BoNT
effect is difficult to conclude from studies where pain is
conditioned by other associated symptoms like dystonia, muscle
contraction or spasticity. One alternative is to critically
appraise clinical trials where BoNT was studied as the active
intervention and pain evaluated as an outcome. From this
analysis there is convincing evidence for the effectiveness of
BoNT in the treatment of pain associated with cervical dystonia.
For all other pain syndromes there have been relatively few,
small sized, placebo-controlled studies (myofascial pain
syndrome, chronic neck and low back pain, piriformis syndrome
and fibromyalgia) and the results of these studies have been
contradictory or non conclusive. To establish the analgesic
properties of BoNT there is a need for appropriately designed,
exploratory randomized controlled studies in well accepted human
models of nociceptive or neuropathic pain. This does not exclude
the subsequent need to conduct pragmatic trials to evaluate the
effectiveness of BoNT in conditions where the improvement of
pain or any associated clinical sign or symptom may be of
clinical relevance
(121)
Fietta P, Fietta P. Counterbalance between leptin and cortisol
may be associated with fibromyalgia. Psychiatry Clin Neurosci
2006; 60(4):529.
(122)
Finset A, Graugaard PK, Holgersen K. Salivary cortisol response
after a medical interview: the impact of physician communication
behaviour, depressed affect and alexithymia. Patient Educ Couns
2006; 60(2):115-124.
Abstract: OBJECTIVE: To explore if - and possibly how - a
medical interview may affect adrenocortical activity in
musculo-skeletal pain patients with and without alexithymia.
METHODS: Female patients (N = 54) recruited from a patient
organization for fibromyalgia completed the Toronto Alexithymia
Scale (TAS-20) and subgroups with, respectively, low and high
scores were selected for participation. Seven physicians
conducted consultations attempting to vary their communication
in accordance with given guidelines. All consultations were
videotaped and analysed by The Roter Interaction Analysis System
(RIAS) to evaluate the actual content of the consultations.
RESULTS: An increase in depressed affect from pre- to
post-interview was associated with relatively high cortisol
levels 24 h after the consultation, but only in patients with
alexithymia. Psychosocial questions from the physician were
associated with increased depressed affect immediately following
the interview, but not with cortisol responses at any time.
CONCLUSION: In patients with deficient affect regulation,
increase in depressed affect after a medical interview may be
associated with delayed effects in adrenocortical activity,
possibly mediated by rumination. PRACTICE IMPLICATIONS:
Providers should be sensitive to potential deficits of affect
regulation in their patients
(123)
Forseth KO, Gran JT. [Fibromyalgia and drug therapy]. Tidsskr
Nor Laegeforen 2006; 126(11):1486-1487.
(124)
Fregni F, Gimenes R, Valle AC, Ferreira MJ, Rocha RR, Natalle L
et al. A randomized, sham-controlled, proof of principle study
of transcranial direct current stimulation for the treatment of
pain in fibromyalgia. Arthritis Rheum 2006; 54(12):3988-3998.
Abstract: OBJECTIVE: Recent evidence suggests that fibromyalgia
is a disorder characterized by dysfunctional brain activity.
Because transcranial direct current stimulation (tDCS) can
modulate brain activity noninvasively and can decrease pain in
patients with refractory central pain, we hypothesized that tDCS
treatment would result in pain relief in patients with
fibromyalgia. METHODS: Thirty-two patients were randomized to
receive sham stimulation or real tDCS with the anode centered
over the primary motor cortex (M1) or the dorsolateral
prefrontal cortex (DLPFC) (2 mA for 20 minutes on 5 consecutive
days). A blinded evaluator rated the patient's pain, using the
visual analog scale for pain, the clinician's global impression,
the patient's global assessment, and the number of tender
points. Other symptoms of fibromyalgia were evaluated using the
Fibromyalgia Impact Questionnaire and the Short Form 36 Health
Survey. Safety was assessed with a battery of neuropsychological
tests. To assess potential confounders, we measured mood and
anxiety changes throughout the trial. RESULTS: Anodal tDCS of
the primary motor cortex induced significantly greater pain
improvement compared with sham stimulation and stimulation of
the DLPFC (P < 0.0001). Although this effect decreased after
treatment ended, it was still significant after 3 weeks of
followup (P = 0.004). A small positive impact on quality of life
was observed among patients who received anodal M1 stimulation.
This treatment was associated with a few mild adverse events,
but the frequency of these events in the active-treatment groups
was similar to that in the sham group. Cognitive changes were
similar in all 3 treatment groups. CONCLUSION: Our findings
provide initial evidence of a beneficial effect of tDCS in
fibromyalgia, thus encouraging further trials
(125)
Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for
chronic noncancer pain: a meta-analysis of effectiveness and
side effects. CMAJ 2006; 174(11):1589-1594.
Abstract: BACKGROUND: Chronic noncancer pain (CNCP) is a major
health problem, for which opioids provide one treatment option.
However, evidence is needed about side effects, efficacy, and
risk of misuse or addiction. METHODS: This meta-analysis was
carried out with these objectives: to compare the efficacy of
opioids for CNCP with other drugs and placebo; to identify types
of CNCP that respond better to opioids; and to determine the
most common side effects of opioids. We searched MEDLINE,
EMBASE, CENTRAL (up to May 2005) and reference lists for
randomized controlled trials of any opioid administered by oral
or transdermal routes or rectal suppositories for CNCP (defined
as pain for longer than 6 mo). Extracted outcomes included pain,
function or side effects. Methodological quality was assessed
with the Jadad instrument; analyses were conducted with Revman
4.2.7. RESULTS: Included were 41 randomized trials involving
6019 patients: 80% of the patients had nociceptive pain
(osteoarthritis, rheumatoid arthritis or back pain); 12%,
neuropathic pain (postherpetic neuralgia, diabetic neuropathy or
phantom limb pain); 7%, fibromyalgia; and 1%, mixed pain. The
methodological quality of 87% of the studies was high. The
opioids studied were classified as weak (tramadol, propoxyphene,
codeine) or strong (morphine, oxycodone). Average duration of
treatment was 5 (range 1-16) weeks. Dropout rates averaged 33%
in the opioid groups and 38% in the placebo groups. Opioids were
more effective than placebo for both pain and functional
outcomes in patients with nociceptive or neuropathic pain or
fibromyalgia. Strong, but not weak, opioids were significantly
superior to naproxen and nortriptyline, and only for pain
relief. Among the side effects of opioids, only constipation and
nausea were clinically and statistically significant.
INTERPRETATION: Weak and strong opioids outperformed placebo for
pain and function in all types of CNCP. Other drugs produced
better functional outcomes than opioids, whereas for pain relief
they were outperformed only by strong opioids. Despite the
relative shortness of the trials, more than one-third of the
participants abandoned treatment
(126)
Garcia-Campayo J, Pascual A, Alda M, Marzo J, Magallon R, Fortes
S. The Spanish version of the FibroFatigue Scale: validation of
a questionnaire for the observer's assessment of fibromyalgia
and chronic fatigue syndrome. Gen Hosp Psychiatry 2006;
28(2):154-160.
Abstract: OBJECTIVE: To examine some of the psychometric
properties of the Spanish version of the FibroFatigue Scale
(FFS). METHODS: FFS was administered to 120 patients diagnosed
with fibromyalgia and chronic fatigue syndrome. Internal
consistency was evaluated by using Cronbach's alpha, test-retest
reliability with weighted kappa and construct validity by
correlations among FFS, the Fibromyalgia Impact Questionnaire
(FIQ), the EuroQol 5D (EQ-5D) and the Hospital Anxiety and
Depression Scale (HADS). The interrater reliability was tested
using analysis of variance with patients and raters as
independent factors. RESULTS: Internal consistency (alpha) was
.88, test-retest reliability was .91, and interrater reliability
was .93. Significant correlations were obtained between overall
FFS and the FIQ (.55, P<.01), the EQ-5D (-.48, P<.01) and the
HADS depression subscale (.25, P<.01), but not with the HADS
anxiety subscale. CONCLUSION: These results support the
reliability and validity of the data obtained with the Spanish
version of the FSS
(127)
Garcia J, Simon MA, Duran M, Canceller J, Aneiros FJ.
Differential efficacy of a cognitive-behavioral intervention
versus pharmacological treatment in the management of
fibromyalgic syndrome. Psychol Health Med 2006; 11(4):498-506.
Abstract: Given that studies about the differential efficacy of
existing treatments in fibromyalgia syndrome are scarce, the aim
of this study was to compare the differential efficacy of a
cognitive-behavioral and a pharmacological therapy on
fibromyalgia. Using a randomized controlled clinical trial, 28
fibromyalgic patients were assigned to one of following
experimental conditions: (a) pharmacological treatment (i.e.,
cyclobenzaprine), (b) cognitive-behavioral intervention (i.e.,
stress inoculation training), (c) combined pharmacological and
cognitive-behavioral treatment and (d) no treatment. The results
show the superiority of cognitive-behavioral intervention to
reduce the severity of fibromyalgia both at the end of the
treatment and at follow-up. We conclude that
cognitive-behavioral interventions must be considered a primary
treatment of fibromyalgia syndrome
(128)
Geenen R, Van MH. The ostrich strategy towards affective issues
in alexithymic patients with fibromyalgia. Patient Educ Couns
2006; 60(2):97-99.
(129)
Gillis ME, Lumley MA, Mosley-Williams A, Leisen JC, Roehrs T.
The health effects of at-home written emotional disclosure in
fibromyalgia: a randomized trial. Ann Behav Med 2006;
32(2):135-146.
Abstract: BACKGROUND: The presence and severity of the chronic
pain syndrome fibromyalgia (FM) is associated with unresolved
stress and emotional regulation difficulties. Written emotional
disclosure is intended to reduce stress and may improve health
of people with FM. PURPOSE: This study tests the effects of
at-home, written emotional disclosure about stressful
experiences on the health of people with FM and uses multiple
follow-ups to track the time course of effects of disclosure.
METHODS: Adults with FM (intention-to-treat, n=83; completers,
n=72) were randomized to write for 4 days at home about either
stressful experiences (disclosure group) or neutral time
management (control group). Group differences in immediate mood
effects and changes in health from baseline to 1-month and
3-month follow-ups were examined. RESULTS: Written disclosure
led to an immediate increase in negative mood, which did not
attenuate across the 4 writing days. Repeated-measures analyses
from baseline to each follow-up point were conducted on both
intention-to-treat and completer samples, which showed similar
outcomes. At 1 month, disclosure led to few health benefits, but
control writing led to less negative affect and more perceived
support than did disclosure. At 3-month follow-up, these
negative affect and social support effects disappeared, and
written disclosure led to a greater reduction in global impact,
poor sleep, health care utilization, and (marginally) physical
disability than did control writing. Interpretation of these
apparent benefits needs to be made cautiously, however, because
the disclosure group had somewhat poorer health than controls at
baseline and the control group showed some minor worsening over
time. CONCLUSIONS: Written emotional disclosure can be conducted
at home, and there is tentative evidence that disclosure
benefits the health of people with FM. The benefits, however,
may be delayed for several months after writing and may be of
limited clinical significance
(130)
Glass JM. Cognitive dysfunction in fibromyalgia and chronic
fatigue syndrome: new trends and future directions. Curr
Rheumatol Rep 2006; 8(6):425-429.
Abstract: Fibromyalgia (FM) and chronic fatigue syndrome (CFS)
patients often have memory and cognitive complaints. Objective
cognitive testing demonstrates long-term and working memory
impairments. In addition, CFS patients have slow
information-processing, and FM patients have impaired control of
attention, perhaps due to chronic pain. Neuroimaging studies
demonstrate cerebral abnormalities and a pattern of increased
neural recruitment during cognitive tasks. Future work should
focus on the specific neurocognitive systems involved in
cognitive dysfunction in each syndrome
(131)
Gordon C, Emiliozzi C, Zartarian M. Use of a mechanical massage
technique in the treatment of fibromyalgia: a preliminary study.
Arch Phys Med Rehabil 2006; 87(1):145-147.
Abstract: OBJECTIVE: To investigate how a mechanical massage
technique (LPG technique) could contribute to the treatment of
fibromyalgia. DESIGN: Feasibility study. SETTING: A single
center. PARTICIPANTS: Ten women having a preexisting diagnosis
of fibromyalgia based on American College of Rheumatology
criteria were enrolled. INTERVENTION: Subjects received a total
of 15 sessions of mechanical massage administered by a physical
therapist once a week. MAIN OUTCOME MEASURES: The Fibromyalgia
Impact Questionnaire and a physical examination scoring tender
points (number, pain intensity). Evaluations were conducted at
the screening visit, after 7 sessions (V7), and after completion
of 15 sessions (V15). RESULTS: Most of the parameters (pain
intensity, physical function, number of tender points) showed a
significant improvement at V15 compared with screening.
CONCLUSIONS: The findings suggest the possibility that the
studied intervention might be associated with positive outcomes
in women with fibromyalgia, and support the need for a
controlled clinical trial to determine its efficacy
(132)
Gupta A, McBeth J, Macfarlane GJ, Morriss RK, Dickens C, Ray D
et al. Pain thresholds and tender point counts as predictors of
new chronic widespread pain in psychologically distressed
subjects. Ann Rheum Dis 2006; .
Abstract: OBJECTIVE: Tender points are a general measure of
distress both in community and clinic subjects. It has been
suggested that multiple tender points should be regarded as the
early stages of somatization of distress. Similarly, there is
recent evidence to suggest that chronic widespread pain is one
manifestation of the somatization of distress. Given that a high
tender point count and chronic widespread pain are clinical
hallmarks of the fibromyalgia syndrome, we hypothesized that in
psychologically distressed subjects, a high tender point count,
or a low pain threshold would predict the development of chronic
widespread pain in the future. METHODS: In this population based
prospective study, 245 psychologically distressed adults between
25- 65 years, free of chronic widespread pain, were identified,
based on a detailed pain questionnaire, and a psychosocial
questionnaire comprising the Somatic Symptom Checklist and the
Illness Behaviour subscale of the Illness Attitude Scales. These
subjects took part in a pain threshold examination with a
Fischer pressure algometer. Tender point counts were computed by
including all areas with a pain threshold below 4kg/cm2.
Individuals were followed up at 15 months, at which time 231
(97% of subjects still living at their baseline address)
provided data on pain status, using the same instruments.
RESULTS: At follow-up, 26 subjects (11%) developed new chronic
widespread pain. Neither baseline pain threshold, nor tender
point count, adjusted for age, gender and baseline pain status,
predicted the development of new chronic widespread pain.
CONCLUSION: Psychologically distressed subjects free of chronic
widespread pain are not at an increased risk of its development
if they have high tender points or low pain thresholds. Data
from this population based prospective study suggest that a low
pain-threshold in subjects with chronic widespread pain is
likely to be a secondary phenomenon as a result of pain or
associated distress rather than being the antecedent of symptoms
(133)
Gur A. Physical therapy modalities in management of
fibromyalgia. Curr Pharm Des 2006; 12(1):29-35.
Abstract: The etiology of fibromyalgia syndrome (FM) is
uncertain and the prognosis for symptomatic recovery is
generally poor. A wide variety of interventions are used in the
management of FM. There is, however, no clear consensus on the
treatment of choice and FM remains relatively refractory to
treatment. Therefore, prevention, causal therapy and
rehabilitation are not possible. FM patients frequently use
alternative therapies, indicating dissatisfaction or
ineffectiveness of traditional medical therapy. Alternative
therapies are generally perceived to be more "natural" and as a
result, to have fewer adverse effects. Despite the positive
results found, the number of publications related to the
application of physical therapy modalities such as acupuncture,
transcutaneous electrical stimulation, laser, biofeedback,
electrotherapy and magnetic field is still scant, especially
concerning FM treatment. The demonstration of a long-term
effective intervention for managing the symptoms associated with
FM is needed. Multidisciplinary approaches to management include
physical and medical therapeutic strategies. Treatment
modalities should be individualised for patients based on target
symptoms and impairment in functioning. Patience and positive
attitude on part of the physician and active involvement of
patients and their families in treatment are likely to enhance
improvement. It can be concluded that there is a need for
larger, more systematic and methodologically sound randomised
controlled clinical trials to evaluate the effectiveness of
physical therapy modalities of managing FM. We will review some
of the existing studies of physical therapy relevant in the
treatment of FM and give some practical advice for their use
(134)
Gurer G, Sendur OF, Ay C. Serum lipid profile in fibromyalgia
women. Clin Rheumatol 2006; 25(3):300-303.
Abstract: The etiology and pathogenic mechanisms of fibromyalgia
(FM) syndrome are unknown. A number of studies have shown that
there is an association between some of the musculoskeletal
system diseases and hyperlipidemia. The aims of this study were
(1) to compare the serum lipid profile among FM and healthy
women and (2) to investigate the relationship between serum
lipid levels and FM findings. One hundred sixty-four women (82
women with FM as study group and 82 healthy women as control
group) were enrolled in the study. The mean serum total
cholesterol and low-density lipoprotein cholesterol (LDL-c) were
found significantly higher in the FM group than that in the
control group (p<0.05). However, There was no statistically
significant difference in the mean serum triglyceride,
high-density lipoprotein cholesterol (HDL-c), and very
low-density lipoprotein cholesterol (VLDL-c) values between the
two groups (p>0.05). In the FM group, we could not find a
significant correlation between the serum lipid profile values
and the FM parameters (p>0.05)
(135)
Gusi N, Tomas-Carus P, Hakkinen A, Hakkinen K, Ortega-Alonso A.
Exercise in waist-high warm water decreases pain and improves
health-related quality of life and strength in the lower
extremities in women with fibromyalgia. Arthritis Rheum 2006;
55(1):66-73.
Abstract: OBJECTIVE: To evaluate the short- and long-term
efficacy of exercise therapy in a warm, waist-high pool in women
with fibromyalgia. METHODS: Thirty-four women (mean +/- SD
tender points 17 +/- 1) were randomly assigned to either an
exercise group (n = 17) to perform 3 weekly sessions of training
including aerobic, proprioceptive, and strengthening exercises
during 12 weeks, or to a control group (n = 17). Maximal
unilateral isokinetic strength was measured in the knee
extensors and flexors in concentric and eccentric actions at 60
degrees /second and 210 degrees /second, and in the shoulder
abductors and adductors in concentric contractions.
Health-related quality of life (HRQOL) was assessed using the
EQ-5D questionnaire; pain was assessed on a visual analog scale.
All were measured at baseline, posttreatment, and after 6
months. RESULTS: The strength of the knee extensors in
concentric actions increased by 20% in both limbs after the
training period, and these improvements were maintained after
the de-training period in the exercise group. The strength of
other muscle actions measured did not change. HRQOL improved by
93% (P = 0.007) and pain was reduced by 29% (P = 0.012) in the
exercise group during the training, but pain returned close to
the pretraining level during the subsequent de-training.
However, there were no changes in the control group during the
entire period. CONCLUSION: The therapy relieved pain and
improved HRQOL and muscle strength in the lower limbs at low
velocity in patients with initial low muscle strength and high
number of tender points. Most of these improvements were
maintained long term
(136)
Hagen K, Pettersen E, Stovner LJ, Skorpen F, Zwart JA. No
association between chronic musculoskeletal complaints and
Val158Met polymorphism in the Catechol-O-methyltransferase gene.
The HUNT study. BMC Musculoskelet Disord 2006; 7:40.:40.
Abstract: BACKGROUND: The Catechol-O-methyltransferase (COMT)
gene contains a functional polymorphism, Val158Met, that has
been found to influence human pain perception. In one study
fibromyalgia was less likely among those with Val/Val genotype.
METHODS: In the 1995-97 Nord-Trondelag Health Study (HUNT), the
association between Val/Met polymorphism at the COMT gene and
chronic musculoskeletal complaints (MSCs) was evaluated in a
random sample of 3017 individuals. RESULTS: The distribution of
the COMT Val158Met genotypes and alleles were similar between
controls and the twelve different chronic MSCs groups. Even when
the Met/Met and Val/Met genotypes were pooled, the distribution
of the Val/Val genotype and other genotypes were similar between
controls and the chronic MSCs groups. CONCLUSION: In this
population-based study, no significant association was found
between Val/Met polymorphism at the COMT gene and chronic MSCs
(137)
Hammond A, Freeman K. Community patient education and exercise
for people with fibromyalgia: a parallel group randomized
controlled trial. Clin Rehabil 2006; 20(10):835-846.
Abstract: OBJECTIVE: To evaluate the effects of a community
patient education -exercise programme, using a
cognitive-behavioural approach, for people with fibromyalgia.
DESIGN: A randomized, parallel group trial with assessments at
0, 4 and 8 months. SETTING: Community leisure centres. SUBJECTS:
People with fibromyalgia (n=183) attending a rheumatology
outpatient department at a large district general hospital.
INTERVENTIONS: Participants were randomized to a patient
education-exercise group (n=97) or relaxation (attention
control) group (n=86). MAIN MEASURES: The Fibromyalgia Impact
Questionnaire (0-80; lower score means better health). Secondary
outcomes included: the Arthritis Self-Efficacy Scale(pain and
other symptoms subscales: 1 -10 scale; higher scores mean
greater self-efficacy) and self-reported improvement. RESULTS:
Fifty participants withdrew or were unable to attend and 133
completed and returned baseline questionnaires: patient
education group (n=71); relaxation group (n=62); 120/133
participants were women. Average age was 48.53 (SD 10.89) years.
Follow-up ranged between 73 and 82% of questionnaires returned.
At four months, there was a difference in average changes in
total Fibromyalgia Impact Questionnaire scores between the two
groups: patient education group--3.38 (SD 9.35); relaxation
group 0.3 (SD 8.85); P=0.02. Arthritis Self-Efficacy Scale
scores were significantly higher in the patient education group:
pain 0.59 (SD 1.45)compared to the relaxation group's--0.12 (SD
1.22); P=0.003; other symptoms (patient education group 0.72 (SD
1.33); relaxation group 0.03 (SD 1.16); P=0.002). At eight
months these differences were no longer apparent. Forty-seven
per cent in the patient education group self-reported
improvement compared with 13% in the relaxation group
(chi2=13.65; P=0.0001). CONCLUSION: Short-term improvements
resulted from the education -exercise programme but were not
sustained. Appropriate selection may improve efficacy
(138)
Hanning CD, Rentowl P. Harmful impact of EU clinical trials
directive: trial of alerting drug in fibromyalgia has had to be
abandoned.. BMJ 2006; 332(7542):666.
(139)
Harris RE, Clauw DJ. How do we know that the pain in
fibromyalgia is "real"? Curr Pain Headache Rep 2006;
10(6):403-407.
Abstract: Fibromyalgia is a common idiopathic pain condition
often resulting in increased morbidity and disability in
patients. The lack of peripheral abnormalities in this disease
has led clinicians and researchers alike to question if this
syndrome represents a valid entity. Recent genetic findings
suggest that specific gene mutations may predispose individuals
to develop fibromyalgia. In addition, neurobiological studies
indicate that fibromyalgia patients have abnormalities within
central brain structures that normally encode pain sensations in
healthy pain-free controls. Future studies that focus on central
neurobiological and/or genetic influences in fibromyalgia may
bring insight into mechanisms of this problematic disease and
ultimately result in improved treatments
(140)
Harris RE, Gracely RH, McLean SA, Williams DA, Giesecke T,
Petzke F et al. Comparison of clinical and evoked pain measures
in fibromyalgia. J Pain 2006; 7(7):521-527.
Abstract: Evoked pain measures such as tender point count and
dolorimetry are often used to determine tenderness in studies of
fibromyalgia (FM). However, these measures frequently do not
improve in clinical trials and are known to be influenced by
factors other than pain such as distress and expectancy. The
purpose of this investigation was to determine whether evoked
pain paradigms that present pressure stimuli in a random fashion
(eg, Multiple Random Staircase [MRS]) would track with clinical
pain improvement in patients with FM better than traditional
measures. Sixty-five subjects enrolled in a randomized clinical
trial of acupuncture were observed longitudinally. Clinical pain
was measured on a 101-point numerical rating scale (NRS) and the
Short Form McGill Pain Questionnaire (SF-MPQ), whereas evoked
pressure sensitivity was assessed via manual tender point count,
dolorimetry, and MRS methods. Improvements in clinical pain and
evoked pain were assessed irrespective of group assignment.
Improvement was seen in clinical pain during the course of the
trial as measured by both NRS (P = .032) and SF-MPQ (P = .001).
The MRS was the only evoked pain measure to improve
correspondingly with treatment (MRS, P = .001; tender point
count and dolorimeter, P > .05). MRS change scores were
correlated with changes in NRS pain ratings (P = .003); however,
this association was not stronger than tender point or
dolorimetry correlations with clinical pain improvement (P >
.05). Pain sensitivity as assessed by random paradigms was
associated with improvements in clinical FM pain. Sophisticated
pain testing paradigms might be responsive to change in clinical
trials. PERSPECTIVE: Trials in fibromyalgia often use both
clinical and experimental methods of pain assessment; however,
these two outcomes are often poorly correlated. We explore the
relationship between changes in clinical and experimental pain
within FM patients. Pressure pain testing that applies stimuli
in a random order is associated with improvements in clinical
pain, but this association was not stronger than other
experimental techniques
(141)
Hauser W, Bernardy K, Arnold B. [Fibromyalgia -- a somatoform
(pain) disorder?]. Schmerz 2006; 20(2):128-139.
Abstract: The hypothesis that fibromyalgia (FM) should be
classified as a somatoform disorder was assessed by reviewing
current clinical studies. According to the ICD-10, somatic
illness beliefs of the patient, high health care utilization,
and frustrating patient-doctor relationships are diagnostic
criteria of somatoform disorders. For the diagnosis of a
somatoform pain disorder, a temporal association between the
manifestation of pain and emotional or psychosocial conflicts
and the exclusion of a depressive disorder are additionally
required. Empirical studies demonstrate a higher lifetime and
current prevalence of psychiatric disorders, childhood
adversities, life events, and daily hassles and a higher health
care utilization of FM patients. Studies also reveal that most
patients believe that both somatic and psychosocial factors have
caused their disorder. The patient-doctor relationship is
characterized to be disappointing for both. Yet in all studies
there were patients who did not fulfill the ICD-10 criteria of a
somatoform (pain) disorder. A biopsychosocial model of FM
differentiating between biological as well as psychosocial
predisposing, triggering, and perpetuating factors in the
pathogenesis of FM is presented as an alternative model.
