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(1) Bradley LA, McKendree-Smith NL, Alarcon GS, Cianfrini LR. Is fibromyalgia a neurologic
disease? Curr Pain Headache Rep 2002; 6( 2):106-114.
Abstract: Fibromyalgia (FM) is characterized by abnormal pain sensitivity in
response to diverse stimuli as well as persistent widespread pain and other
symptoms such as fatigue and sleep disturbance. Progress has been made in
identifying factors that contribute to the etiopathogenesis of abnormal pain
sensitivity, but there is no single model of pathophysiology or treatment of
FM that has gained wide acceptance among health care professionals. We
review the literature on the etiopathogenesis of abnormal pain sensitivity
in FM and describe an explanatory model that serves as a source of testable
hypotheses in our laboratory. This model posits that interactions of
exogenous (eg, environmental stressors) and endogenous (eg, neuroendocrine
dysfunction) abnormalities in genetically predisposed individuals lead to a
final common pathway, ie, alterations in central nervous system function and
neuropeptide production that underlie central sensitization and abnormal
pain sensitivity. This model also suggests that efforts to develop and
evaluate treatments for FM should focus on interventions with direct or
indirect effects on central functions that influence pain sensitivity
(2) Martinez-Lavin
M, Vidal M, Barbosa RE, Pineda C, Casanova JM, Nava A. Norepinephrine-evoked
pain in fibromyalgia. A randomized pilot study [ISRCTN70707830]. BMC
Musculoskelet Disord 2002; 3(1):2.
Abstract: BACKGROUND: Fibromyalgia syndrome displays sympathetically
maintained pain features such as frequent post-traumatic onset and stimuli-
independent pain accompanied by allodynia and paresthesias. Heart rate
variability studies showed that fibromyalgia patients have changes
consistent with ongoing sympathetic hyperactivity. Norepinephrine- evoked
pain test is used to assess sympathetically maintained pain syndromes. Our
objective was to define if fibromyalgia patients have norepinephrine-evoked
pain. METHODS: Prospective double blind controlled study. Participants:
Twenty FM patients, and two age/sex matched control groups; 20 rheumatoid
arthritis patients and 20 healthy controls. Ten micrograms of norepinephrine
diluted in 0.1 ml of saline solution were injected in a forearm. The
contrasting substance, 0.1 ml of saline solution alone, was injected in the
opposite forearm. Maximum local pain elicited during the 5 minutes
post-injection was graded on a visual analog scale (VAS). Norepinephrine-evoked
pain was diagnosed when norepinephrine injection induced greater pain than
placebo injection. Intensity of norepinephrine-evoked pain was calculated as
the difference between norepinephrine minus placebo-induced VAS scores.
RESULTS: Norepinephrine-evoked pain was seen in 80 % of FM patients (95%
confidence intervals 56.3 -- 94.3%), in 30 % of rheumatoid arthritis
patients and in 30 % of healthy controls (95% confidence intervals 11.9 --
54.3) (p < 0.05). Intensity of norepinephrine-evoked pain was greater in FM
patients (mean plus minus SD 2.5 plus minus 2.5) when compared to rheumatoid
arthritis patients (0.3 plus minus 0.7), and healthy controls (0.3 plus
minus 0.8) p < 0.0001. CONCLUSIONS: Fibromyalgia patients have
norepinephrine-evoked pain. This finding supports the hypothesis that
fibromyalgia may be a sympathetically maintained pain syndrome
(3) von WD. Use
of mindfulness meditation for fibromyalgia. Am Fam Physician 2002;
65(3):380, 384.
(4) Ostuni P,
Botsios C, Sfriso P, Punzi L, Chieco-Bianchi F, Semerano L et al.
Fibromyalgia in Italian patients with primary Sjogren's syndrome . Joint
Bone Spine 2002; 69(1):51-57.