Hopefully the biopsychosocial model and the distinction of
subgroups will enable more differentiated and tailored
psychotherapeutic and pharmacological treatment strategies
(142)
Hauser W, Wilhelm R, Klein W, Zimmer C. [Causal illness
attributions and healthcare utilization in fibromyalgia
syndrome]. Schmerz 2006; 20(2):119-127.
Abstract: INTRODUCTION: High utilization of medical services has
been described for patients with fibromyalgia syndrome (FMS).
There are no studies available that assess whether the patients'
subjective illness beliefs influence their behavior in utilizing
healthcare. METHODS: Examinations were performed by taking the
history of pain treatment in 100 FMS patients evaluated by
experts for the social court and 25 patients attending an
outpatient pain center. The subjective illness theories were
drawn from the patients' responses to the German Pain
Questionnaire (GPQ). The statements made on the GPQ regarding
utilization of healthcare services were compared with the
records and the answers given in the interview on pain therapy.
RESULTS: Of the patients, 44% specified a somatic, 2% a
psychogenic, 9% none, and 45% a psychosomatic illness belief.
The patients were classified as high utilizers of specialized
medical services in 25% of the cases and of
psychiatric-psychotherapeutic services in 14%. No significant
correlations between the type of subjective illness theory and
utilization of specialized medical or
psychiatric-psychotherapeutic services were observed.
CONCLUSION: From the psychosomatic viewpoint, only part of the
FMS patients exhibited an inordinately one-sided somatic illness
belief. The utilization of healthcare services cannot be
explained by the subjective perception of the illness
(143)
Havas M. Electromagnetic hypersensitivity: biological effects of
dirty electricity with emphasis on diabetes and multiple
sclerosis. Electromagn Biol Med 2006; 25(4):259-268.
Abstract: Dirty electricity is a ubiquitous pollutant. It flows
along wires and radiates from them and involves both extremely
low frequency electromagnetic fields and radio frequency
radiation. Until recently, dirty electricity has been largely
ignored by the scientific community. Recent inventions of
metering and filter equipment provide scientists with the tools
to measure and reduce dirty electricity on electrical wires.
Several case studies and anecdotal reports are presented.
Graham/Stetzer (GS) filters have been installed in schools with
sick building syndrome and both staff and students reported
improved health and more energy. The number of students needing
inhalers for asthma was reduced in one school and student
behavior associated with ADD/ADHD improved in another school.
Blood sugar levels for some diabetics respond to the amount of
dirty electricity in their environment. Type 1 diabetics require
less insulin and Type 2 diabetics have lower blood sugar levels
in an electromagnetically clean environment. Individuals
diagnosed with multiple sclerosis have better balance and fewer
tremors. Those requiring a cane walked unassisted within a few
days to weeks after GS filters were installed in their home.
Several disorders, including asthma, ADD/ADHD, diabetes,
multiple sclerosis, chronic fatigue, fibromyalgia, are
increasing at an alarming rate, as is electromagnetic pollution
in the form of dirty electricity, ground current, and radio
frequency radiation from wireless devices. The connection
between electromagnetic pollution and these disorders needs to
be investigated and the percentage of people sensitive to this
form of energy needs to be determined
(144)
Havermark AM, Langius-Eklof A. Long-term follow up of a physical
therapy programme for patients with fibromyalgia syndrome. Scand
J Caring Sci 2006; 20(3):315-322.
Abstract: The purpose of this study was to evaluate, in a
long-term perspective, the impact of a physical therapy-based
educational programme on patients with fibromyalgia syndrome
(FMS). The programme includes information about the syndrome,
information about pain and muscle physiology, training in warm
water, stretching, body awareness therapy and relaxation in
groups of 15 patients twice weekly, 2 hours during 10 weeks. A
total of 240 patients with FMS participated in the study before
and immediately after the programme and at a follow up with a
mean of 35 months after the programme. Health status as measured
with the Fibromyalgia Impact Questionnaire was answered by the
patients at all three measurement points. Questionnaires
concerning self-care, self-motivation and sense of coherence
(SOC) were distributed at the follow up. The results showed a
significant improvement on several symptoms when comparing
before and after the programme, and at the time of follow up the
patients' rated well-being was still improved. The results also
showed that the patients' pretreatment perception of symptoms,
well-being and SOC are predictors to the perception of general
health at the follow up of a physical therapy programme. The
conclusion is that a physical therapy programme for patients
with FMS may have a positive impact on patients' general
well-being but not on other symptoms
(145)
Hayden RJ, Louis DS, Doro C. Fibromyalgia and myofascial pain
syndromes and the workers' compensation environment: an update.
Clin Occup Environ Med 2006; 5(2):455-4xi.
Abstract: Fibromyalgia and myofascial pain syndromes are terms
used to describe a constellation of complaints ranging from
generalized aches to specific tender trigger points often
accompanied by fatigue, depression, and sleep disturbances. In
the past 5 years, research has been directed primarily at
determining the pathophysiology of fibromyalgia and myofascial
pain syndromes and the treatment of patients' comorbidities to
alleviate their symptomatology. Controversy exists as to whether
fibromyalgia and myofascial pain syndromes represent a specific
pathology or are merely terms to describe clinical conditions
that provide patients with the reassurance that their symptoms
are real and help clinicians with therapeutic direction. In the
occupational health setting, this uncertainty can lead to
significant difficulty in determining short- and long-term
disability and assigning culpability to an individual's work
environment
(146)
Herman PM, Sherman KJ, Erro JH, Cherkin DC, Milliman B, Adams
LA. A method for describing and evaluating naturopathic whole
practice. Altern Ther Health Med 2006; 12(4):20-28.
Abstract: CONTEXT: Even though complementary and alternative
medicine (CAM) is generally practiced as distinct systems of
medicine, almost all CAM research has focused on single
therapies. In order to more adequately evaluate the
effectiveness of these medical systems, studies that evaluate
the outcome of intact whole systems are needed. One challenge
lies in defining the whole medical system (and any medical
system it is compared to) in a way that ensures treatment
fidelity. OBJECTIVE: This paper presents a proposed method to
measure treatment fidelity (treatment criteria) in studies of
the naturopathic medical system. DESIGN: Illustrative example of
the theory-based development and post-hoc "testing" of treatment
criteria against an existing database of actual treatments
prescribed by a random sample of naturopathic physicians. MAIN
OUTCOME MEASURES: Treatment criteria for 3
conditions--menopausal symptoms, bowel dysfunction, and
fatigue/fibromyalgia--and their comparison to actual treatments
prescribed. RESULTS: A set of meaningful, measurable treatment
criteria based on the naturopathic practice principles were
defined that could have generated the majority (82%-93%) of
treatment prescriptions given at visits for these conditions.
Several of the treatment criteria components are common across
the 3 conditions studied, and might be appropriate for all
visits to doctors of naturopathy (NDs). Others are specific to
each condition. In addition to ensuring model validity, these
criteria help identify critical components of care, enable study
replication, provide a measure of quality of care, and are one
step toward allowing CAM to be studied as it is generally
practiced-as distinct systems of medicine. SETTING: Work was
performed at Bastyr University and the University of Arizona
(147)
Hirsh AT, Waxenberg LB, Atchison JW, Gremillion HA, Robinson ME.
Evidence for sex differences in the relationships of pain, mood,
and disability. J Pain 2006; 7(8):592-601.
Abstract: Disability demonstrates strong univariate associations
with pain and negative mood. These relationships are more
complex at the multivariate level and might be further
complicated by sex differences. We investigated sex differences
in the relationships of pain and negative mood to overall
disability and to disability in specific functional domains. One
hundred ninety-seven consecutive patients with low back,
myofascial, neck, arthritis, and fibromyalgia pain were
recruited from university pain clinics and completed measures of
disability and negative mood. Overall disability and disability
in voluntary activities were significantly associated with pain
and negative mood (factor score) for both sexes. Significant sex
differences emerged in the strength of the disability-mood
relationship, with women evincing a stronger relationship.
Disability in obligatory activities was also significantly
related to pain and negative mood for both sexes; however, there
were no sex differences in the strength of these relationships.
Mediation analyses indicated that, in men, negative mood
partially mediated the relationship between pain and both
overall disability and disability in voluntary activities;
mediation was not supported for disability in obligatory
activities. In women, negative mood fully mediated the
relationship between pain and all 3 types of disability. These
data suggest that disability is more directly related to pain in
men. In women, the effect of pain on disability appears to
operate through negative mood. PERSPECTIVE: Results of this
study demonstrate that sex differences exist in the
relationships of pain, mood, and disability. Men and women might
thus benefit from treatment interventions that differentially
target these variables
(148) Hochlehnert A, Richter A, Bludau HB, Bieber C,
Blumenstiel K, Mueller K et al.
A
computer-based information-tool for chronic pain patients.
Computerized information to support the process of shared
decision-making. Patient Educ Couns 2006; 61(1):92-98.
Abstract: OBJECTIVE: Assessment of the use of a computerized
information-tool in the context of a shared decision-making
process with chronic pain patients. METHODS: In the scope of a
prospective and randomized study on shared decision-making with
Fibromyalgia patients, a total of 75 patients had access to
computer-based information about their illness. Fibromyalgia is
a condition of chronic wide-spread pain, belonging to
rheumatism, which mainly affects mature female patients. The
majority of the patients in our study are female (93%) with an
average age of 50 years. The computer-based information-tool
provided the patients with detailed information about
pathogenesis, typical symptoms, treatment options and prognosis.
Six evaluative questions were posed to the participants
concerning the assessment of the information presented, the
handling of the programme, the need for an introduction to the
programme, the quality of the layout and the assessment of the
length of time spent in front of the computer and the assessment
of the usefulness of such a tool in general practitioners'
offices. Furthermore, psychological self-assessment
questionnaires were filled out by the participants. RESULTS: The
patients highly appreciate the possibility of using
computer-based information-tools and endorse the implementation
of such tools in general practitioners' offices. CONCLUSION:
Computerized information leads to a better understanding of the
illness and the treatment options on the part of the patient.
PRACTICAL IMPLICATIONS: For further practical use it is crucial
to provide an introduction to the handling of a computer to
unskilled patients
(149)
Hoseini SS, Hoseini M, Gharibzadeh S. Sprouting phenomenon, a
new model for the role of A-beta fibers in wind up. Med
Hypotheses 2006; 66(4):805-807.
Abstract: Wind up is a progressive frequency-dependent
facilitation of the responses of nociceptive neurons observed on
the application of repetitive (usually electrical) stimuli of
constant intensity. The NMDA and NK1 receptors are essentially
involved in wind up. After induction of wind up, stimulation of
C-fibers show the characteristics of wind up, but stimulation of
Abeta fibers for induction of wind up is controversial. In this
study, we have proposed a new model for the role of Abeta fibers
in wind up, through sprouting of nerve fibers in the dorsal horn
of spinal cord. We named it "sprouting phenomenon". It has been
reported that in some clinical hyperalgesic states induced by
peripheral injury or inflammation, wind up may aggravate the
pain. For example, studies have indicated the presence of wind
up in post-surgical states, some neuropathic pains, fibromyalgia
syndrome, and post-herpetic neuralgia. According to sprouting
phenomenon, it seems that some clinical interventions can be
assessed to alleviate post-inflammatory pains: (1) Immediate and
complete relief of inflammation by anti-inflammatory agents to
prevent repetitive excitation of C-fibers and subsequent
morphological changes of dorsal horn laminae; (2) using local
anesthetics in order to prevent pain signal transmission; (3)
prevention of sprouting by intrathecal injection of some
anti-proliferation agents; (4) using NMDA or NK1 receptor
antagonists to prevent central mechanism of wind up. Some
clinical trials have indicated the effectiveness of these
antagonists. It is worth noting that future clinical studies are
needed to validate these predictions
(150)
Hughes G, Martinez C, Myon E, Taieb C, Wessely S. The impact of
a diagnosis of fibromyalgia on health care resource use by
primary care patients in the UK: an observational study based on
clinical practice. Arthritis Rheum 2006; 54(1):177-183.
Abstract: OBJECTIVE: To investigate the impact of a diagnosis of
fibromyalgia (FM) in clinical practice on health care resource
use in the UK. METHODS: Rates of visits, prescriptions,
referral, and diagnostic testing were estimated in patients who
had been diagnosed as having FM between 1998 and March 2003 in
UK primary care and compared with those in matched controls.
Rates were calculated in 6-month intervals from 10 years before
until 4 years after the FM diagnosis. RESULTS: Patients (2260)
were newly diagnosed as having FM; 81.3% were women. Their mean
age was 49 years. FM patients had considerably higher rates of
visits, prescriptions, and testing from at least 10 years prior
to diagnosis compared with controls. By the time of diagnosis,
FM patients had 25 visits and 11 prescriptions per year compared
with 12 visits and 4.5 prescriptions per year in controls. Visit
rates were highest for depression, followed by fatigue, chest
pain, headache, and sleep disturbance. Following diagnosis,
visits for most symptoms and health care use markers declined,
but within 2-3 years, most visits rose to levels at or higher
than those at diagnosis. CONCLUSION: Primary care patients who
had been diagnosed as having FM reported higher rates of illness
and health care resource use for at least 10 years prior to
their diagnosis, which suggests that illness behavior may play a
role. Being diagnosed as having FM may help patients cope with
some symptoms, but the diagnosis has a limited impact on health
care resource use in the longer term, possibly because there is
little effective treatment
(151)
Hughes L. Physical and psychological variables that influence
pain in patients with fibromyalgia. Orthop Nurs 2006;
25(2):112-119.
Abstract: BACKGROUND: Fibromyalgia is a syndrome of chronic
pain. Its etiology is unknown and treatment is not well defined.
PURPOSE: The purpose of this study was to determine the
influence of specific variables on pain in 107 women with
fibromyalgia. METHODS: Data collection included two pain
measurements administered by the researcher, four survey
questionnaires self-administered by the participants (measuring
activity, fatigue, depression, and demographic data), and three
measures of physical fitness for flexibility, strength, and
endurance. FINDINGS: Fatigue, pelvic pain, and physical trauma
explained 23% of the variance in sensory pain; activity,
depression, and pelvic pain explained 23% of affective pain; and
a flare-up of symptoms and depression explained 25% of the
intensity of pain experienced by the participants. CONCLUSION:
Nurses should consider decreasing depression and fatigue and
increasing activity so that fibromyalgia pain may be lessened
during care
(152) Husser D, Bollmann A, Kuhne C, Molling J, Klein HU.
Evaluation of noncardiac chest pain: diagnostic approach, coping
strategies and quality of life. Eur J Pain 2006; 10(1):51-55.
Abstract: BACKGROUND: Approximately 30% of coronary angiograms
are negative for significant coronary artery disease and
patients are classified as having noncardiac chest pain (NCCP).
So far, no systematic diagnostic approach to patients with NCCP
investigating for possible esophageal, psychiatric and
musculoskeletal abnormalities exists. Furthermore, coping
strategies and quality of life are poorly characterized in NCCP
patients. METHODS AND RESULTS: A simple diagnostic approach was
applied to 37 consecutive patients (21 female, age 61+/-12
years) with angina-like chest pain and normal coronary
angiograms. Twenty-one patients were found to suffer from
psychiatric disorders (combined anxiety (A) and depression (D):
n = 10, D: n = 5, panic disorder (P): n = 3, somatization (S): n
= 3) based on their Symptom Check List 90 scores and according
to DSM IV-R criteria. Sixteen patients had an improvement of
their chest pain after oral esomeprazole (40 mg for 7 days) and
were therefore diagnosed with gastroesophageal reflux disease
(GERD). Musculoskeletal abnormalities including chostochondritis
(n = 4), thoracic spondylodynia (n = 1), and fibromyalgia (n =
1) were found in six patients. Multiple diagnoses were confirmed
in six patients with GERD (additional D n = 3, additional
musculoskeletal disorders n = 3). Patients with psychiatric
disorders showed a diminished quality of life (MOS-SF 36), more
frequent chest pain, less treatment satisfaction (Seattle Angina
Questionnaire) and more rumination (Trier Coping Scales)
compared to GERD patients. CONCLUSIONS: Immediate combined
psychiatric and orthopedic evaluation as well as esomeprazole
administration following exclusion of coronary artery disease
may confirm the causes of noncardiac chest pain. Identification
of psychiatric disorders seems especially warranted since these
patients experience a reduced quality of life and exhibit
pathologic coping strategies
(153)
Hwang E, Barkhuizen A. Update on rheumatologic mimics of
fibromyalgia. Curr Pain Headache Rep 2006; 10(5):327-332.
Abstract: Fibromyalgia is a common disorder of diffuse
musculoskeletal pain. Several rheumatic diseases can mimic
fibromyalgia, and a clinician would not want to miss these
diagnoses because of their potential long-term sequelae, such as
progressive joint damage or life- or organ-threatening disease
if they remain untreated. This paper discusses the typical
clinical presentations of selected rheumatic diseases (systemic
lupus erythematosus, rheumatoid arthritis, ankylosing
spondylitis, polymyalgia rheumatica, and osteoarthritis) then
highlights the key features in history, laboratory testing, and
radiographic imaging that aid the clinician in differentiating
between fibromyalgia and these rheumatic diseases
(154)
Iaboni A, Ibanez D, Gladman DD, Urowitz MB, Moldofsky H. Fatigue
in systemic lupus erythematosus: contributions of disordered
sleep, sleepiness, and depression. J Rheumatol 2006;
33(12):2453-2457.
Abstract: OBJECTIVE: To clarify the role of sleep disorders,
sleepiness, and depression in patients with systemic lupus
erythematosus (SLE) who complain of disabling tiredness.
METHODS: Patients with SLE (31 women, 4 men) with disabling
tiredness were evaluated with the Epworth Sleepiness Scale (ESS)
and overnight polysomnography, followed by daytime multiple
sleep latency tests (MSLT) and the Beck Depression Inventory
(BDI). Their polysomnography was compared with 17 healthy,
asymptomatic controls. RESULTS: Polysomnography of the patients
in comparison with healthy controls showed impaired sleep
efficiency (p < 0.02), high arousal frequencies (p < 0.01),
increased stage 1 sleep (p < 0.02), decreased stage 3/4
slow-wave sleep (p < 0.02), and a high percentage (77% of
patients) with increased alpha-EEG non-REM sleep. In 23% of
patients periodic limb movement (PLM) disorder was observed
(mean PLM index 31.1 +/- 15); 26% of patients had obstructive
sleep apnea (mean apnea/hypopnea index 19.3 +/- 10), and one
patient had narcolepsy-cataplexy. Remarkably, 51% of patients
were excessively sleepy on both the ESS and MSLT (mean sleep
latency < 10 min). This excessive daytime sleepiness was not
related to sleep restriction. There was no association between
sleepiness and SLE disease features such as neuropsychiatric
SLE, medications, fibromyalgia, or disease activity. As a whole,
the study group reported mild to moderate depression (mean BDI =
15.8 +/- 9.9). Within the group, the sleepy patients had lower
BDI scores than the non-sleepy patients (p < 0.02), and fewer of
the sleepy patients were depressed (p < 0.04). CONCLUSION:
Primary sleep disorders, sleepiness, and depression are common
in tired SLE patients. Tiredness in SLE that is the result of
excessive daytime sleepiness can be distinguished from tiredness
of depression. Such distinctions will help identify appropriate
treatment for tired patients with SLE
(155)
Ifergane G, Buskila D, Simiseshvely N, Zeev K, Cohen H.
Prevalence of fibromyalgia syndrome in migraine patients.
Cephalalgia 2006; 26(4):451-456.
Abstract: Fibromyalgia syndrome (FMS) is a chronic pain syndrome
of unknown aetiology characterized by diffuse pain over more
than 3 months and tenderness in specific sites named tender
points. The aim of this study was to assess the prevalence and
severity of FMS among patients suffering from episodic migraine.
Ninety-two consecutive patients (20 male, 72 female) fulfilling
the International Headache Society criteria for migraine with
and without aura from a tertiary headache clinic were evaluated.
A headache and generalized pain history was recorded, tender
points were evaluated by thumb palpation. The diagnosis of FMS
was made based on the 1990 American College of Rheumatology
classification criteria for FMS. Sixteen (22.2%) of the female
patients and none of the male patients were diagnosed as
suffering from FMS. Migraine severity and characteristics were
similar to other female migraine patients. Patients suffering
from migraine-FMS had lower quality of life scores and higher
levels of mental distress. A high incidence of FMS was found
among female migraine patients but not in males. The coexistence
of FMS should be considered when choosing a prophylactic
migraine therapy
(156)
Iovino P, Tremolaterra F, Consalvo D, Sabbatini F, Mazzacca G,
Ciacci C. Perception of electrocutaneous stimuli in irritable
bowel syndrome. Am J Gastroenterol 2006; 101(3):596-603.
Abstract: BACKGROUND AND AIM: Irritable bowel syndrome (IBS) and
fibromyalgia syndrome (FMS) are common conditions with some
similarities, but different perceptual responses to somatic and
visceral stimuli. The purpose of this study was to assess in a
large group of IBS patients the somatic perception by
transcutaneous electrical nerve stimulation (TENS) and its
relation to the level of severity and presence of FMS. METHODS:
In 99 patients grouped by the validated functional bowel
disorder severity index (FBDSI) in mild, moderate, and severe
IBS and in 33 healthy controls (HC), we studied discomfort
thresholds and perception of somatic stimuli at control (hands
and elbows) and active (trapezius) sites by TENS and by using a
specific questionnaire. RESULTS: The use of TENS showed that IBS
showed significant higher thresholds and lower perception
cumulative score compared to HC. The severity of IBS is
significantly associated with age and mean control site values
for discomfort and borderline associated with gender in the
ordinal model constructed for the ascending series protocol. The
severity of IBS is also significantly associated with the active
cumulative perception score in the long stimulus protocol. Due
to limited sample size of IBS men with FMS, analyses of
discomfort thresholds and cumulative perception score by FMS
were done only for women. IBS women without FMS had
significantly higher mean control site values for discomfort and
significantly lower active cumulative perception score than HC.
IBS women with FMS had significantly lower mean active site
values for discomfort thresholds than IBS women without FMS
(Dunn's test p < 0.05). CONCLUSIONS: IBS patients showed somatic
hypoalgesia to electrical stimuli. The severity of IBS and the
presence of FMS influence the perception of somatic stimuli
induced by TENS
(157)
Jackson JL, O'Malley PG, Kroenke K. Antidepressants and
cognitive-behavioral therapy for symptom syndromes. CNS Spectr
2006; 11(3):212-222.
Abstract: Somatic symptoms are common in primary care and
clinicians often prescribe antidepressants as adjunctive
therapy. There are many possible reasons why this may work,
including treating comorbid depression or anxiety, inhibition of
ascending pain pathways, inhibition of prefrontal cortical areas
that are responsible for "attention" to noxious stimuli, and the
direct effects of the medications on the syndrome. There are
good theoretical reasons why antidepressants with balanced
norepinephrine and serotonin effects may be more effective than
those that act predominantly on one pathway, though head-to-head
comparisons are lacking. For the 11 painful syndromes review in
this article, cognitive-behavioral therapy is most consistently
demonstrated to be effective, with various antidepressants
having more or less randomized controlled data supporting or
refuting effectiveness. This article reviews the randomized
controlled trial data for the use of antidepressant and
cognitive-behavior therapy for 11 somatic syndromes: irritable
bowel syndrome, chronic back pain, headache, fibromyalgia,
chronic fatigue syndrome, tinnitus, menopausal symptoms, chronic
facial pain, noncardiac chest pain, interstitial cystitis, and
chronic pelvic pain. For some syndromes, the data for or against
treatment effectiveness is relatively robust, for many, however,
the data, one way or the other is scanty
(158)
Jamil H, Nassar-McMillan SC, Salman WA, Tahar M, Jamil LH. Iraqi
Gulf War veteran refugees in the U.S.: PTSD and physical
symptoms. Soc Work Health Care 2006; 43(4):85-98.
Abstract: Veterans of the Gulf War present various symptoms and
maladies. Reports by governmental and private entities have
yielded mixed results and have been fraught with criticisms of
biased research design. The vast majority of these studies have
focused on U.S. veterans, with a much smaller number focusing
upon British veterans. Very few have examined Iraqi Gulf War
veterans. Our study involves administering a health issues
questionnaire to a sample of Iraqi Gulf War veteran refugees in
the U.S. Results indicate relationships between Post-Traumatic
Stress Disorder (PTSD) scores and health outcome measures of
chronic fatigue, fibromyalgia, functional status, quality of
life, and health care utilization in terms of frequency and
level of intensity. Implications for further inquiry are
presented
(159)
Janal MN, Ciccone DS, Natelson BH. Sub-typing CFS patients on
the basis of 'minor' symptoms. Biol Psychol 2006; 73(2):124-131.
Abstract: The diagnosis of chronic fatigue syndrome (CFS), an
illness characterized by medically unexplained fatigue, depends
on a clinical case definition representing one or more
pathophysiological mechanisms. To prepare for studies of these
mechanisms, this study sought to identify subtypes of CFS. In
161 women meeting 1994 criteria for CFS, principal components
analysis of the 10 'minor' symptoms of CFS produced three
factors interpreted to indicate musculoskeletal, infectious and
neurological subtypes. Extreme scores on one or more of these
factors characterized about 2/3 of the sample. Those
characterized by the neurological factor were at increased risk
of reduced scores on cognitive tests requiring attention,
working memory, long-term memory or rapid performance. In
addition, the neurological subtype was associated with reduced
levels of function. Those characterized by the musculoskeletal
factor were at increased risk for the diagnosis of fibromyalgia
(chronic widespread pain and mechanical allodynia) and reduced
physical function. Those characterized by the infectious factor
were less likely to evidence co-occurring fibromyalgia, and
showed lesser risk of functional impairment. The prevalence of
disability was increased in those with the highest scores on any
of the subtypes, as well as in those with high scores on
multiple factors. Depression and anxiety, while frequently
present, were not more prevalent in any particular subtype, and
did not increase with the severity of specific symptom reports.
Results suggest that subtypes of CFS may be identified from
reports of the minor diagnostic symptoms, and that these
subtypes demonstrate construct validity
(160)
Jevremovic D, Torbenson M, Murray JA, Burgart LJ, Abraham SC.
Atrophic autoimmune pangastritis: A distinctive form of antral
and fundic gastritis associated with systemic autoimmune
disease. Am J Surg Pathol 2006; 30(11):1412-1419.
Abstract: The 2 major recognized forms of atrophic gastritis are
autoimmune and environmental atrophic gastritis. These differ in
their topographical distribution in the stomach, histologic
features, and etiology. Autoimmune atrophic gastritis results
from immune-mediated destruction of specialized oxyntic glands,
is restricted to the body and fundus, and shows characteristic
neuroendocrine hyperplasia. Environmental atrophic gastritis is
associated with long-standing Helicobacter pylori infection and
preferentially involves antrum and transition zone mucosa. In
this study, we describe a distinctive form of atrophic gastritis
that differs markedly from both of these classic variants. This
gastritis is characterized by: (1) intense mucosal inflammatory
infiltrates, persisting even into the phase of severe glandular
atrophy, (2) pangastric distribution with diffuse involvement of
both body and antrum, (3) lack of association with H. pylori,
and (4) lack of neuroendocrine hyperplasia. The 8 patients
presented ranged from 1 to 75 years and showed a slight female
predominance (5F:3M). All had systemic autoimmune and/or
connective tissue diseases including autoimmune enterocolitis (4
cases), systemic lupus erythematosus, refractory sprue,
autoimmune hemolytic anemia, and disabling fibromyalgia.
Positive serum autoimmune markers were documented in 7 of 8
(87%) patients, but serologies for antiparietal cell and
anti-intrinsic factor antibodies were undertaken in only 1
patient each and were negative. We propose that the distinctive
histology of this form of atrophic pangastritis and its
association with systemic autoimmune disease suggests an
autoimmune process directed against multiple cell lineages in
the stomach. The development of multifocal low-grade dysplasia
in 1 patient, a 19-year-old woman, suggests that this condition
might have neoplastic potential
(161)
Jochims A, Ludascher P, Bohus M, Treede RD, Schmahl C. [Pain
processing in patients with borderline personality disorder,
fibromyalgia, and post-traumatic stress disorder]. Schmerz 2006;
20(2):140-150.
Abstract: The authors review relevant experimental studies on
pain perception and processing in psychiatric disorders with
traumatic stress as an etiological factor. In borderline
personality disorder, post-traumatic stress disorder, and
fibromyalgia neurophysiological and neuropsychological patterns
of pain processing appear to be different. Experimental studies
in borderline patients show a desensitization of pain thresholds
whereas patients with fibromyalgia show an opposite pattern,
which could be explained by a central augmentation of pain
processing. Furthermore, the authors outline methods to assess
pain perception (peripheral and central) and describe the
neurobiological mechanisms of pain processing, particularly the
distinction between the sensory-discriminative lateral system
and the affective-motivational medial system. Finally,
suggestions for further research and implications for therapy
are proposed
(162)
Johannesson U, de Boussard CN, Brodda JG, Bohm-Starke N.
Evidence of diffuse noxious inhibitory controls (DNIC) elicited
by cold noxious stimulation in patients with provoked
vestibulodynia. Pain 2006; .
Abstract: Provoked vestibulodynia is a common cause of
superficial dyspareunia in young women. Recent evidence has
pointed out the importance of studying endogenous pain
modulation in these women. An impairment of diffuse noxious
inhibitory controls (DNIC) has been suggested in chronic pain
conditions with a female predominance such as fibromyalgia and
temporomandibular disorder. Our aim was to examine whether
patients with provoked vestibulodynia and healthy women with or
without combined oral contraceptives (COC) display a DNIC
response to cold noxious stimulation. Twenty patients with
provoked vestibulodynia not using COC, 20 healthy women on COC
and 20 healthy women without COC were included and tested days
7-11 of their menstrual cycle. Pressure pain thresholds (PPTs)
and pain ratings using VAS were measured on the arm and leg
before and during a cold pressor test. A socio-medical
questionnaire, the Hospital and Anxiety Depression Scale and the
Short Form-36 were completed. The majority of the subjects in
all three study groups significantly increased their PPTs during
cold noxious stimulation indicating a DNIC response. The
patients displayed lower PPTs compared to the healthy women.
Depression, anxiety and bodily pain were more often reported by
the patients. No differences related to the intake of COC were
observed between the healthy women. In conclusion, women with
provoked vestibulodynia as well as healthy women irrespective of
COC status display a DNIC response indicating an endogenous pain
inhibition. However, the results imply a systemic
hypersensitivity in women with vestibulodynia with low general
pain thresholds as compared to healthy women
(163)
Johnson EO, Kostandi M, Moutsopoulos HM.
Hypothalamic-pituitary-adrenal axis function in Sjogren's
syndrome: mechanisms of neuroendocrine and immune system
homeostasis. Ann N Y Acad Sci 2006; 1088:41-51.:41-51.
Abstract: To date, evidence suggests that rheumatic diseases are
associated with hypofunctioning of the
hypothalamic-pituitary-adrenal (HPA) axis. Sjogren's syndrome
(SS), the second most common autoimmune disorder, is
characterized by diminished lacrimal and salivary gland
secretion. To examine HPA axis activity in SS patients, the
adrenocorticotropin (ACTH) response to ovine
corticotropin-releasing factor (oCRH) was used as a direct
measure of corticotrophic function, and the plasma cortisol
response to the ACTH released during oCRH stimulation as an
indirect measure of adrenal function. Significantly lower basal
ACTH and cortisol levels were found in patients with SS and were
associated with a blunted pituitary and adrenal response to oCRH
compared to normal controls. Fibromyalgia (FM) patients
demonstrated elevated evening basal ACTH and cortisol levels and
a somewhat exaggerated peak, delta, and net integrated ACTH
response to oCRH. A subgroup of SS patients also met the
diagnostic criteria for FM and demonstrated a pituitary-adrenal
response that was intermediate to SS and FM. These findings
suggest not only adrenal axis hypoactivity in SS and FM
patients, but also that varying patterns of adrenal and thyroid
axes dysfunction may exist in patients with different rheumatic
diseases
(164)
Johnson KM, Bradley KA, Bush K, Gardella C, Dobie DJ, Laya MB.
Frequency of mastalgia among women veterans. Association with
psychiatric conditions and unexplained pain syndromes. J Gen
Intern Med 2006; 21 Suppl 3:S70-5.:S70-S75.
Abstract: OBJECTIVE: To determine the prevalence and frequency
of mastalgia and its association with psychiatric conditions and
unexplained pain syndromes. DESIGN, SETTING, AND PARTICIPANTS:
Cross-sectional mailed survey completed by 1,219 female veterans
enrolled at the VA Puget Sound Health Care System in 1998.
MEASUREMENTS: Breast pain in the past year, unrelated to
pregnancy, was categorized as infrequent (< or =monthly) or
frequent (> or =weekly) mastalgia. Surveys assessed
posttraumatic stress disorder (PTSD), depression, panic
disorder, and alcohol misuse with validated screening tests, as
well as self-reported past-year chronic pelvic pain,
fibromyalgia, and irritable bowel syndrome. RESULTS: The
response rate was 63%. Fifty-five percent of the respondents
reported past-year mastalgia. Of these, 15% reported frequent
mastalgia. Compared to women without mastalgia, women reporting
frequent mastalgia were more likely to screen positive for PTSD
(odds ratio [OR] 5.2, 95% confidence interval [CI] 3.2 to 8.4),
major depression (OR 4.2, 2.6 to 6.9), panic disorder (OR 7.1,
3.9 to 12.8), eating disorder (OR 2.6, 1.5 to 4.7), alcohol
misuse (OR 1.8, 1.1 to 2.8), or domestic violence (OR 3.1, 1.9
to 5.0), and to report fibromyalgia (OR 3.9, 2.1 to 7.4),
chronic pelvic pain (OR 5.4, 2.7 to 10.5), or irritable bowel
syndrome (OR 2.8, 1.6 to 4.8). Women with infrequent mastalgia
were also more likely than women without mastalgia to screen
positive for PTSD, depression, or panic disorder, or report
pelvic pain or irritable bowel syndrome, although associations
were weaker than with frequent mastalgia. CONCLUSIONS: Like
other unexplained pain syndromes, frequent mastalgia is strongly
associated with PTSD and other psychiatric conditions.
Clinicians seeing patients with frequent mastalgia should
inquire about anxiety, depression, alcohol misuse, and trauma
history
(165)
Johnson LM, Zautra AJ, Davis MC. The role of illness uncertainty
on coping with fibromyalgia symptoms. Health Psychol 2006;
25(6):696-703.
Abstract: This study examined the role of illness uncertainty in
pain coping among women with fibromyalgia (FM), a chronic pain
condition of unknown origin. Fifty-one FM participants completed
initial demographic and illness uncertainty questionnaires and
underwent 10-12 weekly interviews regarding pain, coping
difficulty, and coping efficacy. Main outcome measures included
weekly levels of difficulty coping with FM symptoms and coping
efficacy. Multilevel analyses indicated that pain elevations for
those high in illness uncertainty predicted increases in coping
difficulty. Furthermore, when participants had more difficulty
coping, they reported lower levels of coping efficacy. Results
were consistent with hypothesized effects. Illness uncertainty
accompanied by episodic pain negatively influenced coping
efficacy, an important resource in adaptation to FM
(166)
Jonas C. [Fibromyalgia: rheumatologic or psychiatric disease?].
Presse Med 2006; 35(11 Pt 2):1679-1680.
(167)
Jones KD, Adams D, Winters-Stone K, Burckhardt CS. A
comprehensive review of 46 exercise treatment studies in
fibromyalgia (1988-2005). Health Qual Life Outcomes 2006;
4:67.:67.
Abstract: The purpose of this review was to: (1) locate all
exercise treatment studies of fibromyalgia (FM) patients from
1988 through 2005, (2) present in tabular format the key details
of each study and (3) to provide a summary and evaluation of
each study for exercise and health outcomes researchers.
Exercise intervention studies in FM were retrieved through
Cochrane Collaboration Reviews and key word searches of the
medical literature, conference proceedings and bibliographies.
Studies were reviewed for inclusion using a standardized
process. A table summarizing subject characteristics, exercise
mode, timing, duration, frequency, intensity, attrition and
outcome variables was developed. Results, conclusions and
comments were made for each study. Forty-six exercise treatment
studies were found with a total of 3035 subjects. The strongest
evidence was in support of aerobic exercise a treatment
prescription for fitness and symptom and improvement. In
general, the greatest effect and lowest attrition occurred in
exercise programs that were of lower intensity than those of
higher intensity. Exercise is a crucial part of treatment for
people with FM. Increased health and fitness, along with symptom
reduction, can be expected with exercise that is of appropriate
intensity, self-modified, and symptom-limited. Exercise and
health outcomes researchers are encouraged to use the extant
literature to develop effective health enhancing programs for
people with FM and to target research to as yet understudied FM
subpopulations, such as children, men, older adults, ethnic
minorities and those with common comorbidities of osteoarthritis
and obesity
(168)
Kajantie E, Phillips DI. The effects of sex and hormonal status
on the physiological response to acute psychosocial stress.
Psychoneuroendocrinology 2006; 31(2):151-178.
Abstract: Whether one is male or female is one of the most
important determinants of human health. While males are more
susceptible to cardiovascular and infectious disease, they are
outnumbered by women for many autoimmune disorders, fibromyalgia
and chronic pain. Recently, individual differences in the
physiological response to stress have emerged as a potentially
important risk factor for these disorders. This raises the
possibility that sex differences in prevalence of disease could
at least in part be explained by sex differences in the nature
of the physiological response to stress. In a
psychophysiological laboratory, the autonomic nervous system
response can be provoked by many different stressors including
physical, mental and psychosocial tasks, while the
hypothalamic-pituitary-adrenal axis (HPAA) response seems to be
more specific to a psychosocial challenge incorporating ego
involvement. The responses of both systems to different
psychosocial challenges have been subject to extensive research,
although in respect of sex differences the HPAA response has
probably been more systematically studied. In this review, we
focus on sex differences in HPAA and autonomic nervous system
responses to acute psychosocial stress. Although some
differences are dependent on the stressor used, the responses of
both systems show marked and consistent differences according to
sex, with the phase of the menstrual cycle, menopausal status
and pregnancy having marked effects. Between puberty and
menopause, adult women usually show lower HPAA and autonomic
responses than men of same age. However, the HPAA response is
higher in the luteal phase, when for example post stress free
cortisol levels approach those of men. After menopause, there is
an increase in sympathoadrenal responsiveness, which is
attenuated during oral hormone replacement therapy, with most
evidence suggesting that HPAA activity shows the same trends.
Interestingly, pregnancy is associated with an attenuated
response of the sympathoadrenal and HPAA systems at least as
assessed by biochemical stimulation. It is likely that these sex
differences in autonomic function are a result of estrogen
exposure which attenuates sympathoadrenal responsiveness. The
HPAA is however somewhat more complex and evidence now suggests
the influence of other modifiers such as arginine vasopressin
(AVP) and the regulation of circulating cortisol bioavailability
by corticosteroid-binding globulin (CBG). The pronounced and
multi-faceted sex differences in stress responsiveness suggest
that they are a product of a strong evolutionary pressure. We
hypothesise that this has to a great deal been driven by the
need to protect the fetus from the adverse effects of maternal
stress responses, in particular excess glucocorticoid exposure.
Studying this hypothesis may have a fundamental impact on our
understanding about how adult health is set during early life
and how adult disease could be prevented in men and women
(169)
Kaki AM. Pain clinic experience in a teaching hospital in
Western, Saudi Arabia. Relationship of patient's age and gender
to various types of pain. Saudi Med J 2006; 27(12):1882-1886.
Abstract: OBJECTIVE: To show the practice of a pain clinic in
Saudi Arabia, to estimate the prevalence of various types of
chronic pain managed in there and to find the relationship of
patient's age and gender to type of pain. METHODS: A
retrospective study was carried out over a period of 5 years
(January 2000 - December 2004) at a teaching hospital in Jeddah.
A total of 1686 patient's data was reviewed, including the
giving diagnosis, types of pain and demographic data. RESULTS:
The common age was 50-59 years (25.4%), with a preponderance of
female (56.8%) over male (43.2%). For given diagnosis low back
pain (LBP) was the most common (45.4%), followed by painful
neuralgia (15.6%), headache (9.7%), cancer pain (8.7%), and
cervicobrachialgia (8.1%). The prevalence of fibromyalgia
(7.9%), headache (12.1%) and cervicobrachialgia (10.7%) was more
common among female, in comparison to male (2.4%), (6.4%) and
(4.7%) respectively. While painful neuralgia was more frequent
among male (19.9%) than female (12.3%), (p<0.001). Low back pain
showed higher prevalence among old patients, while headache and
sickle cell disease were more common among younger age group.
Combined nociceptive and neuropathic pain was the most common
pathophysiological type observed (39%), followed by nociceptive
pain (36.2%) and the least one was psychological pain (2.7%).
CONCLUSION: Various types of chronic pain managed in the pain
clinic requesting full understanding of pain neurophysiology as
well as familiarity with contributing factors to the prevalence
of pain
(170)
Karper WB, Jannes CR, Hampton JL. Fibromyalgia syndrome: the
beneficial effects of exercise. Rehabil Nurs 2006;
31(5):193-198.
Abstract: This article highlights positive outcomes for a
convenience sample of six women (49-64 years of age) with
fibromyalgia syndrome (FMS) who participated in an exercise
program over 5 years. This group showed improvement with various
FMS symptoms,fitness, and psychosocial factors early in the
program, then showed further improvement as a result of adding
new exercises to the protocol during the fourth and fifth years.
Data suggest that certain people with FMS can improve their
functional capacity with exercise over time, and move to even
higher levels of physical function while aging and coping with
FMS. Practical advice is provided for rehabilitation nurses
regarding exercise and FMS
(171)
Kasikcioglu E, Dinler M, Berker E. Reduced tolerance of exercise
in fibromyalgia may be a consequence of impaired
microcirculation initiated by deficient action of nitric oxide.
Med Hypotheses 2006; 66(5):950-952.
Abstract: Although the underlying mechanism responsible for
muscular fatigue and exercise intolerance remains to be
elucidated, it is reported two major mechanisms, central and
peripheral hypothesis. As a peripheral mechanism, there are few
reports on abnormalities of the microcirculation in patients
with fibromyalgia. The key point to note is that ischemia
associated with a modest decline in tissue oxygen causes muscle
fatigue. It has been shown that have been found low muscle
levels of phosphates and abnormalities in microcirculation in
fibromyalgia. Based on several novel data, production
abnormalities of nitric oxide level might lead to symptoms of
fatigue as a long term effect. There a vicious cycle concerning
impairment of microcirculation in FM. The cycle is firstly
initiated decrease of production of nitric oxide in the
endothelial level by some trigger factors. Changed level of
nitric oxide may cause microcirculation abnormalities in the
tissue levels, muscular region. At the end of these phases,
muscular fatigue and exercise intolerance may progressively
develop in the FM. It is possible that this theory appears to
provide a physiopathological explanation for decreased exercise
capacity in patients with fibromyalgia. This paper describes a
plausible mechanism for the development of exercise intolerance
on microcirculation abnormalities
(172)
Kassam A, Patten SB. Major depression, fibromyalgia and labour
force participation: a population-based cross-sectional study.
BMC Musculoskelet Disord 2006; %19;7:4.:4.
Abstract: BACKGROUND: Previous studies have documented an
elevated frequency of depressive symptoms and disorders in
fibromyalgia, but have not examined the association between this
comorbidity and occupational status. The purpose of this study
was to describe these epidemiological associations using a
national probability sample. METHODS: Data from iteration 1.1 of
the Canadian Community Health Survey (CCHS) were used. The CCHS
1.1 was a large-scale national general health survey. The
prevalence of major depression in subjects reporting that they
had been diagnosed with fibromyalgia by a health professional
was estimated, and then stratified by demographic variables.
Logistic regression models predicting labour force participation
were also examined. RESULTS: The annual prevalence of major
depression was three times higher in subjects with fibromyalgia:
22.2% (95% CI 19.4 - 24.9), than in those without this
condition: 7.2% (95% CI 7.0 - 7.4). The association persisted
despite stratification for demographic variables. Logistic
regression models predicting labour force participation
indicated that both conditions had an independent (negative)
effect on labour force participation. CONCLUSION: Fibromyalgia
and major depression commonly co-occur and may be related to
each other at a pathophysiological level. However, each syndrome
is independently and negatively associated with labour force
participation. A strength of this study is that it was conducted
in a large probability sample from the general population. The
main limitations are its cross-sectional nature, and its
reliance on self-reported diagnoses of fibromyalgia
(173)
Kato K, Sullivan PF, Evengard B, Pedersen NL. Chronic widespread
pain and its comorbidities: a population-based study. Arch
Intern Med 2006; 166(15):1649-1654.
Abstract: BACKGROUND: Chronic widespread pain (CWP), the
cardinal symptom of fibromyalgia, is prevalent and co-occurs
with numerous symptom-based conditions such as chronic fatigue
syndrome, joint pain, headache, irritable bowel syndrome, and
psychiatric disorders. Few studies have examined the
comorbidities of CWP in the general population. Furthermore,
little is known about the importance of familial (genetic and
family environmental) factors in the etiology of co-occurrence.
METHODS: Data were obtained from 44 897 individuals in the
Swedish Twin Registry via computer-assisted telephone interview
from 1998 through 2002 (age >/=42 years; 73.2% response rate).
Screening for CWP was based on the American College of
Rheumatology criteria without clinical evaluation. Measures for
comorbidities were based on standard criteria when available.
Odds ratios (ORs) were calculated in case-control and co-twin
control designs to assess the effect of familial confounding in
the associations. RESULTS: Considerable co-occurrences were
found in CWP cases for chronic fatigue (OR, 23.53; 95%
confidence interval [CI], 19.67-28.16), joint pain (OR, 7.41;
95% CI, 6.70-8.21), depressive symptoms (OR, 5.26; 95% CI,
4.75-5.82), and irritable bowel syndrome (OR, 5.17; 95% CI,
4.55-5.88). In co-twin control analyses, ORs were no longer
significant for psychiatric disorders, whereas they decreased
but remained significant for most other comorbidities. No
changes in ORs were observed for headache. CONCLUSIONS:
Associations between CWP and most comorbidities are mediated by
unmeasured genetic and family environmental factors in the
general population. The extent of mediation via familial factors
is likely to be disorder specific
(174)
Kato K, Sullivan PF, Evengard B, Pedersen NL. Importance of
genetic influences on chronic widespread pain. Arthritis Rheum
2006; 54(5):1682-1686.
Abstract: OBJECTIVE: To estimate the relative importance of
genetic and environmental factors in chronic widespread pain,
and to assess whether there are sex differences in the type or
magnitude of these influences. METHODS: Data were collected from
a national sample of twins > or = 42 years of age, all of whom
were participants in the Swedish Twin Registry. The presence of
chronic widespread pain was assessed via computer-assisted
telephone interviews, which were conducted between 1998 and
2002, using the American College of Rheumatology criteria for
fibromyalgia. No clinical examinations were performed. In
preliminary analyses, probandwise concordance rates and
tetrachoric correlations were calculated. Structural equation
modeling was then performed to estimate additive genetic, shared
environmental, and nonshared environmental sources of
variability in susceptibility for the development of chronic
widespread pain. RESULTS: Of 61,355 eligible twins, 44,897
individuals (73.2%) responded to the interview. Both members of
15,950 pairs responded to the items regarding pain symptoms; of
these pairs, 4,170 were monozygotic, 5,881 were same-sex
dizygotic, and 5,755 were opposite-sex dizygotic. The prevalence
of chronic widespread pain was 4.1%, and the ratio of women to
men was 3.3 to 1. Probandwise concordance rates and tetrachoric
correlations suggested modest genetic influences for both women
and men. Genetic and shared environmental influences explained
approximately half of the total variance, with no indication of
sex differences in either the type or magnitude of these
influences. CONCLUSION: Individual differences in the likelihood
of developing chronic widespread pain reflect modest genetic
influences. There are no significant sex differences in the type
or expression of the genes responsible for chronic widespread
pain or in the magnitude of the relative importance of these
influences on chronic widespread pain
(175)
Katz RS, Wolfe F, Michaud K. Fibromyalgia diagnosis: a
comparison of clinical, survey, and American College of
Rheumatology criteria. Arthritis Rheum 2006; 54(1):169-176.
Abstract: OBJECTIVE: The American College of Rheumatology (ACR)
criteria for fibromyalgia are the de facto criteria used for
research. However, ACR criteria are not generally utilized by
nonrheumatologists, and rheumatologists may diagnose
fibromyalgia in patients who do not satisfy the ACR criteria. We
undertook this study to determine concordance between ACR
criteria and clinician diagnosis and between proposed survey
criteria and clinician diagnosis. METHODS: Consecutive patients
in a clinical practice setting were evaluated by tender point
examination, survey criteria for fibromyalgia (Regional Pain
Scale score > or =8 and fatigue score > or =6), and clinical
diagnosis. RESULTS: Among the 206 patients, the clinician
diagnosed fibromyalgia in 49.0%, while 29.1% satisfied ACR
criteria and 40.3% satisfied survey criteria. Clinical and
survey criteria were concordant in 74.8% of cases (kappa = 0.49
[95% confidence interval 0.36, 0.60]). Clinical criteria and ACR
criteria were concordant in 75.2% of cases (kappa = 0.50 [95%
confidence interval 0.35, 0.59]), and survey criteria and ACR
criteria were concordant in 72.3% (kappa = 0.40 [95% confidence
interval 0.25, 0.51]). The ACR tender point criterion (> or =11)
was not a factor in clinical and survey criteria. However, the
tender point count was useful in clinical diagnosis. CONCLUSION:
Clinical diagnosis and ACR and survey criteria are moderately
concordant (72-75%) and address a common pool of symptoms and
physical findings. Because there is no gold standard for
fibromyalgia diagnosis and because fibromyalgia is often viewed
as a trait diagnosis, all methods of diagnosis have utility. The
survey method has the advantage that it does not require
physical examination
(176)
Kim SH, Jang TJ, Moon IS. Increased expression of
N-methyl-D-aspartate receptor subunit 2D in the skin of patients
with fibromyalgia. J Rheumatol 2006; 33(4):785-788.
Abstract: OBJECTIVE: We studied the expression of
N-methyl-D-aspartate receptors (NMDAR) in skin of patients with
fibromyalgia (FM) to investigate their role. METHODS: The
presence of NMDAR subtype 2B (NR2B) and subtype 2D (NR2D) was
examined in skin tissues by immunohistochemistry and immunoblot.
Skin tissues from 11 female patients with FM were examined and
compared to those of 8 age- and sex-matched healthy controls.
RESULTS: NR2D expression was increased in the skin of patients
with FM versus controls. There was no difference in the
expression of NR2B between FM patients and controls. CONCLUSION:
The increased expression of NMDAR found in FM skin could be
indicative of a more generalized increase in other peripheral
nerves. This suggests that NR2D-selective antagonists may have
implications in the treatment of allodynia in patients with FM
(177)
Kone-Paut I. [Fibromyalgia]. Arch Pediatr 2006; 13(6):548-550.
(178)
Kool MB, Woertman L, Prins MA, Van MH, Geenen R. Low
relationship satisfaction and high partner involvement predict
sexual problems of women with fibromyalgia. J Sex Marital Ther
2006; 32(5):409-423.
Abstract: To examine the predictive potential of relationship
variables on sexual functioning in women with fibromyalgia, we
instructed 63 women (age 21-54 years) to fill out several
questionnaires. Low relationship satisfaction was the strongest
and most-frequent predictor of problematic sexual functioning.
In addition, more fatigue and--only after taking account of
relationship satisfaction--more active engagement (i.e.,
involvement) of the spouse were associated with reduced sexual
functioning and satisfaction. Our study suggests that for women
with fibromyalgia, relationship satisfaction is good for sexual
functioning. Although having an involved spouse is good for the
relationship, it may be bad for sexual functioning
(179)
Koulil SV, Effting M, Kraaimaat FW, Lankveld WV, Helmond TV,
Cats H et al. A Review of cognitive behaviour therapies and
exercise programmes for fibromyalgia patients: State of the art
and future directions. Ann Rheum Dis 2006; .
Abstract: This review provides an overview of the effects of
non- pharmacological treatments for patients with fibromyalgia
(FM), including cognitive behaviour therapy, exercise training
programmes or a combination of the two. After summarizing and
discussing preliminary evidence of the rationale of
non-pharmacological treatment in FM, we will review and examine
controlled trials for possible predictors of treatment success
such as patient and treatment characteristics. Despite support
for their suitability in FM, the effects of non- pharmacological
interventions are limited and positive outcomes largely
disappear in the long term. However, within the various FM
populations treatment outcomes showed considerable individual
variations. In particular, specific subgroups of patients
characterized by relatively high levels of psychological
distress seem to benefit most from non-pharmacological
interventions. Preliminary evidence of retrospective treatment
analyses suggest that the efficacy may be enhanced by offering
tailored treatment approaches in an early stage to patients who
are at risk of developing chronic physical and psychological
impairments
(180)
Krakow B. Potential impact of sleep disorder treatment in
fibromyalgia patients. Arch Intern Med 2006; 166(12):1323-1324.
(181)
Kurland JE, Coyle WJ, Winkler A, Zable E. Prevalence of
irritable bowel syndrome and depression in fibromyalgia. Dig Dis
Sci 2006; 51(3):454-460.
Abstract: The purpose of this study was to determine the point
prevalence of depressive symptoms, using the PRIME-MD
questionnaire, and irritable bowel syndrome (IBS), while
comparing the Rome II to the Rome I criteria, in patients with
fibromyalgia (FM) and rheumatologic controls in an outpatient
setting. The prevalence of IBS in FM patients (n = 105) was 63%
by Rome I and 81% by Rome II criteria. The prevalence of IBS in
controls (n = 62) was 15% by Rome I and 24% by Rome II criteria
(FM vs. control; P < 0.001). Depressive symptoms were met in 40%
of FM patients and 8% of controls (P < 0.001). The coexistence
of IBS and depressive symptoms in the FM patients was 31% (Rome
I) and 34% (Rome II). The prevalence of IBS and depressive
symptoms was higher in FM patients compared to the control
population. Identification of IBS and depressive symptoms in FM
patients might enable clinicians to better meet the needs of
this patient population
(182)
Kurtais Y, Kutlay S, Ergin S. Exercise and cognitive-behavioural
treatment in fibromyalgia syndrome. Curr Pharm Des 2006;
12(1):37-45.
Abstract: Fibromyalgia syndrome is a nonarticular rheumatic
disorder characterised by diffuse musculoskeletal pain,
stiffness, fatigue, disturbed sleep and tender points. The
pathophysiology is not well understood and treatment remains a
challenge. Although pharmacological therapy is still the primary
treatment choice, a long-term effective intervention has not
been demonstrated yet. Thus, besides pharmacotherapy, other
multimodal interventions are often used. Exercise and
cognitive-behavioural treatments which exist in the multimodal
approach and encompass largely self-managed strategy, are
reviewed in this article. Although, there is a great number of
exercise studies, the large diversity of outcome measures and
measurement instruments that have been used in studies, varying
intensity and types of exercises, small sample sizes, high
attrition rates, large variability in baseline function, symptom
severity and psychosocial status limit to come to a conclusion
about the efficacy of exercise in the treatment of fibromyalgia
syndrome. There are also inconclusive results about the efficacy
of cognitive-behavioural treatment because of limited number of
studies with small sample sizes of patients with fibromyalgia
syndrome. However, the results of the trials overall demonstrate
the beneficial effects of both different types of exercise and
cognitive-behavioural treatment, on the other hand, there is
still a need for larger, more systematic and randomised
controlled trials to evaluate the effectiveness
(183) Laske C, Stransky E, Eschweiler GW, Klein R, Wittorf A,
Leyhe T et al.
Increased
BDNF serum concentration in fibromyalgia with or without
depression or antidepressants. J Psychiatr Res 2006; .
Abstract: Fibromyalgia (FM) is still often viewed as a
psychosomatic disorder. However, the increased pain sensitivity
to stimuli in FM patients is not an "imagined" histrionic
phenomena. Pain, which is consistently felt in the musculature,
is related to specific abnormalities in the CNS pain matrix.
Brain-derived neurotrophic factor (BDNF) is an endogenous
protein involved in neuronal survival and synaptic plasticity of
the central and peripheral nervous system (CNS and PNS). Several
lines of evidence converged to indicate that BDNF also
participates in structural and functional plasticity of
nociceptive pathways in the CNS and within the dorsal root
ganglia and spinal cord. In the latter, release of BDNF appears
to modulate or even mediate nociceptive sensory inputs and pain
hypersensitivity. We were interested, if BDNF serum
concentration may be altered in FM. The present pilot study
assessed to our knowledge for the first time BDNF serum
concentrations in 41 FM patients in comparison to 45 age-matched
healthy controls. Mean serum levels of BDNF in FM patients
(19.6ng/ml; SD 3.1) were significantly increased as compared to
healthy controls (16.8ng/ml; SD 2.7; p<0.0001). In addition,
BDNF serum concentrations in FM patients were independent from
age, gender, illness duration, preexisting recurrent major
depression and antidepressive medication in low doses. In
conclusion, the results from our study indicate that BDNF may be
involved in the pathophysiology of pain in FM. Nevertheless, how
BDNF increases susceptibility to pain is still not known
(184)
Lawson K. Emerging pharmacological therapies for fibromyalgia.
Curr Opin Investig Drugs 2006; 7(7):631-636.
Abstract: Fibromyalgia is a chronic pain disorder for which
pathophysiological mechanisms are difficult to identify and
current drug therapies demonstrate limited effectiveness and
significant tolerability. To date, no drugs have been officially
approved for the indication of fibromyalgia, and randomized,
controlled clinical trials with fibromyalgia patients are taking
place to identify potential therapeutic approaches. Although
emerging therapies, such as the antidepressants duloxetine and
milnacipran and the antiepileptic pregabalin, offer certain
efficacy, randomized controlled trials are generally difficult
due to factors such as a lack of understanding of the
pathophysiology and a heterogenous fibromyalgia patient
population. For a significant advance in the drug treatment of
fibromyalgia, novel clues are still awaited that may offer an
effective therapeutic approach
(185)
Le GP. Is fibromyalgia a muscle disorder? Joint Bone Spine 2006;
73(3):239-242.
Abstract: The presence of abnormalities in fibromyalgia muscle
using current methodological approaches is well established. The
more serious abnormalities are demonstrated by histologic
studies particularly on electron microscopy: disorganisation of
Z bands and abnormalities in the number and shape of
mitochondria. Biochemical studies and P 31 magnetic resonance
spectroscopy show inconstant abnormalities of ATP and
phosphocreatine levels. Mitochondrial abnormalities reduced
capillary circulation and thickened capillary endothelium may
result in decreased availability of oxygen and impaired
oxidative phosphorylation as well as ATP synthesis. These
abnormalities do not seem to be the consequences of the
much-discussed deconditioning of muscles although these
consequences are not well known. Further studies of energy
metabolism of the muscle during exercise are needed
(186)
Leavitt F, Katz RS. Distraction as a key determinant of impaired
memory in patients with fibromyalgia. J Rheumatol 2006;
33(1):127-132.
Abstract: OBJECTIVE: Patients with fibromyalgia (FM) frequently
complain of poor memory, severe enough to affect job performance
and to lead to disability. Yet common practices in
neurocognitive examinations often fail to document cognitive
abnormalities that match the severity of their memory
complaints. Often, neuropsychologists gauge memory competence
with measures free of distraction and produce high rates of
normality on neurocognitive examination. We hypothesized that
neurocognitive tests encoded with a source of stimulus
competition that interferes with the processing and/or
absorption of information would be better than others in gauging
FM memory competence. METHODS: Thirty-five patients with FM and
35 controls, matched for age and sex, and presenting with
complaints of memory loss, completed cognitive measures with and
without stimulus competition. RESULTS: Eleven (31.4%) patients
with FM showed impairment on at least one measure of memory
encoded free of stimulus competition. By comparison, 30 (85.7%)
showed impairment on at least one measure encoded with a source
of stimulus competition. The Auditory Consonant Trigram detected
impairment in 29 (82.6%) cases, and was by far the most
sensitive measure. FM patients lost information at a 58% rate
following a 9 second distraction. This loss was disproportionate
to the loss shown by both age matched controls with memory
problems (40%) and to normative values (20%) based on
individuals free of memory problems. CONCLUSION: The findings
validate the perception of failing memory in patients with FM
and are the first psychometric based evidence to our knowledge
of short-term memory problems in FM linked to interference from
a source of distraction. Adding a source of distraction caused
the majority of FM patients to retain new information poorly,
and may be integral to an understanding of FM memory problems.
Much needs to be learned about why new information is
disproportionately lost by FM populations when a source of
distraction enters the experiential field
(187)
Leblebici B, Pektas ZO, Ortancil O, Hurcan EC, Bagis S, Akman
MN. Coexistence of fibromyalgia, temporomandibular disorder, and
masticatory myofascial pain syndromes. Rheumatol Int 2006; .
Abstract: The purpose of this study was to determine the
association of fibromyalgia (FM) with temporomandibular disorder
(TMD) and masticatory myofascial pain (MMP). Thirty-one
consecutive women diagnosed as having FM according to American
College of Rheumatology criteria and 21 consecutive women
diagnosed as having TMD were included in this prospective study.
All patients were examined by a dentist and a physiatrist to
identify the coexistence of FM and TMD. In the FM group, TMD was
found in 25 (80%) patients, and only 6 (19%) patients had
arthrogenous origin with MMP, whereas 19 (81%) patients had only
MMP without arthrogeonous orgin of those 25 women exhibited TMD.
In the TMD group, the prevalence of FM was 52%, which was
significantly higher in those with TMD of arthrogenous origin
with MMP. Our results indicate that coexistence of FM and TMD
with MMP is high. Pain and tenderness in the masticatory muscles
appear to be an important element in FM, so in some patients it
may be the leading complaint
(188)
Lee SS, Yoon HJ, Park YW. Antipolymer antibody is not associated
with fibromyalgia in Korean female patients. Rheumatol Int 2006;
27(1):73-77.
Abstract: To examine the levels of antipolymer antibody (APA) in
Korean female patients with fibromyalgia (FM) and to determine
whether the levels of APA correlate with FM severity. Serum
samples from patients with FM (n = 69), patients with rheumatoid
arthritis (RA) (n = 71), and controls (n = 75) were assayed for
APA. All of the subjects were female, and the controls were
age-matched healthy volunteers. FM tender point counts and
scores were examined, and FM patients were asked to complete a
Korean version of the Fibromyalgia Impact Questionnaire (FIQ),
the State-Trait Anxiety Inventory (STAI), and the Beck
Depression Inventory (BDI). APA-positive samples were detected
in five (7.2%) of the 69 FM patients, seven (9.9%) of the 71 RA
patients, and four (5.3%) of the 75 controls. The prevalence of
seropositivity and the level of APA in FM patients did not
differ from those in RA patients and controls. The proportion
positive for APA was not higher for FM patients with severe
symptoms than for FM patients with mild symptoms. There was a
negative association between the APA level and age. The APA
level in FM patients was not correlated with age at diagnosis,
age at symptom onset, disease duration, education, tender point
counts and scores, FIQ, STAI, or BDI. The prevalence of APA in
Korean FM patients was quite low. Owing to the low prevalence of
APA in this study, the APA assay did not distinguish FM patients
with severe symptoms from those with mild symptoms
(189)
Lenaerts ME, Gill PS. At the crossroads between tension-type
headache and fibromyalgia. Curr Pain Headache Rep 2006;
10(6):463-466.
Abstract: Fibromyalgia syndrome and tension-type headache have
multiple clinical features in common, and pathogenic mechanisms
partly overlap. Significant differences need to be recognized as
well. Studying the correlations of these often comorbid
conditions represents a unique opportunity to gain insight into
their pathophysiology and that of other chronic pain syndromes,
to increase the accuracy of their diagnosis, and to improve the
therapeutic armamentarium
(190)
Leo RJ, Brooks VL. Clinical potential of milnacipran, a
serotonin and norepinephrine reuptake inhibitor, in pain. Curr
Opin Investig Drugs 2006; 7(7):637-642.
Abstract: Milnacipran is a serotonin (5-HT) and norepinephrine
(NE) reuptake inhibitor currently available for use as an
antidepressant in several countries. Phase III clinical trials
are currently underway to assess its potential role in the
treatment of fibromyalgia syndrome, and in pursuit of US Food
and Drug Administration approval for this indication. Evidence
has accumulated suggesting that in animal models, milnacipran
may exert pain-mitigating influences involving NE- and
5-HT-related processes at supraspinal, spinal and peripheral
levels of pain transmission. Preliminary evidence suggests that
milnacipran may be useful in mitigating pain and fatigue
associated with fibromyalgia. However, its role in addressing
comorbidities associated with fibromyalgia, including visceral
pain and migraine, has yet to be investigated
(191)
Li CD, Fu XY, Jiang ZY, Yang XG, Huang SQ, Wang QF et al.
[Clinical study on combination of acupuncture, cupping and
medicine for treatment of fibromyalgia syndrome]. Zhongguo Zhen
Jiu 2006; 26(1):8-10.
Abstract: OBJECTIVE: To observe the therapeutic effect of
acupuncture at five mental points and moving cupping on the
Hechelu of the back on fibromyalgia syndrome (FS). METHODS:
Sixty-six cases who conformed to the criteria were randomly
divided into the treatment group treated with acupuncture at
five mental points, moving cupping on the Hechelu of the back
and amitriptyline, and the control group treated with
amitriptyline. Clinical therapeutic effects were assessed with
McGill Pain Questionnaire (MPQ) and HAMD depression scale.
RESULTS: The therapeutic effect of the treatment group was
better than that of the control group with a significant
difference between the two groups (P < 0.01). CONCLUSION:
Combination of acupuncture with cupping therapy is an effective
therapy for fibromyalgia syndrome
(192)
Liedberg GM, Burckhardt CS, Henriksson CM. Young women with
fibromyalgia in the United States and Sweden: perceived
difficulties during the first year after diagnosis. Disabil
Rehabil 2006; 28(19):1177-1184.
Abstract: PURPOSE: The major symptoms of fibromyalgia
(FM)--pain, tiredness, disrupted sleep, and muscle
weakness--severely impact everyday activities, including the
paid work role of women who have had FM for a long time. There
are no prospective studies on young and newly diagnosed women
with FM. The aim of the present study was to describe and
compare difficulties young and newly diagnosed women in Sweden
and the United States experienced during their first year after
diagnosis. METHOD: Three interviews, 6 months apart, were
conducted, with 49 Swedish and 45 US women between the ages of
18 and 39. Five open-ended questions were asked concerning
physical, psychological and social difficulties and limitations,
and factors that increased or decreased their difficulties and
limitations. At interviews 2 and 3 the women were also asked
about ways of preventing their difficulties. The answers were
written down and analysed by a content analysis approach.
RESULTS: Consistent categories of difficulties were reported:
symptoms, movements, activities, moods, social network, external
factors and coping strategies. More US women were working
outside their homes than were their Swedish counterparts and
they expressed more difficulties compared with the Swedish
women. CONCLUSIONS: In general, difficulties decreased and
coping strategies increased over the 1-year period in both
groups of newly diagnosed, young women
(193)
Littlejohn GO, Guymer EK. Fibromyalgia syndrome: which
antidepressant drug should we choose. Curr Pharm Des 2006;
12(1):3-9.
Abstract: Fibromyalgia syndrome [FM] has core clinical features
of widespread pain and widespread abnormal tenderness. The
specific cause of the altered neurophysiology that underpins
these clinical manifestations remains unclear. However,
increased sensitisation of neural networks that relates to pain,
as well as interacting mechanoreceptors, appear important
targets for modulation by pharmacological agents. Further, many
FM patients have emotional distress and some are depressed.
Antidepressant agents have therapeutic benefits in FM. If
depression is present antidepressant drugs will provide typical
benefits to mood but not always to other key outcome measures,
such as pain or tenderness. Selective serotonin receptor
reuptake blockers are not as effective for overall FM
improvement as drugs that block both serotonin and
norepinephrine in a relatively balanced way. Thus tricyclic
antidepressants will improve many important FM outcomes but are
effective in only about 40 percent of individuals. Newer agents
of this class, such as duloxetine and milnacipran, show
improvement in key FM outcomes in about 60 percent of patients.
Longer term studies will indicate the durability of these
responses and the overall tolerance of the drugs. Any drug
therapy will need to be integrated with appropriate education,
exercise and attention to psychological modulatory factors to
achieve best results
(194)
Lofgren M, Ekholm J, Ohman A. 'A constant struggle': successful
strategies of women in work despite fibromyalgia. Disabil
Rehabil 2006; 28(7):447-455.
Abstract: PURPOSE: This study aimed to explore, and obtain
increased knowledge of, the strategies used by working women
with fibromyalgia regarding control of pain, fatigue and other
symptoms. METHOD: Qualitative methods with an emergent design
were used. The informants were women with fibromyalgia who had
participated in rehabilitation 6-8 years earlier, and were still
in work. Diaries, focus groups and individual interviews were
used for data collection. Content analysis and grounded theory
were used for the analyses. RESULTS: A model with three
categories emerged. The core category 'constant struggle'
contains eight sub-categories: enjoying life, taking care of
oneself, positive thinking, setting limits, using pain as a
guide, creative solutions, learning/being knowledgeable and
'walking a tightrope'. The category 'grieving process' was a
prerequisite for managing the struggle and the category 'social
support' contained what facilitated the struggle. CONCLUSION:
The informants fought a constant struggle against the symptoms
and the consequences of their fibromyalgia. Their strategies
were action-oriented and evinced a positive spirit. To have
grieved and accepted their situation was a prerequisite for
managing, and support from the family was a help in the struggle
(195)
Longley K. Fibromyalgia: aetiology, diagnosis, symptoms and
management. Br J Nurs 2006; 15(13):729-733.
Abstract: Fibromyalgia is believed to affect about 2% of the UK
population, predominantly women, and is characterized by the
symptoms of widespread musculoskeletal pain, persistent fatigue,
non-refreshing sleep and generalized stiffness. It is also
accompanied by a variety of associated symptoms which can appear
baffling to both patient and doctor alike. Research into this
often dismissed syndrome has increased exponentially over the
last two decades and the evidence is growing to support an
underlying pathology involving pain amplification, sleep
abnormalities, hormonal imbalance and autonomic nervous system
dysfunction. This review looks at diagnosis, research and
current treatment options and offers an insight into the
patients' experience with the medical and nursing professions
(196)
Lormeau C, Falgarone G, Roulot D, Boissier MC. Rheumatologic
manifestations of chronic hepatitis C infection. Joint Bone
Spine 2006; 73(6):633-638.
Abstract: The many rheumatologic manifestations associated with
chronic hepatitis C virus (HCV) infection include arthralgia,
myalgia, arthritis, vasculitis, and sicca syndrome. Arthralgia
is the most common extrahepatic manifestation and may indicate
mixed cryoglobulinemia or an adverse reaction to interferon
therapy. HCV arthritis unrelated to cryoglobulinemia is far less
common but constitutes an independent entity. The picture may
mimic rheumatoid arthritis (RA), particularly as rheumatoid
factor is present in 50-80% of cases. Tests are usually negative
for antibodies to cyclic citrullinated peptides (anti-CCP),
which may help to differentiate the two conditions. The
management of HCV arthritis is empirical and poorly
standardized. Although low-dose glucocorticoid therapy,
hydroxychloroquine, and methotrexate have been used successfully
in several patients, little is known about their hepatic safety
profile. Arthritis associated with cryoglobulinemia usually
responds to antiviral treatment. Sicca syndrome is common in
patients with chronic HCV infection and shares similarities with
primary Sjogren syndrome, suggesting that HCV infection may
deserve to be included among the causes of secondary Sjogren
syndrome. HCV-associated vasculitis is usually related to
cryoglobulinemia, although a few cases of polyarteritis
nodosa-like disease affecting the medium-sized vessels have been
reported. Other conditions reported in patients with chronic HCV
infection include fibromyalgia, systemic lupus erythematosus
(SLE), antiphospholipid syndrome, and osteosclerosis
(197)
Lorusso A, Bruno S, L'Abbate N. [Occupational fitness of workers
with fibromyalgia syndrome]. G Ital Med Lav Ergon 2006;
28(2):172-173.
Abstract: Fibromyalgia is a syndrome characterized by widespread
musculoskeletal chronic pain and by other clinical
manifestations such as stiffness, fatigue, sleep disturbances,
anxiety and depression. The disorder has a considerable impact
on the ability to perform work and daily living activities,
often reducing workforce participation. Fitness to work, in
relation to biomechanically taxing tasks execution, vibration
exposure, environmental microclimatic conditions and night
shift, is discussed
(198)
Lotaif AC, Mitrirattanakul S, Clark GT. Orofacial muscle pain:
new advances in concept and therapy. J Calif Dent Assoc 2006;
34(8):625-630.
Abstract: This manuscript focuses on chronic myogenous pains
affecting the masticatory muscles. The differentiation of
myogenous masticatory pain into subcategories is proposed by
separating myogenous pains according to their location and
anatomic extent. Focal myalgia, regional myalgia, myofascial
pain, and fibromyalgia are classified based on specific
historical and clinical examination criteria. The probable
mechanisms underlying chronic myogenous pains and trigger points
phenomena are discussed. Treatment options of the myogenous
masticatory pain conditions including physical medicine
modalities, as well as several types of pharmacologic agents,
are presented
(199)
Lowe JC, Yellin J, Honeyman-Lowe G. Female fibromyalgia
patients: lower resting metabolic rates than matched healthy
controls. Med Sci Monit 2006; 12(7):CR282-CR289.
Abstract: BACKGROUND: Many features of fibromyalgia and
hypothyroidism are virtually the same, and thyroid hormone
treatment trials have reduced or eliminated fibromyalgia
symptoms. These findings led the authors to test the hypothesis
that fibromyalgia patients are hypometabolic compared to matched
controls. MATERIAL/METHODS: Resting metabolic rate (RMR) was
measured by indirect calorimetry and body composition by
bioelectrical impedance for 15 fibromyalgia patients and 15
healthy matched controls. Measured resting metabolic rate (mRMR)
was compared to percentages of predicted RMR (pRMR) by fat-free
weight (FFW) (Sterling-Passmore: SP) and by sex, age, height,
and weight (Harris-Benedict: HB). RESULTS: Patients had a lower
mRMR (4,306.31+/-1077.66 kJ vs 5,411.59+/-695.95 kJ, p=0.0028)
and lower percentages of pRMRs (SP: -28.42+/-15.82% vs
-6.83+/-12.55%, p<0.0001. HB: -29.20+/-17.43% vs -9.13+/-9.51%,
p=0.0008). Whereas FFW, age, weight, and body mass index (BMI)
best accounted for variability in controls' RMRs, age and fat
weight (FW) did for patients. In the patient group, TSH level
accounted for 28% of the variance in pain distribution, and free
T3 (FT3) accounted for 30% of the variance in pressure-pain
threshold. CONCLUSIONS: Patients had lower mRMR and percentages
of pRMRs. The lower RMRs were not due to calorie restriction or
low FFW. Patients' normal FFW argues against low physical
activity as the mechanism. TSH, FT4, and FT3 levels did not
correlate with RMRs in either group. This does not rule out
inadequate thyroid hormone regulation because studies show these
laboratory values do not reliably predict RMR
(200)
Lucas HJ, Brauch CM, Settas L, Theoharides TC. Fibromyalgia--new
concepts of pathogenesis and treatment. Int J Immunopathol
Pharmacol 2006; 19(1):5-10.
Abstract: Fibromyalgia (FMS) is a debilitating disorder
characterized by chronic diffuse muscle pain, fatigue, sleep
disturbance, depression and skin sensitivity. There are no
genetic or biochemical markers and patients often present with
other comorbid diseases, such as migraines, interstitial
cystitis and irritable bowel syndrome. Diagnosis includes the
presence of 11/18 trigger points, but many patients with early
symptoms might not fit this definition. Pathogenesis is still
unknown, but there has been evidence of increased
corticotropin-releasing hormone (CRH) and substance P (SP) in
the CSF of FMS patients, as well as increased SP, IL-6 and IL-8
in their serum. Increased numbers of activated mast cells were
also noted in skin biopsies. The hypothesis is put forward that
FMS is a neuro-immunoendocrine disorder where increased release
of CRH and SP from neurons in specific muscle sites triggers
local mast cells to release proinflammatory and neurosensitizing
molecules. There is no curative treatment although low doses of
tricyclic antidepressants and the serotonin-3 receptor
antagonist tropisetron, are helpful. Recent nutraceutical
formulations containing the natural anti-inflammatory and mast
cell inhibitory flavonoid quercetin hold promise since they can
be used together with other treatment modalities
(201)
Lund I, Lundeberg T, Carleson J, Sonnerfors H, Uhrlin B,
Svensson E. Corticotropin releasing factor in urine--a possible
biochemical marker of fibromyalgia. Responses to massage and
guided relaxation. Neurosci Lett 2006; 403(1-2):166-171.
Abstract: The purpose of this preliminary study was to evaluate
the relationship between a possible biochemical marker of
stress, 24-h urinary concentrations of Corticotropin Releasing
Factor-Like Immunoreactivity (CRF-LI), and ratings of
stress-related symptoms like depression and anxiety, as well as
to evaluate pain and emotional reactions in patients with
fibromyalgia (FM). Another purpose was to study the effects of
massage and guided relaxation, with respect to change in the
same variables. Urine sampling and ratings were performed before
treatments, after and 1 month after completed treatments.
Concentrations of CRF-LI was analysed with radioimmnoassay
technique. For the assessment of depression, anxiety and pain
the CPRS-A questionnaire was used and for rated pain and
emotional reactions the NHP questionnaire was used. The 24-h
urinary concentration of the CRF-LI was found to be related to
depression, mood and inability to take initiative. After
treatment the urinary CRF-LI concentrations and the rated levels
of pain and emotional reactions were found to have decreased. In
conclusion, the 24-h urinary CRF-LI concentration may be used as
a biochemical marker of stress-related symptoms such as
depression in patients with FM and possibly also other
conditions characterized by chronic pain. Therapies such as
massage and guided relaxation may be tried for the amelioration
of pain and stress but further studies are required
(202)
Luyten P, Van HB. Cortisol secretion and symptoms in patients
with fibromyalgia: comment on the article by McLean et al.
Arthritis Rheum 2006; 54(7):2345-2346.
(203)
Madden S, Sim J. Creating meaning in fibromyalgia syndrome. Soc
Sci Med 2006; 63(11):2962-2973.
Abstract: Gaining a diagnosis is considered to legitimate a
person's illness, to both the self and the wider social world,
while also giving hope that treatments, and possibly a cure,
will be found. A further function of diagnosis from the
patient's perspective is to give meaning to the illness
experience, which is often uncertain and confusing. To do so, a
diagnosis must itself have meaning. This paper explores the
creation of meaning in a medically unexplained disorder,
fibromyalgia syndrome (FMS). Semi-structured interviews, in
which the diagnostic process was explored, were conducted with
17 people diagnosed with FMS in the United Kingdom, selected
from a hospital database (16 women, 1 man). Documentary analysis
was also undertaken on information available from support groups
and health professionals. Although initially an acceptable
diagnosis to sufferers, FMS was viewed as a mysterious label,
which provided no meaning at the time of diagnosis. The sought
information was accessed in an attempt to resolve its
meaninglessness, but this proved problematic due to the
ambiguous definition of FMS within the medical and support group
literature, the invisible nature of the illness, and the lack of
an environment where these uncertainties could be openly
discussed. Informants varied in the degree of longer-term
acceptance of a diagnosis of FMS, in relation to the concordance
they achieved between the diagnosis and their experience of
illness
(204)
Mahaney PE, Vu AT, McComas CC, Zhang P, Nogle LM, Watts WL et
al. Synthesis and activity of a new class of dual acting
norepinephrine and serotonin reuptake inhibitors:
3-(1H-indol-1-yl)-3-arylpropan-1-amines. Bioorg Med Chem 2006;
14(24):8455-8466.
Abstract: Compounds with a combination of norepinephrine and
serotonin reuptake inhibition have been approved in the US and
Europe for a number of indications, including major depressive
disorder and pain disorders such as diabetic neuropathy and
fibromyalgia. Efforts to design selective norepinephrine
reuptake inhibitors based on SAR from the aryloxypropanamine
series of monoamine reuptake inhibitors have led to the
identification of a potent new class of dual acting
norepinephrine and serotonin reuptake inhibitors, namely the
3-(1H-indol-1-yl)-3-arylpropan-1-amines
(205)
Mannerkorpi K, Svantesson U, Broberg C. Relationships between
performance-based tests and patients' ratings of activity
limitations, self-efficacy, and pain in fibromyalgia. Arch Phys
Med Rehabil 2006; 87(2):259-264.
Abstract: OBJECTIVE: To investigate the relationship between
performance-based tests, ratings of activity limitations,
self-efficacy, and pain in fibromyalgia. DESIGN: Descriptive.
SETTING: University hospital. PARTICIPANTS: Sixty-nine women
with fibromyalgia (mean age, 45+/-7.8y). INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURES: The patients completed 4
performance-based tests focusing on muscle power function and 3
unloaded arm movements. The patients rated their activity
limitations by means of the subscales of physical function (PF)
and pain on the Fibromyalgia Impact Questionnaire (FIQ), the
Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36),
and the Arthritis Self-Efficacy Scale (ASES). Spearman
correlation coefficient (rho) and multivariate regression
analysis were conducted. RESULTS: The highest correlations were
found between the 6-minute walk test (6MWT) (rho range, -.48 to
.68) and the activity limitations and between hand grip strength
(rho range, -.34 to .57) and the activity limitations. The
regression analysis indicated that hand grip strength explained
25% of the variation in the SF-36 PF scale. The 6MWT plus
endurance of the shoulder muscles explained 24% of the variation
in the FIQ PF scale and the 6MWT plus active abduction of the
shoulder explained 48% of the variation in the ASES function
scale. Correlations between the performance-based tests and the
activity limitations tended to be higher than those between
performance and pain. CONCLUSIONS: The majority of the
performance-based tests and the patients' subjective ratings of
activity limitations showed significant relationships. The 6MWT
and hand grip strength, reflecting activity limitations in the
SF-36, FIQ, and ASES, are recommended for use in clinical
research and in the clinical examination when planning treatment
for patients with fibromyalgia
(206)
Maquet D, Croisier JL, Demoulin C, Faymonville M, Crielaard JM.
[Value of aerobic rehabilitation in the management of
fibromyalgia]. Rev Med Liege 2006; 61(2):109-116.
Abstract: This study assesses the influence of a muscular
aerobic revalidation program on the management of the
fibromyalgia syndrome. After 3 months, benefits consisting of
increased muscle performances associated with a reduction of
pain and an improvement of quality of life were documented. This
study confirms the value of aerobic muscle exercise in
fibromyalgia patients
(207) Marinus J, Van Hilten JJ.
Clinical
expression profiles of complex regional pain syndrome,
fibromyalgia and a-specific repetitive strain injury: more
common denominators than pain? Disabil Rehabil 2006;
28(6):351-362.
Abstract: PURPOSE: To systematically evaluate and compare the
clinical manifestations, disease course, risk factors and
demographic characteristics of Complex Regional Pain Syndrome
type 1 (CRPS), fibromyalgia (FM) and a-specific Repetitive
Strain Injury (RSI). METHOD: A literature search was performed
using terms related to the aforementioned topics and diseases.
Only original clinical studies that included at least 20
subjects were eligible. RESULTS: Fifty-nine studies on CRPS, 73
on FM and 7 on a-specific RSI were identified. The diseases show
similarities in age distribution, male-female ratio, pain
characteristics and sensory signs and symptoms. Motor, autonomic
and trophic changes are frequently reported in CRPS, but only
occasionally in FM and RSI. Systemic symptoms are found in
patients with CRPS and FM, and in a subgroup of patients with
RSI. In all three disorders, symptoms usually start locally, but
may spread to other body regions later, which, in the case of
FM, is a prerequisite for diagnosis. Disease onset is always,
usually, or occasionally of traumatic origin in RSI, CRPS and
FM, respectively. Anxiety and depression are more frequent in
patients compared to controls, but probably not very different
from patients with other pain conditions or chronic diseases.
CONCLUSIONS: Apart from some obvious differences between CRPS,
FM and RSI, the similarities are conspicuous. The common
features of CRPS, FM and a-specific RSI may suggest that a
common pathway is involved, but until patients with these type
of symptoms are assessed with a uniform assessment procedure, a
thorough comparison cannot be made. A systematic evaluation of
patients with a suspected diagnosis of CRPS, FM or RSI, may lead
to a better appreciation of the differences and similarities in
these diseases and help to unravel the underlying mechanisms
(208)
Martin DP, Sletten CD, Williams BA, Berger IH. Improvement in
fibromyalgia symptoms with acupuncture: results of a randomized
controlled trial. Mayo Clin Proc 2006; 81(6):749-757.
Abstract: OBJECTIVE: To test the hypothesis that acupuncture
improves symptoms of fibromyalgia. PATIENTS AND METHODS: We
conducted a prospective, partially blinded, controlled,
randomized clinical trial of patients receiving true acupuncture
compared with a control group of patients who received simulated
acupuncture. All patients met American College of Rheumatology
criteria for fibromyalgia and had tried conservative symptomatic
treatments other than acupuncture. We measured symptoms with the
Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional
Pain Inventory at baseline, immediately after treatment, and at
1 month and 7 months after treatment. The trial was conducted
from May 28, 2002, to August 18, 2003. RESULTS: Fifty patients
participated in the study: 25 in the acupuncture group and 25 in
the control group. Total fibromyalgia symptoms, as measured by
the FIQ, were significantly improved in the acupuncture group
compared with the control group during the study period (P =
.01). The largest difference in mean FIQ total scores was
observed at 1 month (42.2 vs 34.8 in the control and acupuncture
groups, respectively; P = .007). Fatigue and anxiety were the
most significantly improved symptoms during the follow-up
period. However, activity and physical function levels did not
change. Acupuncture was well tolerated, with minimal adverse
effects. CONCLUSION: This study paradigm allows for controlled
and blinded clinical trials of acupuncture. We found that
acupuncture significantly improved symptoms of fibromyalgia.
Symptomatic improvement was not restricted to pain relief and
was most significant for fatigue and anxiety
(209)
Martinez-Lavin M. Fibromyalgia is a neuropathic pain syndrome. J
Rheumatol 2006; 33(4):827-828.
(210)
Matsumoto Y. [Concept of and therapy for Fibromyalgia]. Nippon
Naika Gakkai Zasshi 2006; 95(3):510-515.
(211)
Mayhew E, Ernst E. Acupuncture for fibromyalgia--a systematic
review of randomized clinical trials. Rheumatology (Oxford)
2006; %19;.
Abstract: Objective. Acupuncture is often used and frequently
advocated for the symptomatic treatment of fibromyalgia. A
systematic review has previously demonstrated encouraging
findings. As it is now outdated, we wanted to update it.
Methods. We searched seven electronic databases for relevant
randomized clinical trials (RCTs). The data were extracted and
validated independently by both authors. As no meta-analysis
seemed possible, the results were evaluated in narrative form.
Results. Five RCTs met our inclusion criteria, all of which used
acupuncture as an adjunct to conventional treatments. Their
methodological quality was mixed and frequently low. Three RCTs
suggested positive but mostly short-lived effects and two
yielded negative results. There was no significant difference
between the quality of the negative and the positive RCTs. All
positive RCTs used electro-acupunture. Conclusion. The notion
that acupuncture is an effective symptomatic treatment for
fibromyaligia is not supported by the results from rigorous
clinical trials. On the basis of this evidence, acupuncture
cannot be recommended for fibromyalgia
(212) McIver KL, Evans C, Kraus RM, Ispas L, Sciotti VM,
Hickner RC.
NO-mediated
alterations in skeletal muscle nutritive blood flow and lactate
metabolism in fibromyalgia. Pain 2006; 120(1-2):161-169.
Abstract: The purpose of these investigations was to determine
if differences exist in skeletal muscle nutritive blood flow and
lactate metabolism in women with fibromyalgia (FM) compared to
healthy women (HC); furthermore, to determine if differences in
nitric oxide-mediated systems account for any detected
alterations in blood flow and lactate metabolism and contribute
to exertional fatigue in FM. FM (n = 8) and HC (n = 8) underwent
a cycle ergometry test of aerobic capacity, a muscle biopsy for
determination of nitric oxide synthase (eNOS, nNOS, iNOS)
content, and microdialysis for investigation of muscle nutritive
blood flow and lactate metabolism. During prolonged (3h) resting
conditions, the ethanol outflow/inflow ratio (inversely related
to blood flow) increased in FM over time compared to HC (P <
0.05). FM also exhibited a reduced nutritive blood flow response
to aerobic exercise (P < 0.05). There was an increase in
dialysate lactate in response to acetylcholine in FM, and to
sodium nitroprusside in both groups, with a greater rise in
dialysate lactate in FM (P < 0.05). The iNOS protein content was
higher in FM and was negatively correlated with total exercise
time (r(2) = 0.462, P < 0.05). In conclusion: (1) There is
reduced nutritive flow response to aerobic exercise and reduced
maximal exercise time in FM that might relate to higher iNOS
protein content and contribute to exertional fatigue in FM; (2)
The increased dialysate lactate in FM in response to stimulation
of NOS or a nitric oxide donor suggest that FM may be more
sensitive than HC to the suppressive effect of nitric oxide on
oxidative phosphorylation
(213)
McLean SA, Williams DA, Stein PK, Harris RE, Lyden AK, Whalen G
et al. Cerebrospinal fluid corticotropin-releasing factor
concentration is associated with pain but not fatigue symptoms
in patients with fibromyalgia. Neuropsychopharmacology 2006;
31(12):2776-2782.
Abstract: Previous studies have identified stress system
dysregulation in fibromyalgia (FM) patients; such dysregulation
may be involved in the generation and/or maintenance of pain and
other symptoms. Corticotropin-releasing factor (CRF) is the
principal known central nervous system mediator of the stress
response; however, to date no studies have examined
cerebrospinal fluid (CSF) CRF levels in patients with FM. The
relationship between CSF CRF level, heart rate variability
(HRV), and pain, fatigue, and depressive symptoms was examined
in patients with FM. Among participants (n=26), CSF CRF levels
were associated with sensory pain symptoms (r=0.574, p=0.003)
and affective pain symptoms (r=0.497, p=0.011), but not fatigue
symptoms. Increased HRV was also strongly associated with
increased CSF CRF and FM pain. In multivariate analyses
adjusting for age, sex, and depressive symptoms, the association
between CSF CRF and sensory pain symptoms (t=2.54, p=0.027)
persisted. Women with FM who reported a history of physical or
sexual abuse had lower CSF CRF levels than women who did not
report such a history. CSF CRF levels are associated with both
pain symptoms and variation in autonomic function in FM.
Differences in CSF CRF levels among women with and without a
self-reported history of physical or sexual abuse suggest that
subgroups of FM patients may exist with different
neurobiological characteristics. Further studies are needed to
better understand the nature of the association between CSF CRF
and pain symptoms in FM
(214)
McNally JD, Matheson DA, Bakowsky VS. The epidemiology of
self-reported fibromyalgia in Canada. Chronic Dis Can 2006;
27(1):9-16.
Abstract: Fibromyalgia (FM) is a poorly understood condition
characterized by chronic diffuse musculoskeletal pain. This
study describes the self-reported epidemiology of FM in Canada
using data collected from the Canadian Community Health Survey,
Cycle 1.1 (2000). FM prevalence rates with corresponding 95
percent confidence intervals were calculated. The Canadian
prevalence rate was 1.1 percent with a female-to-male ratio of
six to one. In women, rates increased with age up to 65 years,
declining thereafter. Data collected on-age-at- diagnosis is
presented and demonstrates a surprising number of newly
diagnosed FM cases among people in their 20s and 30s, signifying
that FM is a problem for people of all ages. The association
with FM and a number of sub-populations was also investigated.
With respect to geography and environment, the FM prevalence
rate in women was shown to be approximately two percent in all
Canadian regions except Quebec, where it was 1.1 percent.
Further analysis by language suggested that geographical and
cultural differences might best explain this observation.
Finally, an association with a number of behavioral and
socioeconomic determinants of health, including weight, is
presented
(215)
Meeus M, Nijs J. Central sensitization: a biopsychosocial
explanation for chronic widespread pain in patients with
fibromyalgia and chronic fatigue syndrome. Clin Rheumatol 2006;
.
Abstract: In addition to the debilitating fatigue, the majority
of patients with chronic fatigue syndrome (CFS) experience
chronic widespread pain. These pain complaints show the greatest
overlap between CFS and fibromyalgia (FM). Although the
literature provides evidence for central sensitization as cause
for the musculoskeletal pain in FM, in CFS this evidence is
currently lacking, despite the observed similarities in both
diseases. The knowledge concerning the physiological mechanism
of central sensitization, the pathophysiology and the pain
processing in FM, and the knowledge on the pathophysiology of
CFS lead to the hypothesis that central sensitization is also
responsible for the sustaining pain complaints in CFS. This
hypothesis is based on the hyperalgesia and allodynia reported
in CFS, on the elevated concentrations of nitric oxide presented
in the blood of CFS patients, on the typical personality styles
seen in CFS and on the brain abnormalities shown on brain
images. To examine the present hypothesis more research is
required. Further investigations could use similar protocols to
those already used in studies on pain in FM like, for example,
studies on temporal summation, spatial summation, the role of
psychosocial aspects in chronic pain, etc
(216)
Menzies V, Taylor AG, Bourguignon C. Effects of guided imagery
on outcomes of pain, functional status, and self-efficacy in
persons diagnosed with fibromyalgia. J Altern Complement Med
2006; 12(1):23-30.
Abstract: OBJECTIVES: (1) To investigate the effects of a 6-week
intervention of guided imagery on pain level, functional status,
and self-efficacy in persons with fibromyalgia (FM); and (2) to
explore the dose-response effect of imagery use on outcomes.
DESIGN: Longitudinal, prospective, two-group, randomized,
controlled clinical trial. SETTING AND SUBJECTS: The sample
included 48 persons with FM recruited from physicians' offices
and clinics in the mid-Atlantic region. INTERVENTION:
Participants randomized to Guided Imagery (GI) plus Usual Care
intervention group received a set of three audiotaped guided
imagery scripts and were instructed to use at least one tape
daily for 6 weeks and report weekly frequency of use (dosage).
Participants assigned to the Usual Care alone group submitted
weekly report forms on usual care. MEASURES: All participants
completed the Short-Form McGill Pain Questionnaire (SF-MPQ),
Arthritis Self- Efficacy Scale (ASES), and Fibromyalgia Impact
Questionnaire (FIQ), at baseline, 6, and 10 weeks, and submitted
frequency of use report forms. RESULTS: FIQ scores decreased
over time in the GI group compared to the Usual Care group (p =
0.03). Ratings of self-efficacy for managing pain (p = 0.03) and
other symptoms of FM also increased significantly over time (p =
< 0.01) in the GI group compared to the Usual Care group. Pain
as measured by the SF-MPQ did not change over time or by group.
Imagery dosage was not significant. CONCLUSIONS: This study
demonstrated the effectiveness of guided imagery in improving
functional status and sense of self-efficacy for managing pain
and other symptoms of FM. However, participants' reports of pain
did not change. Further studies investigating the effects of
mind-body interventions as adjunctive self-care modalities are
warranted in the fibromyalgia patient population
(217)
Michaud K, Wolfe F. The association of rheumatoid arthritis and
its treatment with sinus disease. J Rheumatol 2006;
33(12):2412-2415.
Abstract: OBJECTIVE: To determine if rates of sinus disease are
increased in patients with rheumatoid arthritis (RA) and whether
RA treatment alters the risk of sinus disease. METHODS: As part
of a longitudinal study of rheumatic disease outcomes, 7,243
patients with RA, 1,667 with osteoarthritis (OA), and 447 with
fibromyalgia (FM) were evaluated for important sinus problems in
2003. We defined an important sinus problem as one that required
a physician visit. RESULTS: The lifetime prevalence of sinus
disorders among all patients was 42.9%. During the previous 6
months 22.3% of patients with RA, 23.9% with OA, and 25.1% with
FM visited a physician for a sinus problem and 22.4%, 23.9%, and
25.1% , respectively, received a prescription medication for a
sinus problem. After adjustment for age and sex, the rate of
physician visits for a sinus problem was significantly lower for
patients with RA (22.1%) compared to patients with OA (24.8%).
The strongest predictor of sinus problems among all patients was
a history of allergy or asthma. Sinus problems were more common
among users of etanercept: odds ratio (OR) 1.2; 95% confidence
interval (CI): 1.0-1.4 univariably, and OR 1.2; 95% CI: 1.0-1.4
multivariably. Sulfasalazine (OR 0.7; 95% CI: 0.5-0.9) and
leflunomide (OR 0.8; 95% CI: 0.7-1.0) had a protective effect on
sinus problems. CONCLUSIONS: Sinus problems are decreased in
patients with RA compared to OA and FM. Slight protective
effects on sinus problems are noted with sulfasalazine and
leflunomide, and a slight increase in risk of sinus problems is
noted with etanercept
(218)
Michielsen HJ, Van HB, Leirs I, Vandenbroeck A, Onghena P.
Depression, attribution style and self-esteem in chronic fatigue
syndrome and fibromyalgia patients: is there a link? Clin
Rheumatol 2006; 25(2):183-188.
Abstract: The aims of the present study were to compare a single
diagnosis (chronic fatigue syndrome, CFS) and a double diagnosis
(CFS + fibromyalgia, CFS+FM) group regarding depression,
attribution style and self-esteem as well as to examine whether
attribution style is a mediator in the relationship between
self-esteem and depression. Eighty-five patients (CFS: 47,
CFS+FM: 38) completed questionnaires on attribution style,
self-esteem and depression. The single and double diagnosis
groups tended to differ slightly, but the differences were never
statistically significant. In addition, only one condition was
met of the four conditions mentioned by Baron and Kenny to
establish that mediation exists between two variables. In
conclusion, an external attribution style does not protect the
CFS or CFS+FM patients with a low self-esteem from depression.
The prevalence rate of depression was high in both patient
samples, of which clinicians should be aware
(219)
Mielenz T, Jackson E, Currey S, DeVellis R, Callahan LF.
Psychometric properties of the Centers for Disease Control and
Prevention Health-Related Quality of Life (CDC HRQOL) items in
adults with arthritis. Health Qual Life Outcomes 2006; 4:66.:66.
Abstract: BACKGROUND: Measuring health-related quality of life
(HRQOL) is important in arthritis and the SF-36v2 is the current
state-of-the-art. It is only emerging how well the Centers for
Disease Control and Prevention (CDC) HRQOL measures HRQOL for
people with arthritis. This study's purpose is to assess the
psychometric properties of the 9-item CDC HRQOL (4-item Healthy
Days Core Module and 5-item Healthy Days Symptoms Module) in an
arthritis sample using the SF-36v2 as a comparison. METHODS: In
Fall 2002, a cross-sectional study acquired survey data
including the CDC HRQOL and SF-36v2 from 2 North Carolina
populations of adult patients reporting osteoarthritis,
rheumatoid arthritis, and fibromyalgia; 2182 (52%) responded.
The first item of both the CDC HRQOL and the SF-36v2 was general
health (GEN). All 8 other CDC HRQOL items ask for the number of
days in the past 30 days that respondents experienced various
aspects of HRQOL. Exploratory principal components analyses
(PCA) were conducted on each sample and the combined samples of
the CDC HRQOL. The multitrait-multimethod matrix (MTMM) was used
to compute correlations between each trait (physical health and
mental health) and between each method of measurement (CDC HRQOL
and SF36v2). The relative contribution of the CDC HRQOL in
predicting the physical component summary (PCS) and the mental
component summary (MCS) was determined by regressing the CDC
HRQOL items on the PCS and MCS scales. RESULTS: All 9 CDC HRQOL
items loaded primarily onto 1 factor (explaining 57% of the item
variance) representing a reasonable solution for capturing
overall HRQOL. After rotation a 2 factor interpretation for the
9 items was clear, with 4 items capturing physical health
(physical, activity, pain, and energy days) and 3 items
capturing mental health (mental, depression, and anxiety days).
All of the loadings for these two factors were greater than
0.70. The CDC HRQOL physical health factor correlated with PCS
(r = -.78, p < 0.0001) and the mental health factor correlated
with MCS (r = -.71, p < 0.0001). The relative contribution of
the CDC HRQOL in predicting PCS was 73% (R2 = .73) when GEN was
included in the CDC HRQOL score and 65% (R2 = .65) when GEN was
removed. The relative contribution of the CDC HRQOL in
predicting MCS was 56% (R2 = .56) when GEN was included and
removed. CONCLUSION: The CDC HRQOL appears to have strong
psychometric properties in individuals with arthritis in both
community-based and subspecialty clinical settings. The 9 item
CDC HRQOL is a reasonable measure for overall HRQOL and the two
subscales, representing physical and mental health, are
reasonable when the goal is to examine those aspects
(220)
Mitani Y, Fukunaga M, Kanbara K, Takebayashi N, Ishino S, Nakai
Y. Evaluation of psychophysiological asymmetry in patients with
fibromyalgia syndrome. Appl Psychophysiol Biofeedback 2006;
31(3):217-225.
Abstract: Fibromyalgia syndrome (FMS) is characterized by
systemic pain of unknown etiology, and is often accompanied by
various psychological symptoms. In the present study,
differences in surface electromyographic (SEMG) levels of the
trapezius muscle, skin temperature (TEMP) and skin conductance
level (SCL) were compared between the right and left side of the
body in 31 FMS and 47 control subjects (Control Group). We
observed significant asymmetries of SEMG level, TEMP and SCL in
the FMS Group. These asymmetries might be related to central,
peripheral and autonomic nervous system dysfunctions. Marked
increase of SEMG levels, and a decrease of TEMP and SCL were
observed at the dominant side in the FMS Group, and a negative
correlation of SEMG levels with TEMP and SCL was found. These
results suggest that continued antalgic postures in response to
pain at the dominant side in FMS patients might lead to
asymmetries of SEMG level, TEMP and SCL. Thus, a focus on pain
related behaviors and muscle asymmetry might be a useful
therapeutic approach
(221)
Mizuno J, Ann Y, Kawamura G, Asahara M, Sekiyama H, Arita H et
al. [Postponed or canceled drug challenge tests and side effects
of the test drug--a report of four cases]. Masui 2006;
55(2):169-173.
Abstract: Drug challenge test (DCT) is performed to evaluate
chronic pain pharmacologically and determine its medical
treatment. One test drug is administered in one day for DCT and
characterization of the test drug. Four patients developed side
effects of the test drugs for DCT in whom other drug tests were
postponed or canceled. A 58-year-old man with multiple arthritis
of rheumatic arthritis and fibromyalgia had headache, nausea,
and vomiting all day after ketamine test. A 76-year-old man with
chronic general pain and failed back surgery syndrome had
vomiting and abdominal discomfort two hours after morphine test
and had redness and itching on his bilateral forearms the
following day. A 78-year-old man with chronic lumbar and right
lower limb pain due to L 4-5 lumbar disc herniation and
postherpetic neuralgia felt dizzy, fell down and bruised on his
lower back and left knee twelve hours after morphine test. A
32-year-old woman with chronic pelvic pain had skin eruption on
her thigh the day after phentolamine test. Although the amount
of the test drug in DCT is small and its half-life is short,
long-term side effects might occur. We should decrease the
amounts or frequencies of ketamine and morphine, and administer
them taking long intervals before other tests
(222)
Montoya P, Sitges C, Garcia-Herrera M, Rodriguez-Cotes A,
Izquierdo R, Truyols M et al. Reduced brain habituation to
somatosensory stimulation in patients with fibromyalgia.
Arthritis Rheum 2006; 54(6):1995-2003.
Abstract: OBJECTIVE: To examine brain activity elicited by
repetitive nonpainful stimulation in patients with fibromyalgia
(FM) and to determine possible psychophysiologic abnormalities
in their ability to inhibit irrelevant sensory information.
METHODS: Fifteen female patients with a diagnosis of FM (ages
30-64 years) and 15 healthy women (ages 39-61 years)
participated in 2 sessions, during which electrical activity
elicited in the brain by presentation of either tactile or
auditory paired stimuli was recorded using an
electroencephalogram. Each trial consisted of 2 identical
stimuli (S1 and S2) delivered with a randomized interstimulus
interval of 550 msec (+/-50 msec), which was separated by a
fixed intertrain interval of 12 seconds. Event-related
potentials (ERPs) elicited by 40 trials were averaged separately
for each sensory modality. RESULTS: ERP amplitudes elicited by
the somatosensory and auditory S2 stimuli were significantly
reduced compared with those elicited by S1 stimuli in the
healthy controls. Nevertheless, significant amplitude reductions
from S1 stimuli to S2 stimuli were observed in FM patients for
the auditory, but not the somatosensory, modality. CONCLUSION:
Our findings suggest that in FM patients, there is abnormal
information processing, which may be characterized by a lack of
inhibitory control to repetitive nonpainful somatosensory
information during stimulus coding and cognitive evaluation
(223)
Muller W, Fiebich BL, Stratz T. [5-HT3 receptor antagonists als
analgetics in rheumatic diseases.]. Z Rheumatol 2006; %20;.
Abstract: Various rheumatic diseases like fibromyalgia, systemic
inflammatory rheumatic disorders and localized diseases, such as
arthritides and activated arthroses, tendinopathies and
periarthropathies, as well as trigger points can be improved
considerably by treatment with the 5-HT3 receptor antagonist
tropisetron. Particularly in the latter group of diseases, local
injections have done surprisingly rapid analgesic action. This
effect matches that of local anesthetics, but lasts considerably
longer and is comparable to local injections of local
anesthetics combined with corticosteroids. The action of the
5-HT3 receptor antagonists can be attributed to an
antinociceptive effect that occurs at the same time as an
antiphlogistic and probably also an immunosuppressive effect.
Whereas an inhibited release of substance P from the
nociceptors, and possibly some other neurokins as well, seems to
be the most likely explanation for the antinociceptive action,
the antiphlogistic effect is primarily due to an inhibited
formation of various different phlogistic substances; in some
conditions, like systemic inflammatory rheumatic diseases, for
example, the 5-HT3 receptor antagonists may exert an
immunosuppressive effect in addition to this
(224)
Muller W, Fiebich BL, Stratz T. New treatment options using
5-HT3 receptor antagonists in rheumatic diseases. Curr Top Med
Chem 2006; 6(18):2035-2042.
Abstract: In vitro studies have shown that a blockade of 5-HT3
receptors brings about a reduction of tumor necrosis factor,
IL-1 beta, IL-2, IL-6 as well as a decrease in prostaglandins.
Clinical trials have provided evidence of pain reduction in a
subgroup of fibromyalgia syndrome and, moreover, have
demonstrated that tropisetron injected locally for insertion
tendinoses and myofascial syndromes with associated trigger
points leads to an alleviation of pain that is comparable to
injections with the combination of corticosteroids and local
anesthetics. The effects achieved by intra-articular injections
in cases of osteoarthritis and rheumatoid arthritis paralleled
those exerted by intraarticular injection of corticosteroids. In
addition, the positive effects produced by systemically
administered tropisetron on scleroderma need to be considered
since they suggest that this therapeutic principle can also be
applied systemically in immunologic processes
(225)
Munce SE, Weller I, Robertson Blackmore EK, Heinmaa M, Katz J,
Stewart DE. The role of work stress as a moderating variable in
the chronic pain and depression association. J Psychosom Res
2006; 61(5):653-660.
Abstract: OBJECTIVE: This article aims to examine the role of
work stress as a moderating variable in the chronic
pain-depression association, as well as sex differences in this
link. METHODS: The analyses were carried out using the Canadian
Community Health Survey Cycle 1.1. Key variables were chronic
pain conditions (fibromyalgia, arthritis/rheumatism, back
problems, and migraine headaches), work stress, and depression.
The total sample comprises 78,593 working individuals. RESULTS:
In this working sample, 7.6% met criteria for major depression,
but the prevalence increased to 12% in those also reporting
chronic pain. Both depression and comorbid chronic pain and
depression were twice as prevalent in women as in men. Having a
chronic pain condition and overall work stress emerged as the
strongest predictors of depression. Unexpectedly, however, none
of the work stress domains moderated the chronic pain and
depression association. CONCLUSION: The impact of work stress
should be considered in the etiology and management of major
depression
(226)
Naschitz JE, Mussafia-Priselac R, Kovalev Y, Zaigraykin N,
Slobodin G, Elias N et al. Patterns of hypocapnia on tilt in
patients with fibromyalgia, chronic fatigue syndrome,
nonspecific dizziness, and neurally mediated syncope. Am J Med
Sci 2006; 331(6):295-303.
Abstract: OBJECTIVES: To assess whether head-up tilt-induced
hyperventilation is seen more often in patients with chronic
fatigue syndrome (CFS), fibromyalgia, dizziness, or neurally
mediated syncope (NMS) as compared to healthy subjects or those
with familial Mediterranean fever (FMF). PATIENTS AND METHODS: A
total of 585 patients were assessed with a 10-minute supine,
30-minute head-up tilt test combined with capnography.
Experimental groups included CFS (n = 90), non-CFS fatigue (n =
50), fibromyalgia (n = 70), nonspecific dizziness (n = 75), and
NMS (n =160); control groups were FMF (n = 90) and healthy (n =
50). Hypocapnia, the objective measure of hyperventilation, was
diagnosed when end-tidal pressure of CO2 (PETCO2) less than 30
mm Hg was recorded consecutively for 10 minutes or longer. When
tilting was discontinued because of syncope, one PETCO2
measurement of 25 or less was accepted as hyperventilation.
RESULTS: Hypocapnia was diagnosed on tilt test in 9% to 27% of
patients with fibromyalgia, CFS, dizziness, and NMS versus 0% to
2% of control subjects. Three patterns of hypocapnia were
recognized: supine hypocapnia (n = 14), sustained hypocapnia on
tilt (n = 76), and mixed hypotensive-hypocapnic events (n = 80).
Hypocapnia associated with postural tachycardia syndrome (POTS)
occurred in 8 of 41 patients. CONCLUSIONS: Hyperventilation
appears to be the major abnormal response to postural challenge
in sustained hypocapnia but possibly merely an epiphenomenon in
hypotensive-hypocapnic events. Our study does not support an
essential role for hypocapnia in NMS or in postural symptoms
associated with POTS. Because unrecognized hypocapnia is common
in CFS, fibromyalgia, and nonspecific dizziness, capnography
should be a part of the evaluation of patients with such
conditions
(227)
Nelson PJ, Tucker S. Developing an intervention to alter
catastrophizing in persons with fibromyalgia. Orthop Nurs 2006;
25(3):205-214.
Abstract: PURPOSE: The purpose of this pilot study was to
develop and evaluate a brief psychoeducational intervention to
decrease pain catastrophizing, a focus on pain and its negative
consequences in patients with fibromyalgia. DESIGN: A case-study
design was used to design the targeted intervention. The
intervention was piloted with 2 small groups of patients and
family members. SAMPLE: Thirty-nine patients with fibromyalgia
completed the surveys; patients/family members (N = 9) and ten
interdisciplinary staff members participated in separate focus
groups or e-mail surveys to provide data to develop the
intervention. Two additional groups of patients and family
members (N = 7) participated in the pilot intervention sessions.
FINDINGS: Catastrophic thinking and associated declines in
function were confirmed by survey results and focus group
themes. A 2-hour session using self-efficacy theory was
developed from these findings and other data sources. The
patients/family members in pilot groups reported an increased
knowledge of pain catastrophizing and satisfaction with the
intervention. IMPLICATIONS FOR NURSING PRACTICE: A brief,
psychoeducational offering that targets the reduction of
catastrophizing is a feasible addition to the usual treatment
protocol in a fibromyalgia treatment program and warrants
further study
(228)
Nilsen KB, Westgaard RH, Stovner LJ, Helde G, Ro M, Sand TH.
Pain induced by low-grade stress in patients with fibromyalgia
and chronic shoulder/neck pain, relation to surface
electromyography. Eur J Pain 2006; 10(7):615-627.
Abstract: The mechanisms of pain causation in fibromyalgia (FMS)
and chronic shoulder/neck pain (SNP) are still debated. We
wanted to compare muscle activity and pain development during
and after low-grade mental stress in FMS and SNP patients.
Twenty-three women with FMS, 29 women with chronic SNP and 35
healthy women performed a stressful task lasting 60 min followed
by a 30 min recovery period. We recorded surface
electromyography over the trapezius, neck, temporalis and
frontalis muscles. Subjects reported their pain at the
corresponding locations together with the development of fatigue
and perceived tension. Significant differences between FMS and
SNP groups were not observed either for muscular or subjective
responses. SNP patients and controls responded with more pain in
the trapezius and neck regions than in the forehead, in contrast
to FMS patients who had a more generalized pain response.
Development of pain, tension and fatigue was not related to
muscle activity for any group. We conclude that FMS and SNP
patients have similar pain and electromyographic responses. The
results suggest that similar pathophysiological mechanisms are
involved although the responses are more generalised in FMS than
in SNP patients. Muscular activity did not explain the pain
which developed during the stressful task for either group. Pain
lasted longer during recovery in both FMS and SNP patients
compared to healthy controls, possibly a result of
disease-related sensitisation in pain pathways
(229)
Nishishinya MB, Rivera J, Alegre C, Pereda CA. [Non
pharmacologic and alternative treatments in fibromyalgia]. Med
Clin (Barc ) 2006; 127(8):295-299.
(230)
O'neill S, Manniche C, Graven-Nielsen T, rendt-Nielsen L.
Generalized deep-tissue hyperalgesia in patients with chronic
low-back pain. Eur J Pain 2006; .
Abstract: Some chronic painful conditions including e.g.
fibromyalgia, whiplash associated disorders, endometriosis, and
irritable bowel syndrome are associated with generalized
musculoskeletal hyperalgesia. The aim of the present study was
to determine whether generalized deep-tissue hyperalgesia could
be demonstrated in a group of patients with chronic low-back
pain with intervertebral disc herniation. Twelve patients with
MRI confirmed lumbar intervertebral disc herniation and 12 age
and sex matched controls were included. Subjects were exposed to
quantitative nociceptive stimuli to the infraspinatus and
anterior tibialis muscles. Mechanical pressure (thresholds and
supra-threshold) and injection of hypertonic saline (pain
intensity, duration, distribution) were used. Pain intensity to
experimental stimuli was assessed on a visual analogue scale
(VAS). Patients demonstrated significantly higher pain intensity
(VAS), duration, and larger areas of pain referral following
saline injection in both infraspinatus and tibialis anterior.
The patients rated significantly higher pain intensity to
supra-threshold mechanical pressure stimulation in both muscles.
In patients, the pressure pain-threshold was lower in the
anterior tibialis muscle compared to controls. In conclusion,
generalized deep-tissue hyperalgesia was demonstrated in chronic
low-back pain patients with radiating pain and MRI confirmed
intervertebral disc herniation, suggesting that this central
sensitization should also be addressed in the pain management
regimes
(231)
Ofluoglu D, Gunduz OH, Kul-Panza E, Guven Z. Hypermobility in
women with fibromyalgia syndrome. Clin Rheumatol 2006;
25(3):291-293.
Abstract: The purpose of this study was to evaluate the
relationship between hypermobility and fibromyalgia syndrome
(FS) in women. Ninety-three women with FS who met the American
College of Rheumatology criteria for FS and 58 healthy women
without FS were included in this study. All women were examined
for hypermobility by blinded observers using the Beighton
criteria. The mean age was 43.5+/-9.9 (21-68) and 40.2+/-11.1
(21-63) years in the FS and control groups, respectively, and
the two groups were statistically similar (p>0.05). The mean
Beighton total score was 4.7+/-2.1 and 2.9+/-2.4 in the FS and
control groups, respectively (p<0.0001). The frequency of joint
hypermobility was 64.2% in the FS group and 22% in the control
group. In accordance with the Beighton criteria (p<0.05), we
found that the joint hypermobility ratio was significantly
higher in patients with FS than in subjects without FS.
Additionally, we evaluated the correlation between the total
Beighton score and the age and number of trigger points. There
were negative correlations between the total Beighton score and
the age (r=-0.42, p<0.001) and number of trigger points
(r=-0.24, p=0.03) in all patients. Hypermobility syndrome is
more common in women with FS than in those in the control group.
Therefore, the relationship between hypermobility and FS should
be taken into consideration in the diagnosis and follow-up of
women, especially those with widespread pain
(232)
Okifuji A, Turk DC. Sex hormones and pain in regularly
menstruating women with fibromyalgia syndrome. J Pain 2006;
7(11):851-859.
Abstract: Fibromyalgia syndrome (FMS) is more prevalent in women
than in men. The skewed sex distribution in the prevalence has
prompted questions of if and how sex hormones may be involved in
the pathophysiology of FMS. In this study, we evaluated the
levels of sex hormones and pain sensitivity at different phases
of a menstrual cycle in regularly menstruating women with FMS
relative to age-matched healthy women. Participants (n = 74 in
each group) underwent a 9-day urine test to identify the date of
ovulation. Three laboratory visits were scheduled to ascertain
the varying levels of estrogen (E) and progesterone (P):
Late-follicular phase (high E, low P); mid-luteal phase (high E,
high P); and perimenstrual phase (low E, low P). At each visit,
blood was drawn and ischemic pain testing was performed. The
groups did not differ in the fluctuation of luteal hormone,
follicular-stimulating hormone, E, and testosterone across a
menstrual cycle. FMS patients showed slightly elevated P levels
during the mid-luteal phase relative to healthy women but levels
were within the normal range. Women with FMS showed consistently
lower pain thresholds and tolerance relative to healthy women
throughout the menstrual cycle. Pain threshold at the late
follicular phase was modestly related to the P level. The
results suggest that the disproportionate prevalence of females
with FMS is not likely to be attributable to hormonal factors.
Furthermore, the role of sex hormones in pain sensitivity for
both FMS and healthy women seems to be limited. PERSPECTIVE:
Normally menstruating women with FMS and healthy women do not
seem to show fluctuating threshold and tolerance to the ischemic
pain test. The role of sex hormones in the hyperalgesia of FMS
appears limited
(233)
Okumus M, Gokoglu F, Kocaoglu S, Ceceli E, Yorgancioglu ZR.
Muscle performance in patients with fibromyalgia. Singapore Med
J 2006; 47(9):752-756.
Abstract: INTRODUCTION: Fibromyalgia (FMS) is a syndrome
expressed by chronic widespread body pain which leads to reduced
physical function and frequent use of healthcare services. This
study was performed to examine the muscle performance comprising
abdominal and lumbar muscle strength, and measurement of chest
expansion in osteoporotic patients with FMS; to evaluate the
relation between muscle performance, pain severity, clinical
findings and physical activity; and to compare the results with
the osteoporotic control group. METHODS: 44 osteoporotic women
with FMS and 46 osteoporotic women who were physically inactive
underwent measurements of three parameters: abdominal and lumbar
muscle strength, and chest expansion. Student's t-test was used
for statistical analysis. RESULTS: The strength of lumbar
muscles and measurement of chest expansion were significantly
decreased in the FMS patients as compared to the controls
(p-value is less than 0.001). However, lumbar and abdominal
muscles strength was low in both patients and controls.
CONCLUSION: Our results indicate that osteoporotic patients with
FMS have impairment in strength of lumbar and abdominal muscles
and in measurement of chest expansion. Further studies are
needed to investigate the mechanism of reduced muscle
performance and the effects of aerobic exercise in this patient
group
(234)
Omura Y. Asbestos as a possible major cause of malignant lung
tumors (including small cell carcinoma, adenocarcinoma &
mesothelioma), brain tumors (i.e. astrocytoma & glioblastoma
multiforme), many other malignant tumors, intractable pain
including fibromyalgia, & some cardio-vascular pathology: safe &
effective methods of reducing asbestos from normal &
pathological areas. Acupunct Electrother Res 2006;
31(1-2):61-125.
Abstract: High incidences of Small Cell Carcinoma &
Adenocarcinoma of the lung, Astrocytoma & Glioblastoma
Multiforme of the brain and Mesothelioma of the lung were found
in those who had a high accumulation of Asbestos in the eyes and
upper respiratory system (nose, larynx, trachea, etc.). When
measured non-invasively using the Bi-Digital O-Ring Test
(BDORT), brain tumors had the highest concentration of Asbestos
(0.2 approximately 2.1 mg BDORT units). Relatively high levels
of Asbestos (0.2 approximately 0.6 mg BDORT units) were found
in: Squamous Cell Carcinoma of the lungs & esophagus,
Adenocarcinoma of the larynx & breast, myelogenic leukemia,
arteries of these cancers, left ventricle of failing heart,
myocardial infarction, some of the narrowed arteries, varicose
veins, cataracts, balding heads, hot flashes, Alzheimer's
Disease and Autism. A small, round or ellipsoidal area, with
diameter of 5 mm or less, was found near the center of every
cancer tissue with a higher level of Asbestos (1 approximately 3
mg), As, Zn, Cr and Se, than in the rest of the tumor; this
small area may be where the cancer initiated. Among areas of
intractable pain with frequent recurrence and gradual worsening,
about 0.2 approximately 0.5 mg BDORT units (or higher) of
Asbestos were found. The author found that in the Astrocytoma
and many other cancer patients, the optimal dose of DHEA
produced very significant reductions of cancer cell telomere
from over 1400 ng in the brain tumors (and over 900 ng in other
cancers) to close to or less than 1 yg (=10(-24) g), with
circulatory improvement by reduction of TXB2. Unlike the
standard, widely used treatment with DHEA 25 approximately 50 mg
daily, which is an overdose; we only gave one optimal dose (1.5
approximately 12.5 mg) and the beneficial effects usually lasted
anywhere between 3-6 months, unless inhibiting factors were
introduced. In addition, once one optimal dose of DHEA was
given, the amount of Asbestos from these tumors decreased very
significantly (30 approximately 99% reduction) with marked
increase in urine Asbestos. One optimal dose of special Cilantro
tablet reduced more Asbestos than DHEA or (+) Qi Gong Energy
Stored Paper. In addition, the application of (+) Solar Energy
Stored Paper often reduces 70 approximately 99% of the Asbestos,
while (+) Qi Gong Energy Stored Paper reduces 50 approximately
99% of the Asbestos
(235)
Osorio CD, Gallinaro AL, Lorenzi-Filho G, Lage LV. Sleep quality
in patients with fibromyalgia using the Pittsburgh Sleep Quality
Index. J Rheumatol 2006; 33(9):1863-1865.
Abstract: OBJECTIVE: To characterize and quantify the sleep
complaints of patients with fibromyalgia (FM) using the
Pittsburgh Sleep Quality Index (PSQI). METHODS: The PSQI was
applied to 30 patients with FM according to American College of
Rheumatology classification criteria and to 30 healthy controls
in individual sessions under similar conditions. RESULTS: The
median global PSQI scores were [median (25-75%)] 12.0 (10-16)
and 3.0 (2.0-5.0) in patients with FM and controls, respectively
(p < 0.001). All PSQI component scores except sleep medications
were significantly higher in patients than controls. Sleep
latency, sleep disturbances, and daytime dysfunction were the
most frequent sleep difficulties experienced by patients with
FM. CONCLUSION: Our results indicate that the PSQI is a useful
instrument for characterizing and quantifying sleep disturbances
in patients with FM
(236)
Ouyang A, Wrzos HF. Contribution of Gender to Pathophysiology
and Clinical Presentation of IBS: Should Management Be Different
in Women? Am J Gastroenterol 2006; 101 Suppl
3:S602-9.:S602-S609.
Abstract: The irritable bowel syndrome (IBS) is found more
commonly in women than men. It is more prevalent in patients
with chronic fatigue syndrome, fibromyalgia, and chronic pelvic
pain, all syndromes characterized by pain and found
predominantly in women. This article reviews evidence for a role
of biological sex factors and gender on the pathways mediating
visceral pain. The effect of gonadal hormones on
gastrointestinal motility and the sensory afferent pathway and
central processing of visceral stimuli and the contribution of
gender role to the clinical presentation are discussed. Although
differences in responses to treatment modalities between genders
exist, the approach to IBS patients in both genders is quite
similar. Nevertheless, a special attention to gender role and
stress-related factors should be addressed. New developments in
research, outlined in the paper, might bring more
gender-specific treatments in the future
(237)
Ozerbil O, Okudan N, Gokbel H, Levendoglu F. Comparison of the
effects of two antidepressants on exercise performance of the
female patients with fibromyalgia. Clin Rheumatol 2006;
25(4):495-497.
Abstract: OBJECTIVE: To compare the effects of two
antidepressants on exercise performance of the female patients
with fibromyalgia. METHODS: Fifteen patients with fibromyalgia
participated in this randomized, double-blind crossover study
composed of two trials separated by a 2-week washout phase. The
pharmacy randomly assigned patients to two groups: (a) placebo
(glucose) in the morning and 25 mg amitriptyline at bedtime or
(b) 20 mg fluoxetine in the morning and placebo at bedtime. The
VO(2max) and Wingate anaerobic test were evaluated. Within 24 h
after 15-day medication, the tests were repeated. RESULTS: Peak
power and fatigue index increased, and VO(2max) and VT did not
change with both fluoxetine and amitriptyline. Mean power
significantly increased after fluoxetine but not after
amitriptyline. CONCLUSION: Both amitriptyline administration and
fluoxetine administration in patients with fibromyalgia have
beneficial effects on anaerobic performance. These effects may
be important in life quality of the female patients with
fibromyalgia
(238)
Ozgocmen S, Ozyurt H, Sogut S, Akyol O. Current concepts in the
pathophysiology of fibromyalgia: the potential role of oxidative
stress and nitric oxide. Rheumatol Int 2006; 26(7):585-597.
Abstract: Fibromyalgia (FM) is a common chronic pain syndrome
with an unknown etiology. Recent years added new information to
our understanding of FM pathophysiology. Researches on genetics,
biogenic amines, neurotransmitters,
hypothalamic-pituitary-adrenal axis hormones, oxidative stress,
and mechanisms of pain modulation, central sensitization, and
autonomic functions in FM revealed various abnormalities
indicating that multiple factors and mechanisms are involved in
the pathogenesis of FM. Oxidative stress and nitric oxide may
play an important role in FM pathophysiology, however it is
still not clear whether oxidative stress abnormalities
documented in FM are the cause or the effect. This should
encourage further researches evaluating the potential role of
oxidative stress and nitric oxide in the pathophysiology of FM
and the efficacy of antioxidant treatments (omega-3 and -6 fatty
acids, vitamins and others) in double blind and placebo
controlled trials. These future researches will enhance our
understanding of the complex pathophysiology of this disorder
(239)
Ozgocmen S, Ozyurt H, Sogut S, Akyol O, Ardicoglu O, Yildizhan
H. Antioxidant status, lipid peroxidation and nitric oxide in
fibromyalgia: etiologic and therapeutic concerns. Rheumatol Int
2006; 26(7):598-603.
Abstract: We proposed to assess the oxidant/antioxidant status,
lipid peroxidation and nitric oxide (NO) in untreated
fibromyalgia (FM) patients and controls. The effect of
amitriptyline (A, 20 mg daily) and sertraline (S, 100 mg daily)
treatment on patients' superoxide dismutase (SOD), xanthine
oxidase (XO), adenosine deaminase (ADA) enzyme activities,
thiobarbituric acid reactive substances (TBARS) and NO levels
was investigated. Thirty female patients with primary FM and
age-matched 16 healthy female controls were included. Patients
received an 8-week course of treatment with either A or S. FM
patients had higher serum levels of TBARS (particularly
malondialdehyde) and lower levels of nitrite compared to
controls whereas enzyme activities were similar. A and S
significantly improved Fibromyalgia Impact Questionnaire (FIQ)
pain scores, Hamilton anxiety and depression rating scales. But
neither A nor S had significant effects on measured oxidative
stress parameters, except SOD activity that was significantly
reduced after S treatment. Total myalgic scores negatively
correlated with XO activity, and depression scales negatively
correlated with levels of TBARS. Our results indicate that
patients with FM are under oxidative stress. These findings
represent a rationale for further research assessing the effect
of free radical scavengers or antioxidant agents like vitamins
and omega-3 fatty acids on peripheral and central mechanisms in
FM
(240)
Ozgocmen S, Yoldas T, Yigiter R, Kaya A, Ardicoglu O. R-R
interval variation and sympathetic skin response in
fibromyalgia. Arch Med Res 2006; 37(5):630-634.
Abstract: BACKGROUND: This study proposed to assess the
autonomic nervous system (ANS) functions in fibromyalgia (FM) by
using two electrophysiological tests, sympathetic skin response
(SSR) and the heart rate variability named R-R interval
variation (RRIV). METHODS: Sympathetic skin response and RRIV
were studied in 29 female patients with FM and 22 healthy
age-matched female controls. R-R interval variation at rest
(R%), during deep breathing (D%), the difference between D% and
R% (D-R) and the ratio of D-R% (D/R) were determined. Pain
threshold was measured using a mechanical algometer. RESULTS:
R-R interval variation at rest (R%) and D/R did not show
significant difference between patients and controls, whereas D%
and D-R were significantly lower in patients compared to
controls. SSR latencies of patients' hands and feet had no
significant difference compared to controls' hand and feet SSR
latencies. SSR latencies of patients' hands correlated
significantly with control point score, total myalgic score,
Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression
Rating Scale. Sympathetic skin response latencies of patients'
feet correlated only with HARS. CONCLUSIONS: Analysis of heart
rate variability may be useful and complementary to clinical
examination in patients with symptoms of dysfunction in
cardiovascular reflex pathways
(241)
Ozgocmen S. New strategies in evaluation of therapeutic efficacy
in fibromyalgia syndrome. Curr Pharm Des 2006; 12(1):67-71.
Abstract: Fibromyalgia (FM) is continuing to be a challenging
and confusing disorder for researchers and clinicians with its
diverse symptoms, poorly understood etiology and
pathophysiology. The use of multiple outcome variables
reflecting the complexity of FM and co-morbid syndromes, makes
it difficult to evaluate the efficacy or effectiveness of the
treatment in clinical trials. Additionally researchers
inevitably rely on patients' self-reported outcome data, which
is prone to error and bias. In this paper, new researches in the
field of FM and practical issues on methodology of pain
assessment (visual analogue scales, paper or electronic diaries
and compliance), core outcome domains in chronic pain assessment
(IMMPACT recommendations), and advances in neuroimaging
techniques like functional magnetic resonance imaging have been
reviewed. Consequently, clinicians and researchers have various
highly validated and adequate outcome domains to assess FM
symptoms and new researches continue to add new valuable
domains. Nevertheless the current problem is to conclude, which
treatment works best for whom and which are the outcome domains
suitable for FM patients or patients' subgroups with different
prominent features. Standardised and appropriate core outcome
domains for FM clinical trails will encourage more complete
investigations, relevant outcome reporting and well-designed
multicenter trials
(242)
Pace F, Zuin G, Di GS, Molteni P, Casini V, Fontana M et al.
Family history of irritable bowel syndrome is the major
determinant of persistent abdominal complaints in young adults
with a history of pediatric recurrent abdominal pain. World J
Gastroenterol 2006; 12(24):3874-3877.
Abstract: AIM: To assess the late outcome of teen-agers with a
previous history of recurrent abdominal pain (RAP) or irritable
bowel syndrome (IBS). METHODS: A group of 67 children with RAP
referred to the department from January 1986 to December 1995
was followed up between 5 and 13 years after the initial
diagnosis by means of a structured telephone interview. We
hypothesized that those patients with persistent adult IBS-like
symptoms would be significantly more likely to report a family
history of IBS in comparison with adults with no persistent
abdominal complaint. RESULTS: Out of the 52 trackable subjects,
15 were found to present IBS-like symptoms at follow-up (29%)
whereas the majority (37 subjects) did not. Subjects with
IBS-like symptoms were almost three times more likely to present
at least one sibling with similar symptoms compared to subjects
not complaining (40.0% vs 16.0%), respectively (P < 0.05 at
Student t test). Subjects with IBS-like symptoms also reported a
higher prevalence of extra-intestinal symptoms, such as back
pain, fibromyalgia, headache, fatigue and sleep disturbances.
CONCLUSION: The study confirms previous observations indicating
that pediatric RAP can predict later development of IBS. The
latter appears to be greatly influenced by intrafamilial
aggregation of symptoms, possibly through the learning of a
specific illness behavior
(243)
Page K, Pagidas K, Derosa MC, Quddus MR. Eosinophilic
perifolliculitis presenting as a painful cystic ovarian mass in
a woman with fibromyalgia: a case report. J Reprod Med 2006;
51(2):141-144.
Abstract: BACKGROUND: Autoimmune oophoritis is characterized by
an ovarian lymphocytic infiltrate and is a rare finding in women
with premature ovarian failure. Eosinophilic perifolliculitis is
a possible variant of autoimmune oophoritis, of which the
pathogenesis and natural history are largely unknown. CASE: A
45-year-old woman, gravida 2, para 2, status post total
abdominal hysterectomy, presented to her internist complaining
of cyclic, throbbing, right lower quadrant pain. Her past
medical history was significant forfibromyalgia. Pelvic
ultrasound demonstrated a 2.3-cm, physiologic-appearing right
ovarian cyst. Follow-up ultrasound showed a 2.2-cm, complex cyst
on the right ovary that increased in size to 4.2 x 3.2 x 3.5 cm
on repeat ultrasound 12 weeks later. Exploratory laparotomy and
bilateral salpingo-oophorectomy were performed. Pathologic
evaluation of the ovaries revealed a 3 x 2 cm regressing corpus
luteal cyst with numerous eosinophils, lymphocytes, macrophages
and plasma cells, infiltrating the cyst zoall. Serum antiovarian
antibodies were positive. CONCLUSION: The patient's pathologic
findings are consistent with the rare entity of eosinophilic
perifolliculitis. The patient's history offibromyalgia is of
particular interest given that both of these diseases may have
an autoimmune etiology. Eosinophilic perifolliculitis should be
considered in the differential diagnosis of premenopausal and
perimenopausal women with pelvic pain and persistent cystic
ovarian enlargement
(244)
Pamuk ON, Yesil Y, Cakir N. Factors that affect the number of
tender points in fibromyalgia and chronic widespread pain
patients who did not meet the ACR 1990 criteria for
fibromyalgia: are tender points a reflection of neuropathic
pain? Semin Arthritis Rheum 2006; 36(2):130-134.
Abstract: OBJECTIVE: This study aims to compare fibromyalgia
(FM) and chronic widespread pain (CWP) patients who do not
fulfill the criteria for tender points (TP). METHODS: We
included 150 patients diagnosed with FM according to ACR 1990
criteria and 42 patients with CWP who did not fulfill TP
criteria for FM into the study. The clinical features of the
patients were recorded, and the TP count was determined. By
means of a visual analog scale (VAS), all patients were
questioned about the severity of pain and FM-related symptoms.
In addition, the patients were administered the Duke Anxiety
Depression (Duke-AD) scale and somatization symptom
questionnaire. Leeds Assessment of Neuropathic Symptoms and
Signs (LANSS) pain scale was used to determine the neuropathic
pain score. RESULTS: According to VAS, the severity of pain,
sleep disturbance, the number of somatization symptoms, LANSS,
and Duke-AD scores were significantly higher in FM patients than
in patients with CWP (all P values <0.05). The number of TP
correlated with severity of pain (r = 0.32, P < 0.001), the
number of somatization symptoms (r = 0.26, P = 0.01), sleep
disturbance (r = 0.18, P = 0.01), and LANSS score (r = 0.4, P <
0.001). Multiple logistic regression analysis revealed that
independent factors that affected the presence of > or =11 TP
were the severity of pain on VAS (OR: 1.03, 95% CI: 1.01-1.06, P
= 0.045) and LANSS score (OR: 1.36, 95% CI: 1.12-1.62, P =
0.001). CONCLUSIONS: CWP patients have symptoms similar to FM
patients, though less severe. The most important factor that
affects the criteria for fulfilling the number TP in CWP
patients is the neuropathic pain score, which suggests that FM
is primarily a neuropathic pain syndrome
(245)
Panton LB, Kingsley JD, Toole T, Cress ME, Abboud G,
Sirithienthad P et al. A comparison of physical functional
performance and strength in women with fibromyalgia, age- and
weight-matched controls, and older women who are healthy. Phys
Ther 2006; 86(11):1479-1488.
Abstract: BACKGROUND AND PURPOSE: The purpose of this study was
to compare functionality and strength among women with
fibromyalgia (FM), women without FM, and older women. SUBJECTS:
Twenty-nine women with FM (age [X+/-SD]=46+/-7 years), 12 age-
and weight-matched women without FM (age=44+/-8 years), and 38
older women who were healthy (age=71+/-7 years) participated.
METHODS: The Continuous Scale-Physical Functional Performance
Test (CS-PFP) was used to assess functionality. Isokinetic leg
strength was measured at 60 degrees/s, and handgrip strength was
measured using a handgrip dynamometer. RESULTS: The women
without FM had significantly higher functionality scores
compared with women with FM and older women. There were no
differences in functionality between women with FM and older
women. Strength measures for the leg were higher in women
without FM compared with women with FM and older women, and both
women with and without FM had higher grip strengths compared
with older women. DISCUSSION AND CONCLUSION: This study
demonstrated that women with FM and older women who are healthy
have similar lower-body strength and functionality, potentially
enhancing the risk for premature age-associated disability
(246)
Pardi D, Black J. gamma-Hydroxybutyrate/sodium oxybate:
neurobiology, and impact on sleep and wakefulness. CNS Drugs
2006; 20(12):993-1018.
Abstract: gamma-Hydroxybutyrate (GHB) is an endogenous short
chain fatty acid and a, mostly oral, pharmacological compound
that has been utilised in a variety of ways. Endogenously, GHB
is synthesised locally within the CNS, mostly from its parent
compound GABA. Sodium oxybate is the sodium salt of GHB and is
used for the exogenous oral administration of GHB. It is likely
that supraphysiological concentrations of GHB from exogenous
administration produce qualitatively different neuronal actions
than those produced by endogenous GHB concentrations.Evidence
suggests a role for GHB as a neuromodulator/neurotransmitter.
Under endogenous conditions and concentrations, and depending on
the cell group affected, GHB may increase or decrease neuronal
activity by inhibiting the release of neurotransmitters that are
co-localised with GHB. After exogenous administration, most of
the observed behavioural effects appear to be mediated via the
activity of GHB at GABA(B) receptors, as long as the
concentration is sufficient to elicit binding, which does not
happen at endogenous concentrations. Endogenous and exogenous
GHB is rapidly and completely converted into CO(2) and H(2)O
through the tricarboxylic acid cycle (Krebs cycle). Sodium
oxybate has been observed to modulate sleep in nonclinical study
participants, and sleep and wakefulness in clinical populations,
including groups with insomnia, fibromyalgia and narcolepsy. In
narcolepsy, sodium oxybate has shown dose-related effects on
various properties of sleep, including increases in slow-wave
sleep duration and delta power, and a reduced number of
night-time awakenings. Furthermore, multiple measures of daytime
sleepiness and cataplexy demonstrated consistent short- and
long-term improvement in response to night-time sodium oxybate
therapy. The most common reported adverse events include
dose-related headache, nausea, dizziness and somnolence
(247)
Patten SB, Williams JV, Wang J. Mental disorders in a population
sample with musculoskeletal disorders. BMC Musculoskelet Disord
2006; 7:37.:37.
Abstract: BACKGROUND: Studies using clinical and volunteer
samples have reported an elevated prevalence of mood disorders
in association with rheumatoid arthritis and osteoarthritis.
Clinical studies using anxiety rating scales have reported
inconsistent results, but studies using diagnostic instruments
have reported that anxiety disorders may be even more strongly
associated with arthritis than is depression. One study reported
an association between lifetime substance use disorders and
arthritis. METHODS: Data from iteration 1.2 of the Canadian
Community Health Survey (CCHS) were used. This was a large-scale
national Canadian health survey which administered the World
Mental Health Composite International Diagnostic Interview to a
sample of 36,984 subjects randomly selected from the national
population. In the CCHS 1.2, subjects were asked whether they
had been diagnosed by a health professional with arthritis or
rheumatism. RESULTS: Subjects reporting arthritis or rheumatism
had an elevated prevalence of mood, anxiety and substance use
disorders. The strength of association resembled that seen in an
omnibus category reporting any chronic condition, but was weaker
than that seen with back pain or fibromyalgia. The effect of
arthritis or rheumatism interacted with age, such that the odds
ratios became smaller with increasing age. Mood and anxiety
disorders, along with arthritis or rheumatism made an
independent contribution to disability. CONCLUSION: Arthritis is
associated with psychiatric morbidity in the general population,
and this morbidity is seen across a variety of mental disorders.
The strength of association is consistent with that seen in
persons with other self-reported medical conditions
(248)
Pedersen BK, Saltin B. Evidence for prescribing exercise as
therapy in chronic disease. Scand J Med Sci Sports 2006; 16
Suppl 1:3-63.:3-63.
Abstract: Considerable knowledge has accumulated in recent
decades concerning the significance of physical activity in the
treatment of a number of diseases, including diseases that do
not primarily manifest as disorders of the locomotive apparatus.
In this review we present the evidence for prescribing exercise
therapy in the treatment of metabolic syndrome-related disorders
(insulin resistance, type 2 diabetes, dyslipidemia,
hypertension, obesity), heart and pulmonary diseases (chronic
obstructive pulmonary disease, coronary heart disease, chronic
heart failure, intermittent claudication), muscle, bone and
joint diseases (osteoarthritis, rheumatoid arthritis,
osteoporosis, fibromyalgia, chronic fatigue syndrome) and
cancer, depression, asthma and type 1 diabetes. For each
disease, we review the effect of exercise therapy on disease
pathogenesis, on symptoms specific to the diagnosis, on physical
fitness or strength and on quality of life. The possible
mechanisms of action are briefly examined and the principles for
prescribing exercise therapy are discussed, focusing on the type
and amount of exercise and possible contraindications
(249)
Perahia DG, Pritchett YL, Desaiah D, Raskin J. Efficacy of
duloxetine in painful symptoms: an analgesic or antidepressant
effect? Int Clin Psychopharmacol 2006; 21(6):311-317.
Abstract: The evidence that the effects of the antidepressant
duloxetine on painful physical symptoms in depression and
chronic pain disorders are a direct analgesic effect rather than
an indirect antidepressant effect is reviewed. Data from
placebo-controlled acute studies of duloxetine in major
depressive disorder, diabetic peripheral neuropathic pain and
fibromyalgia syndrome are included in this review. In
placebo-controlled studies of duloxetine in patients with major
depressive disorder, non-depressed diabetic peripheral
neuropathic pain, and fibromyalgia syndrome, duloxetine has a
statistically significantly greater effect on pain than placebo.
Path analysis suggests that in these patient populations,
approximately 50, 90, and 80%, respectively, of the observed
effect on pain is a direct analgesic effect rather than an
indirect antidepressant effect. In fibromyalgia syndrome
studies, duloxetine had similar and substantial effects on pain
regardless of whether patients had comorbid major depressive
disorder. Pain is a complex experience, involving both the
physiological responses of the nociceptive system and the
processing of that information in brain regions associated with
emotion. While some effects of duloxetine on painful symptoms
can be accounted for by its antidepressant action, the data
strongly suggest that duloxetine also exerts a substantial
direct analgesic effect over and above its antidepressant
effects, in patients with major depressive disorder, diabetic
peripheral neuropathic pain, and fibromyalgia syndrome
(250)
Petrella RJ, Davis P. Improving management of musculoskeletal
disorders in primary care: the Joint Adventures Program. Clin
Rheumatol 2006; .
Abstract: Musculoskeletal disorders represent a large and
growing clinical challenge to primary care clinicians.
Unfortunately, there appears to be a gap in current training and
continuing education to meet this challenge. We used script
concordance within a continuing medical education program
entitled "Joint Adventures" to assist family physicians to
acquire the knowledge, skills, and tools they need to improve
their management of musculoskeletal disorders. Program workshops
were coordinated through a national continuing education program
of the College of Family Physicians of Canada. A group of 54
experts in musculoskeletal disorders including family
physicians, rheumatologists, and orthopedists developed cases
for six areas of management that were identified by family
physicians during a needs survey delivered at a national
scientific congress in primary care. Script concordance
methodology was used in the Joint Adventures workshop to address
knowledge gaps or lack of group consensus in the six areas
including (1) diagnosis of osteoarthritis, (2) treatment and
management of osteoarthritis, (3) treatment and management of
rheumatoid arthritis, (4) diagnosis and treatment of back pain,
(5) diagnosis and treatment of fibromyalgia and diagnosis, and
(6) treatment of shoulder pain. Each workshop session included
5-30 family physicians, a specialist expert, and a family
physician facilitator. Before each session, a group needs
assessment was conducted to identify which one or two of the six
cases would be used. Perceived knowledge and skill acquisition,
self-assessed change in practice, and satisfaction with the
program were measured at the conclusion of each session and
again at 3 months post program. All programs were delivered from
March 2003 to September 2005. Six hundred and fifty family
physicians from across Canada completed the program. In general,
participants reached concordance with each case. Measures of
knowledge and skill acquisition and self-assessed change in
practice were significantly improved with high rates of program
satisfaction. The Joint Adventures program provided family
physicians with knowledge and skills that changed their care of
musculoskeletal disorders. This was achieved using consensus
that was sensitive to local needs. Further use should be
evaluated in other areas of medical practice as well
(251)
Pisetsky DS. Rheumatology in 2006 - crossroads or crisis? Bull
Hosp Jt Dis 2006; 64(1-2):9-11.
Abstract: Rheumatology has made remarkable advances in patient
treatment in the past decade related to the impressive array of
new drugs that have been approved or are undergoing clinical
trial. While this situation should engender optimism for the
future, concerns about sustaining momentum have been raised.
These concerns relate to uncertainty in the research agenda for
major diseases such as osteoarthritis and fibromyalgia, lack of
informatics systems to allow accurate assessment of risks and
benefits of new treatments, and a paucity of clinical trials in
rheumatoid arthritis aimed at sustained remission or cure.
Fortunately, the opportunities for the future remain very bright
because of burgeoning research in biomedicine and outcomes
assessment as well as progress in developing personalized
medicine to individualize treatment better
(252)
Porter-Moffitt S, Gatchel RJ, Robinson RC, Deschner M,
Posamentier M, Polatin P et al. Biopsychosocial profiles of
different pain diagnostic groups. J Pain 2006; 7(5):308-318.
Abstract: Different pain diagnoses have been examined separately
in various research studies. The major aim of the present
investigation was to add to the current understanding of the
various groups of patients who make up the chronic pain
population. This study expanded the research literature by
including 7 different predominantly chronic pain syndromes
(fibromyalgia, upper extremity pain, cervical pain, thoracic
pain, lumbar pain, lower extremity pain, and headache). These 7
groups were examined by using a broad array of variables
focusing on demographic, self-reported psychosocial, and
physical/functional factors. There were 661 patients included
from an interdisciplinary treatment program who had been given 1
physical pain diagnosis. Results revealed differences among the
7 groups with regard to self-reported physical/functional
limitations. The headache group had less physical/functional
impairment than most of the other groups. On the other hand, the
lumbar, fibromyalgia, and lower extremity groups had the most
physical/functional problems. On self-reported psychosocial
measures, the fibromyalgia group had the most difficulties, and
the lower extremity and lumbar groups had fewer problems in this
area. Overall, though, besides the fibromyalgia group, there was
a lack of differences among the other groups on the psychosocial
measures. PERSPECTIVE: Biopsychosocial profiles were examined
for different pain diagnostic groups. Seven different pain
groups were compared. It was discovered that, in general, the
lumbar, fibromyalgia, and lower extremity groups reported more
physical/functional limitations, and the fibromyalgia and
headache groups reported more psychosocial difficulties
(253)
Price DD, Zhou Q, Moshiree B, Robinson ME, Nicholas VG.
Peripheral and central contributions to hyperalgesia in
irritable bowel syndrome. J Pain 2006; 7(8):529-535.
Abstract: Irritable bowel syndrome (IBS) is a common
gastrointestinal disorder seen by gastroenterologists. We
discuss some recent evidence for potential neural mechanisms
that could contribute to somatic and visceral hyperalgesia in
IBS patients. The combination of research studies of human IBS
patients and studies of rats with delayed rectal
hypersensitivity after recovery from experimentally induced
neonatal colitis strongly suggests a mechanism wherein both
primary visceral hyperalgesia and secondary widespread cutaneous
hyperalgesia are dynamically maintained by tonic impulse input
from the noninflamed colon and/or rectum. The secondary
hyperalgesia is likely to be at least partly related to
sensitization of spinal cord dorsal horn neurons and in this
respect might be similar to other persistent pain conditions
such as fibromyalgia and complex regional pain syndrome.
PERSPECTIVE: Pain in irritable bowel syndrome is likely to be at
least partly maintained by peripheral impulse input from the
colon/rectum and central sensitization, yet it is also highly
modifiable by psychological factors such as nocebo and placebo
effects. A synergistic interaction might occur between
psychological factors and abnormal afferent processing
(254)
Prins MA, Woertman L, Kool MB, Geenen R. Sexual functioning of
women with fibromyalgia. Clin Exp Rheumatol 2006; 24(5):555-561.
Abstract: OBJECTIVE: To examine sexual functioning at the
specific phases of the sexual response cycle among women with
fibromyalgia. METHODS: The Questionnaire for screening Sexual
Dysfunctions - Short Form (QSD-SF) was filled out by 63
premenopausal, heterosexual women with fibromyalgia (age: 21-54
years) who were recruited at meetings of regional patient
associations. RESULTS: The women with fibromyalgia did not
differ from healthy women of an age reference group with respect
to functioning in the excitement and the orgasm phases, but
reported more problems with sexual desire and satisfaction, more
pain in their body, and insensitivity (but not pain) in their
genitals before, during or after having sex. Mental distress,
but not pain, was a significant predictor of virtually all
aspects of sexual dysfunction. CONCLUSION: Our study generates
the hypothesis that the psychological but not the physiological
aspect of the sexual response cycle is more disturbed than
normal in fibromyalgia. This finding needs confirmation in a
more representative population
(255)
Qin L, Guo W. Functional mixed-effects model for periodic data.
Biostatistics 2006; 7(2):225-234.
Abstract: Periodic data are frequently collected in biomedical
experiments. We consider the underlying periodic curves giving
rise to these data, and account for the periodicity in their
functional model to improve estimation and inference. We propose
to incorporate the periodic constraint in the functional
mixed-effects model setting. Both the fixed functional effects
and random functional effects are modeled in the same periodic
functional space, hence the population-average estimates and
subject-specific predictions are all periodic. An efficient
algorithm is given to estimate the proposed model by an O(N)
modified Kalman filtering and smoothing algorithm. The proposed
method is evaluated in different scenarios through simulations.
Treatments to none-full period data and missing observations
along the period are also given. Analysis of a cortisol data set
obtained from a study on fibromyalgia is conducted as
illustration
(256)
Raheim M, Haland W. Lived experience of chronic pain and
fibromyalgia: women's stories from daily life. Qual Health Res
2006; 16(6):741-761.
Abstract: The hermeneutic-phenomenological study presented in
this article is grounded in a lifeworld perspective. The authors
aimed at rich descriptions of women's lived experience of
chronic pain and fibromyalgia. They conducted individual
life-form interviews with 12 women with fibromyalgia. On the
basis of the women's stories, three typologies were developed:
at the will of the treacherous body-powerlessness; struggling to
escape the treacherous body- ambivalence; and caring for the
treacherous body-coping. The lived experience described in the
typologies were further interpreted according to the
existentials: lived body, lived time and space, and lived
relations. The women's stories point to a world experienced as
fundamentally changed by a body in chronic pain, describing a
struggle in which they feel that their existence is at stake
(257) Raphael KG, Janal MN, Nayak S, Schwartz JE, Gallagher
RM.
Psychiatric comorbidities in a community sample of women with
fibromyalgia. Pain 2006; 124(1-2):117-125.
Abstract: Prior studies of careseeking fibromyalgia (FM)
patients often report that they have an elevated risk of
psychiatric disorders, but biased sampling may distort true
risk. The current investigation utilizes state-of-the-art
diagnostic procedures for both FM and psychiatric disorders to
estimate prevalence rates of FM and the comorbidity of FM and
specific psychiatric disorders in a diverse community sample of
women. Participants were screened by telephone for FM and MDD,
by randomly selecting telephone numbers from a list of
households with women in the NY/NJ metropolitan area. Eligible
women were invited to complete physical examinations for FM and
clinician-administered psychiatric interviews. Data were
weighted to adjust for sampling procedures and population
demographics. The estimated overall prevalence of FM among women
in the NY/NJ metropolitan area was 3.7% (95% CI=3.2, 4.4), with
higher rates among racial minorities. Although risk of current
MDD was nearly 3-fold higher in community women with than
without FM, the groups had similar risk of lifetime MDD. Risk of
lifetime anxiety disorders, particularly obsessive compulsive
disorder and post-traumatic stress disorder, was approximately
5-fold higher among women with FM. Overall, this study found a
community prevalence for FM among women that replicates prior
North American studies, and revealed that FM may be even more
prevalent among racial minority women. These community-based
data also indicate that the relationship between MDD and FM may
be more complicated than previously thought, and call for an
increased focus on anxiety disorders in FM
(258)
Reich JW, Johnson LM, Zautra AJ, Davis MC. Uncertainty of
illness relationships with mental health and coping processes in
fibromyalgia patients. J Behav Med 2006; 29(4):307-316.
Abstract: Fibromyalgia syndrome (FMS) is a chronic
musculoskeletal pain condition poorly understood in terms of
etiology and treatment by both physicians and patients. This
condition of "uncertainty of illness" was examined as a variable
involved in the adjustment of FMS patients, relating it to their
depression, anxiety, affect, and coping styles. Fifty-one
community-residing FMS patients provided self-report information
on subsets of adjustment variables. Both cross-sectional and
more dynamic longitudinal analyses showed that illness
uncertainty was significantly associated with anxiety, negative
affect, and avoidant and passive coping. Its positive
relationship with depression was eliminated when a control
variable, pain helplessness, was included as a covariate.
Longitudinally, illness uncertainty interacted with
interpersonally stressful daily events in predicting reports of
reduced positive affect, suggesting that illness uncertainty
acts as a risk factor for affective disturbances during
stressful times. Implications of these results for therapeutic
interventions are discussed
(259)
Reich JW, Olmsted ME, van Puymbroeck CM. Illness uncertainty,
partner caregiver burden and support, and relationship
satisfaction in fibromyalgia and osteoarthritis patients.
Arthritis Rheum 2006; 55(1):86-93.
Abstract: OBJECTIVE: Fibromyalgia syndrome (FMS) is
characterized by uncertainty in diagnosis, treatment, and
outcome. This study assessed the role of uncertainty of illness
in relationship satisfaction in patients with FMS and
osteoarthritis (OA). METHODS: A total of 51 patients with FMS
responded to self-report instruments assessing their uncertainty
about their illness, functional ability, average pain, and
relationship satisfaction. Their partners independently reported
on their sense of caregiver burden and their supportiveness
toward the patients. Thirty-two patients with OA and their
partners served as a control group. RESULTS: Patients'
functional ability and pain were related to partner caregiver
burden. Partner caregiver burden was related to lower levels of
partner supportiveness for the FMS dyads, but not for the OA
dyads. Relationship satisfaction of patients with FMS was
related to their higher levels of uncertainty of illness in
interaction with their functional disability and pain and their
partners' supportiveness. Under high levels of uncertainty of
illness, low levels of partner supportiveness were related to
lower patient relationship satisfaction, whereas low levels of
uncertainty of illness were significant interacting variables in
the OA sample. CONCLUSION: The results suggest that uncertainty
of illness is a prominent feature affecting patients with FMS in
their relationships with their partners. Suggestions for
additional research to explore the role of uncertainty of
illness in social relationships are presented, and the
therapeutic implications for patient/partner relationships are
explored
(260)
Robinson RL, Jones ML. In search of pharmacoeconomic evaluations
for fibromyalgia treatments: a review. Expert Opin Pharmacother
2006; 7(8):1027-1039.
Abstract: Fibromyalgia is characterised by chronic widespread
pain of unknown aetiology and affects approximately 2% of the
population. It can cause significant patient disability,
sizeable economic costs, complex management decisions and
controversy for healthcare providers. In lieu of uniformly
approved treatments for fibromyalgia, patients may try multiple
pharmacological and non-pharmacological therapies with
questionable efficacy. The literature lacks pharmacoeconomic
studies that balance the cost and benefit of interventions. In
the absence of this work, cost outcomes are reviewed in this
paper. Due to inconclusive results, further study is needed on
fibromyalgia treatment cost-effectiveness. These analyses could
provide useful information for policy and evidence-based
practice guidelines toward optimal disease management. Medical
professionals should be a driving force in understanding the
clinical and economic challenges of fibromyalgia
(261)
Rosado ML, Pereira JP, da Fonseca JP, Branco JC. [Cultural
adaptation and validation of the "Fibromyalgia Impact
Questionnaire"--Portuguese version]. Acta Reumatol Port 2006;
31(2):157-165.
Abstract: The aim of this study was to translate the
Fibromyalgia Impact Questionnaire (FIQ) into Portuguese
(Portugal) and to evaluate its reliability and validity by use
with Portuguese--speaking patients with Fibromyalgia. After
translating the FIQ into Portuguese we administered it to 68
patients with Fibromyalgia together with an informed consent, a
Portuguese version of the Health Assessment Questionnaire (HAQ)
and a formulary with the socio-demographic characteristics and
duration of the complaints. The content validity was assessed
with a panel of experts, with high consensus. In the concurrent
validity, we obtained significant correlations between the FIQ
first item and the HAQ [r = 0,531 (p = 0,001)]. Cronbach's alpha
was 0,814, indicating an acceptable level of internal
consistency. In conclusion, the Portuguese version of the FIQ is
a reliable and valid instrument for measuring health status and
physical functioning in Portuguese patients with Fibromyalgia.
This instrument is available for use in the clinical practice
(262)
Ruiz MR, Rodriguez SJ, Perula L, Fernandez I, Martinez J,
Fernandez MJ et al. [Problems and Solutions in Health Care for
Chronic Diseases. A Qualitative Study With Patients and
Doctors.]. Aten Primaria 2006; 38(9):483-489.
Abstract: BACKGROUND. Chronic diseases represent a challenge for
health systems and the professionals most involved in chronic
care. Despite biomedical advances, the results of care for
chronic problems are not as good as they should be. OBJECTIVE.
To find out what doctors and patients think of care for some of
the main chronic illnesses; to detect concrete areas of deficit
and lack of satisfaction felt by both sides and possible lines
of improvement; to raise mutual understanding between patients
and doctors. PARTICIPANTS. Forty-one patients with fibromyalgia
or diabetes mellitus, carers for people with Alzheimer's and
breast cancer patients. Forty-three family doctors involved in
health care delivery to this kind of patient. METHODS. Four
discussion groups. Transcription and syntactical, semantic and
pragmatic contents analysis, with both pre-established and
emerging categories of consensus. RESULTS. Patients thought,
with different nuances as a function of the problem put forward,
that questions of respectful, human and integrated care, clear
and suitable information, and consistent follow-up were
important and insufficiently covered by doctors and health
services. Doctors thought that many of their efforts in caring
for these patients were useless, and thought it important to
reconsider their clinical responsibilities and the
patient-doctor relationship. Doctors highlighted the limitations
in the health care resources available for working with these
patients. CONCLUSIONS. To tackle prevalent chronic problems
requires, in the view of doctors and patients, important
modifications that are related mainly to the kind of
relationship between the two, with new clinical responsibilities
and certain organisational care delivery features
(263)
Sampson SM, Rome JD, Rummans TA. Slow-frequency rTMS reduces
fibromyalgia pain. Pain Med 2006; 7(2):115-118.
Abstract: OBJECTIVE: Evidence suggests that fibromyalgia (FM) is
a centrally mediated pain disorder. Antidepressants, including
electroconvulsive therapy, provide some symptomatic relief in FM
and other pain disorders. Repetitive transcranial magnetic
stimulation (rTMS) is a new antidepressant treatment, which may
also be useful in treating chronic pain. DESIGN: As part of a
larger study, four women with depression, FM, and borderline
personality disorder received 1-Hz rTMS applied to the right
dorsolateral prefrontal cortex. Subjects rated pain using an
11-point Likert scale. RESULTS: Pretreatment pain averaged 8.2
(7-9.5) and reduced to 1.5 (0-3.5) after treatment (P < 0.009).
All had improvement in pain, and two had complete resolution of
pain. Only one of the four subjects had an antidepressant
response. CONCLUSIONS: These preliminary findings suggest a
possible role for rTMS in treating FM
(264)
Sarac AJ, Gur A. Complementary and alternative medical therapies
in fibromyalgia. Curr Pharm Des 2006; 12(1):47-57.
Abstract: This article describes the studies that have been
performed evaluating complementary or alternative medical (CAM)
therapies for efficacy and some adverse events fibromyalgia
(FM). There is no permanent cure for FM; therefore, adequate
symptom control should be goal of treatment. Clinicians can
choose from a variety of pharmacologic and nonpharmacologic
modalities. Unfortunately, controlled studies of most current
treatments have failed to demonstrate sustained, clinically
significant responses. CAM has gained increasing popularity,
particularly among individuals with FM for which traditional
medicine has generally been ineffective. Some herbal and
nutritional supplements (magnesium, S- adenosylmethionine) and
massage therapy have the best evidence for effectiveness with
FM. Other CAM therapies such as chlorella, biofeedback,
relaxation have either been evaluated in only one randomised
controlled trials (RCT) with positive results, in multiple RCTs
with mixed results (magnet therapies) or have positive results
from studies with methodological flaws (homeopathy, botanical
oils, balneotherapy, anthocyanidins and dietary modifications).
Another CAM therapy such as chiropractic care has neither
well-designed studies nor positive results and is not currently
recommended for FM treatment. Once CAM therapies have been
better evaluated for safety and long-term efficacy in
randomised, placebo-controlled trials, they may prove to be
beneficial in treatments for FM. It would then be important to
assess studies assessing cost-benefit analyses comparing
conventional therapies and CAM
(265)
Sarchielli P, Alberti A, Candeliere A, Floridi A, Capocchi G,
Calabresi P. Glial cell line-derived neurotrophic factor and
somatostatin levels in cerebrospinal fluid of patients affected
by chronic migraine and fibromyalgia. Cephalalgia 2006;
26(4):409-415.
Abstract: The aim of the present study was to verify
cerebrospinal fluid (CSF) levels of glial cell line-derived
neurotrophic factor (GDNF) and somatostatin, both measured by
sensitive immunoassay, in: 16 chronic migraine (CM) patients, 15
patients with an antecedent history of migraine without aura
diagnosed as having probable chronic migraine (PCM) and probable
analgesic-abuse headache (PAAH), 20 patients affected by primary
fibromyalgia syndrome (PFMS), and 20 control subjects.
Significantly lower levels of GDNF and somatostatin were found
in the CSF of both CM and PCM + PAAH patients compared with
controls (GDNF =P < 0.001, P < 0.002; somatostatin = P < 0.002,
P < 0.0003), without significant difference between the two
groups. PFMS patients, with and without analgesic abuse, also
had significantly lower levels of both somatostatin and GDNF (P
< 0.0002, P < 0.001), which did not differ from those of CM and
PCM + PAAH patients. A significant positive correlation emerged
between CSF values of GDNF and those of somatostatin in CM (r =
0.70, P < 0.02), PCM + PAAH (r = 0.78, P < 0.004), and PFMS
patients (r = 0.68, P < 0.008). Based on experimental findings,
it can be postulated that reduced CSF levels of GDNF and
somatostatin in both CM and PCM + PAAH patients can contribute
to sustained central sensitization underlying chronic head pain.
The abuse of simple or combination analgesics does not seem to
influence the biochemical changes investigated, which appear to
be more strictly related to the chronic pain state, as
demonstrated also for fibromyalgia
(266)
Sarkar S, Woolf CJ, Hobson AR, Thompson DG, Aziz Q. Perceptual
wind-up in the human oesophagus is enhanced by central
sensitisation. Gut 2006; 55(7):920-925.
Abstract: BACKGROUND: Oesophageal acid infusion induces enhanced
pain hypersensitivity in non-acid exposed upper oesophagus
(secondary hyperalgesia) in patients with non-cardiac chest
pain, thus suggesting central sensitisation contributes to
visceral pain hypersensitivity in functional gut disorders
(FGD). Perceptual wind-up (increased pain perception to constant
intensity sensory stimuli at frequencies>or=0.3 Hz) is used as a
proxy for central sensitisation to investigate pain syndromes
where pain hypersensitivity is important (for example,
fibromyalgia). AIMS: Wind-up in central sensitisation induced
human visceral pain hypersensitivity has not been explored. We
hypothesised that if wind-up is a proxy for central
sensitisation induced human visceral pain hypersensitivity, then
oesophageal wind-up should be enhanced by secondary
hyperalgesia. METHODS: In eight healthy volunteers (seven males;
mean age 32 years), perception at pain threshold to a train of
20 electrical stimuli applied to the hand and upper oesophagus
(UO) at either 0.1 Hz (control) or 2 Hz was determined before
and one hour after a 30 minute lower oesophageal acid infusion.
RESULTS: Wind-up occurred only with the 2 Hz train in the UO and
hand (both p=0.01). Following acid infusion, pain threshold
decreased (17 (4)%; p=0.01) in the UO, suggesting the presence
of secondary hyperalgesia. Wind-up to the 2 Hz train increased
in the UO (wind-up ratio 1.4 (0.1) to 1.6 (0.1); p=0.03) but not
in the hand (wind-up ratio 1.3 (0.1) and 1.3 (0.1); p=0.3)
CONCLUSION: Enhanced wind-up after secondary oesophageal
hyperalgesia suggests that visceral pain hypersensitivity
induced by central sensitisation results from increased central
neuronal excitability. Wind-up may offer new opportunities to
investigate the contribution of central neuronal changes to
symptoms in FGD
(267)
Sarzi-Puttini P, Atzeni F, Diana A, Doria A, Furlan R. Increased
neural sympathetic activation in fibromyalgia syndrome. Ann N Y
Acad Sci 2006; 1069:109-17.:109-117.
Abstract: Fibromyalgia (FM) is a syndrome characterized by
widespread musculoskeletal pain, although the mechanisms
underlying the pain have not been fully elucidated. FM patients
describe a number of nonspecific symptoms, such as anxiety,
depression, fatigue, unrefreshing sleep, and gastrointestinal
complaints, which appear after a flu-like illness, or after
physical or emotional trauma in half of the patients, and are
often exacerbated by exertion, stress, lack of sleep, and
weather changes. There may also be symptoms of orthostatic
intolerance, which suggests underlying abnormalities in
cardiovascular neural regulation. Research suggests that various
components of the central nervous system are involved, including
the hypothalamic-pituitary-adrenal (HPA) axis, pain-processing
pathways, and the autonomic nervous system (ANS). This review
discusses the general aspects of the altered HPA and ANS,
sympathetic overactivity, and alterations in cardiovascular
autonomic responses to gravitational stimuli
(268)
Schley M, Legler A, Skopp G, Schmelz M, Konrad C, Rukwied R.
Delta-9-THC based monotherapy in fibromyalgia patients on
experimentally induced pain, axon reflex flare, and pain relief.
Curr Med Res Opin 2006; 22(7):1269-1276.
Abstract: OBJECTIVE: Fibromyalgia (FM) is a chronic pain
syndrome characterized by a distinct mechanical hyperalgesia and
chronic pain. Recently, cannabinoids have been demonstrated as
providing anti-nociceptive and anti-hyperalgesic effects in
animal and human studies. Here, we explored in nine FM patients
the efficacy of orally administered delta-9-tetrahydrocannabinol
(THC) on electrically induced pain, axon reflex flare, and
psychometric variables. RESEARCH DESIGN AND METHods: Patients
received a daily dose of 2.5-15 mg of delta-9-THC, with a weekly
increase of 2.5 mg, as long as no side effects were reported.
Psychometric variables were assessed each week by means of the
West Haven-Yale Multidimensional Pain Inventory (MPI),
Pittsburgh Sleep Quality Index (PSQI), Medical outcome
survey-short form (MOS SF-36), the Pain Disability Index (PDI),
and the Fibromyalgia Impact Questionnaire (FIQ). In addition,
patients recorded daily, in a diary, their overall pain
intensity on a numeric scale. Each week, pain and axon reflex
flare was evoked experimentally by administration of high
intensity constant current pulses (1 Hz, pulse width 0.2 ms,
current increase stepwise from 2.5-12.5 mA every 3 minutes)
delivered via small surface electrodes, attached to the volar
forearm skin. MAIN OUTCOME MEASURES: Daily pain recordings by
the patient, experimentally induced pain, and axon reflex flare
recorded by a laser Doppler scanner. RESULTS: Five of nine FM
patients withdrew during the study due to adverse side effects.
Delta-9-THC had no effect on the axon reflex flare, whereas
electrically induced pain was significantly attenuated after
doses of 10-15 mg delta-9-THC (p < 0.05). Daily-recorded pain of
the FM patients was significantly reduced (p < 0.01).
CONCLUSIONS: This pilot study demonstrated that a generalized
statement that delta-9-THC is an analgetic drug cannot be made.
However, a sub-population of FM patients reported significant
benefit from the delta-9-THC monotherapy. The unaffected
electrically induced axon reflex flare, but decreased pain
perception, suggests a central mode of action of the cannabinoid
(269) Schneider MJ, Brady DM, Perle SM.
Commentary:
differential diagnosis of fibromyalgia syndrome: proposal of a
model and algorithm for patients presenting with the primary
symptom of chronic widespread pain. J Manipulative Physiol Ther
2006; 29(6):493-501.
(270)
Schofferman J. Restoration of function: the missing link in pain
medicine? Pain Med 2006; 7 Suppl 1:S159-65.:S159-S165.
Abstract: ABSTRACT The goals of treatment for patients with
chronic pain are reduction in pain, improvement in function, and
restoration of psychological health. In order to meet these
goals, there must be specific attention directed toward
rehabilitation and restoration of function in parallel with the
treatment of pain. Functional impairments have been demonstrated
in patients with chronic pain in the back, neck, and
extremities, and other sites, as well as in patients with
fibromyalgia. Functional impairment in chronic pain can be
diffuse or focal. In addition to nociceptive and neuropathic
problems, there may be psychological problems including
fear-avoidance. Common fears include the fear that activity will
cause more pain, the fear due to misunderstandings that pain
with activity means further damage, or the fear that the pain is
a symptom of serious pathology. Functional restoration requires
first quantifying deficits using interviews, validated
questionnaires for physical function and psychological
condition, and when possible, direct measurements of focal and
general function. A cognitive-behavioral approach appears to
work best. Treatment stresses education and clarification of
possible misconceptions, exercise to targeted levels, and graded
exposure to painful activities. Patients are taught that it is
safe to exercise despite pain and that there is no risk of harm.
Graded exposure requires progressive activity and exercise that
emphasizes training in strength, flexibility range of motion,
and endurance despite pain. Exercises are quota or
goal-directed, and not influenced by the pain. After specific
deficits in muscle strength and flexibility are identified and
quantified, they become the major foci of therapy. Repeated
single effort strength maximums are established. Each week or
twice weekly, new goals are set based on the individual's
progress. Although rehabilitation concentrates on function and
does not specifically address pain, quite often as function
improves, there is reduction in pain and improvement in
psychological health
(271)
Schug SA. Combination analgesia in 2005-a rational approach:
focus on paracetamol-tramadol. Clin Rheumatol 2006; 25 Suppl
1:16-21. Epub;%2006 Jun 2.:16-21.
Abstract: A multimodal (or balanced) approach to anaesthesia is
a familiar concept that offers important benefits in the
management of both acute and chronic pain. Rational combinations
of analgesic agents with different mechanisms of action can
achieve improved efficacy and/or tolerability and safety
compared with equianalgesic doses of the individual drugs.
Combining different agents also enhances efficacy in complex
pain states that involve multiple causes. Combinations of
paracetamol plus a weak opioid agent are widely used. One such
combination, paracetamol plus tramadol, exploits the
well-established complementary pharmacokinetics and mechanisms
of action of these two drugs. This combination has demonstrated
genuine synergy in animal studies and also combines
paracetamol's rapid onset of efficacy with tramadol's prolonged
analgesic effect. Numerous studies have confirmed the efficacy
and tolerability of paracetamol plus tramadol in both acute and
chronic pain. As a single-dose treatment for acute
post-operative pain, this combination delivers rapid and
sustained pain relief that is greater than either agent alone.
There is also extensive evidence for efficacy in the long-term
management of chronic pain conditions, including osteoarthritis,
low back pain and fibromyalgia. In the setting of chronic pain,
paracetamol plus tramadol has shown sustained efficacy, safety
and tolerability for up to 2 years without the development of
tolerance. The efficacy of this combination has been
demonstrated as well in respect to reduction of pain intensity
and, more importantly, with regard to improvement of function
and quality of life and the reduction of disability. Comparative
trials have shown that paracetamol plus tramadol has comparable
efficacy to paracetamol plus codeine, but with reduced
somnolence and constipation compared with the codeine
combination. The paracetamol plus tramadol combination is also
free of organ toxicity associated with selective and
non-selective non-steroidal anti-inflammatory drugs. Hence,
paracetamol plus tramadol offers an effective and well-tolerated
alternative to anti-inflammatory drugs or other paracetamol plus
weak opioid combinations
(272)
Sendur OF, Gurer G, Bozbas GT. The frequency of hypermobility
and its relationship with clinical findings of fibromyalgia
patients. Clin Rheumatol 2006; .
Abstract: The etiology and pathogenic mechanisms of fibromyalgia
(FM) are unknown. A number of studies have suggested that there
was a link between hypermobility and FM. In this study, we aimed
to expose the frequency of hypermobility in FM patients and its
relation with clinical findings. For this reason, 236 women (118
FM women as study group and 118 healthy women as control group)
were enrolled in the study. Joint hypermobility was evaluated in
the participants by using Beighton scoring system. The rate of
joint hypermobility among FM patients (Beighton score of at
least 4 or more) was found to be higher than the control group
(46.6 vs 28.8%). This result was also statistically meaningful
(p<0.05). In addition, the mean Beighton score of FM group was
observed to be higher than the control (3.68 vs 2.55, p<0.001).
Although not reaching statistical difference (p>0.05), more
severe clinical findings were observed in FM patients with
hypermobility when compared with ones without
(273)
Seng JS, Clark MK, McCarthy AM, Ronis DL. PTSD and physical
comorbidity among women receiving Medicaid: results from
service-use data. J Trauma Stress 2006; 19(1):45-56.
Abstract: Patterns of physical comorbidity among women with
posttraumatic stress disorder (PTSD) were explored using
Michigan Medicaid claims data. PTSD-diagnosed women (n = 2,133)
were compared with 14,948 randomly selected women in three
health outcome areas: ICD-9 categories of disease, chronic
conditions associated with sexual assault history in previous
research, and reproductive health conditions. PTSD was
associated with increased risk of all categories of diseases (OR
range = 1.3-4.8), endometriosis (OR = 2.7), and dyspareunia (OR
= 3.4). When PTSD was not complicated by other mental health
conditions, odds ratios for chronic conditions ranged from 1.9
for fibromyalgia to 4.3 for irritable bowel. Comorbidity with
depression or a dissociative or borderline personality disorder
raised risk in a dose-response pattern
(274)
Serdaroglu M, Capkin E, Ucuncu F, Tosun M. Case report of a
patient with osteopoikilosis. Rheumatol Int 2006; .
Abstract: Osteopoikilosis (OPK) is a benign osteosclerotic
dysplasia of unknown origin, which is an inherited autosomal
disorder. Males and females are equally affected. It is usually
asymptomatic and may only be recognized on radiological
examination. In this study we report a 33-year-old woman with
fibromyalgia who suffers from back and leg pain and was
diagnosed OPK by radiologically and review literature
(275)
Shah MA, Feinberg S, Krishnan E. Sleep-disordered breathing
among women with fibromyalgia syndrome. J Clin Rheumatol 2006;
12(6):277-281.
Abstract: BACKGROUND: In clinical practice, polysomnograms
("sleep studies") are seldom ordered for patients with
fibromyalgia, although sleep issues dominate the symptom
complex. One reason for this is the lack of understanding how
information from these studies could aid clinical decisions.
METHODS: The authors conducted a chart review of one
rheumatologist's community-based practice where polysomnograms
were offered routinely to all women who met the American College
of Rheumatology criteria for fibromyalgia. Interpretation of
these standardized protocol-based polysomnograms was performed
by a board-certified neurologist using standard criteria.
RESULTS: Mean age of the study subjects (n = 23) was 45
(standard deviation, 7.8) years. Median body mass index was 27
kg/m2 (interquartile range 20-48). These women had poor sleep
with many arousals (median arousal index 23), apnea-hypopneas
(median apnea-hypopnea index 22, interquartile range 17-30).
Desaturation was common with half the patients having nadir
oxygen saturation less than 87%. Restless legs were detected in
polysomnograms among many women who clinically denied it (mean
leg movement index 5.8). CONCLUSIONS: A large proportion of
women with fibromyalgia in a general rheumatology practice had
sleep-disordered breathing, which can be detected using sleep
polysomnograms. Studies are needed to examine if treatment of
the commonly detected sleep apnea will have a beneficial effect
on symptoms of fibromyalgia
(276)
Shaver JL, Wilbur J, Robinson FP, Wang E, Buntin MS. Women's
health issues with fibromyalgia syndrome. J Womens Health
(Larchmt ) 2006; 15(9):1035-1045.
Abstract: BACKGROUND: Fibromyalgia syndrome (FMS) involves
multiple sensory, somatic, and cognitive symptoms that are bound
to affect or be affected by physical and mental health status
and behavioral components of daily life. METHODS: From a
telephone survey of 442 women with and 205 women without FMS as
volunteers, data were compared on (1) general health status, (2)
reproductive and sleep-related diagnoses, and (3) lifestyle
health behaviors. RESULTS: All multiple or logistics regression
analyses for group differences were controlled for age, body
mass index (BMI), race, employment status, marital status,
having a college degree, low household income, and having ever
been diagnosed with depression, with a Bonferroni p value
correction for multiple indicators. Accordingly, FMS negatively
impacted both perceived physical and mental health status,
although relatively more so for physical (p < 0.017). Women with
FMS were more likely to have had reproductive health or
sleep-related diagnoses, including premenstrual syndrome,
dysmenorrhea, breast cysts, bladder cystitis, sleep apnea,
restless leg syndrome, and abnormal leg movements (p < 0.0125).
They were calculated to use less than half as many calories per
week as control women (689 +/- 1293 vs. 1499 +/- 1584 kcal/week,
p < 0.05) and had more sleep pattern difficulties (p < 0.0125),
more negative changes in sexual function (greater odds for 5 of
10 indicators at p < 0.005), and lower alcohol use (odds ratio =
0.39, p < 0.05). CONCLUSIONS: Patients with FMS deserve careful
assessment for reproductive conditions and sleep-related
functional disorders. Besides more research into mechanisms
underlying symptoms, intervention testing specifically to
alleviate sleep problems, low physical activity levels, and
sexual dysfunction should be paramount
(277)
Shir Y, Pereira JX, Fitzcharles MA. Whiplash and fibromyalgia:
an ever-widening gap. J Rheumatol 2006; 33(6):1045-1047.
(278)
Shupak NM, McKay JC, Nielson WR, Rollman GB, Prato FS, Thomas
AW. Exposure to a specific pulsed low-frequency magnetic field:
a double-blind placebo-controlled study of effects on pain
ratings in rheumatoid arthritis and fibromyalgia patients. Pain
Res Manag 2006; 11(2):85-90.
Abstract: BACKGROUND: Specific pulsed electromagnetic fields
(PEMFs) have been shown to induce analgesia (antinociception) in
snails, rodents and healthy human volunteers. OBJECTIVE: The
effect of specific PEMF exposure on pain and anxiety ratings was
investigated in two patient populations. DESIGN: A double-blind,
randomized, placebo-controlled parallel design was used. METHOD:
The present study investigated the effects of an acute 30 min
magnetic field exposure (less than or equal to 400 microTpk;
less than 3 kHz) on pain (McGill Pain Questionnaire [MPQ],
visual analogue scale [VAS]) and anxiety (VAS) ratings in female
rheumatoid arthritis (RA) (n=13; mean age 52 years) and
fibromyalgia (FM) patients (n=18; mean age 51 years) who
received either the PEMF or sham exposure treatment. RESULTS: A
repeated measures analysis revealed a significant
pre-post-testing by condition interaction for the MPQ Pain
Rating Index total for the RA patients, F(1,11)=5.09, P<0.05,
estimate of effect size = 0.32, power = 0.54. A significant
pre-post-effect for the same variable was present for the FM
patients, F(1,15)=16.2, P<0.01, estimate of effect size = 0.52,
power =0.96. Similar findings were found for MPQ subcomponents
and the VAS (pain). There was no significant reduction in VAS
anxiety ratings pre- to post-exposure for either the RA or FM
patients. CONCLUSION: These findings provide some initial
support for the use of PEMF exposure in reducing pain in chronic
pain populations and warrants continued investigation into the
use of PEMF exposure for short-term pain relief
(279)
Simon LS. Is milnacipran effective in treating pain in patients
with fibromyalgia? Nat Clin Pract Rheumatol 2006; 2(3):126-127.
(280)
Singh BB, Wu WS, Hwang SH, Khorsan R, Der-Martirosian C,
Vinjamury SP et al. Effectiveness of acupuncture in the
treatment of fibromyalgia. Altern Ther Health Med 2006;
12(2):34-41.
Abstract: CONTEXT: Fibromyalgia syndrome (FMS) is a prevalent
musculoskeletal disorder associated with pain, mood state
alteration, and disability. A structured and effective treatment
plan for palliative care has not been established. The genesis
of FMS is not clear. FMS occurs primarily in adult women.
DESIGN: Using a quasi-experimental clinical design and following
the criteria of the American College of Rheumatology (ACR), for
FMS, 21 participants completed the study. The mean age was 53.6
years. The data were collected at baseline and at 1 and 2
months. Acupuncture treatments included 17 points for FMS
symptoms, and 8 outcome measures were collected. RESULTS: The
Fibromyalgia Impact Questionnaire (FIQ) showed significant
differences at 1 and 2 months. For the SF-12, 3 subscales showed
significant differences between baseline and 2 months. Four of 6
items were significantly changed. The mean number of general
health symptoms was significantly decreased by 2 months. For the
Catastrophe Index, significant differences were f |