Abstract: OBJECTIVE: To assess the prevalence of fibromyalgia in primary
Sjogren's syndrome and to evaluate the clinical differences between patients
affected with both primary fibromyalgia and primary Sjogren's syndrome and
those affected only with primary fibromyalgia. METHODS: Clinical features of
fibromyalgia were evaluated in 100 consecutive outpatients with primary
Sjogren's syndrome and, as controls, in 90 patients with
non-insulin-dependent diabetes mellitus, in 75 patients with primary
fibromyalgia and in 30 healthy subjects. RESULTS: Fibromyalgia was recorded
in 22% of patients with primary Sjogren's syndrome, in 12.2% with diabetes
and in 3.3% of healthy controls. In the primary Sjogren's syndrome group the
prevalence was significantly higher than in healthy controls (P < 0.01), but
not significantly different than in diabetes. Moreover, primary Sjogren's
syndrome with fibromyalgia and primary fibromyalgia patients did not differ
with respect to the number of tender points, while the mean pain threshold
was lower in the latter (P = 0.05). Purpura, hypergammaglobulinemia,
rheumatoid factor, and a focus score > or = 1 on lip biopsy were
significantly more frequent in primary Sjogren's syndrome patients without
than with fibromyalgia. CONCLUSIONS: As recently reported by other authors,
our study confirms the moderate increase of fibromyalgia prevalence in
primary Sjogren's syndrome. Typical fibromyalgic findings are quite similar
to those of primary fibromyalgia, but surprisingly, primary Sjogren's
syndrome patients with fibromyalgia show a less severe global involvement
than those with primary Sjogren's syndrome alone
(5) Karper WB,
Hopewell R, Hodge M. Exercise program effects on women with fibromyalgia
syndrome. Clin Nurse Spec 2001; 15(2):67-73.
Abstract: The purpose of this study (evaluation) was to examine the effects
of an exercise program on 13 women with physician-diagnosed fibromyalgia
syndrome (FMS). Participants engaged in exercise for 60 minutes each
session. Group 1 (N=7) was in a 3-day-per-week program for 12 months, and
group 2 (N= 6) was in a 3-day-per-week program for six months. Group 3 (N=
3) consisted of three participants from Group 1 who participated for six
additional months past the 12-month period (total-- 18 months). Group 3
attended five sessions per week during the six additional months. All
participants engaged in aerobic and resistance training. Information was
collected on physical fitness, psychosocial, and FMS symptom variables. A
majority of the participants appeared to experience a positive outcome on
numerous measures of physical fitness, psychosocial factors, and FMS
symptoms. Interview data support results. The 13 participants gained various
benefits from the exercise program and functioned the same or better outside
of the program. Implications for advising FMS patients relative to exercise
are given for clinical nurse specialists
(6) Raak R,
Wahren LK. Background pain in fibromyalgia patients affecting clinical
examination of the skin. J Clin Nurs 2002; 11(1):58-64.
Abstract: The purpose of this study was to investigate the relationship
between on-going pain and acute thermal pain in patients suffering from
chronic pain. This experimental study in cold and heat sensitivity was
performed in order to test the following hypothesis: that fibromyalgia
patients scoring high in current background pain tolerate less experimental
thermal pain in the skin than patients with low scores. Ethical aspects of
the study are discussed. The level of tolerable experimental thermal stimuli
was tested and compared between the 'low- score' and the 'high-score'
patients. Background pain seemed to affect the intensity of experimental
cold pain. Clinical routine examinations and bodily care of the skin that
might interfere with background pain in the fibromyalgia patients are
discussed. Clinical practice should be carefully planned in order to assist
fibromyalgia patients in understanding and coping with thermal conditions
that might influence background pain
(7) Gur A,
Karakoc M, Nas K, Cevik R, Sarac J, Demir E. Efficacy of Low Power Laser
Therapy in Fibromyalgia: A Single-blind, Placebo-controlled Trial. Lasers
Med Sci 2002; 17(1):57-61.
Abstract: Low energy lasers are widely used to treat a variety of
musculoskeletal conditions including fibromyalgia, despite the lack of
scientific evidence to support its efficacy. A randomised, single-blind,
placebo- controlled study was conducted to evaluate the efficacy of
low-energy laser therapy in 40 female patients with fibromyalgia. Patients
with fibromyalgia were randomly allocated to active (Ga-As) laser or placebo
laser treatment daily for two weeks except weekends. Both the laser and
placebo laser groups were evaluated for the improvement in pain, number of
tender points, skinfold tenderness, stiffness, sleep disturbance, fatigue,
and muscular spasm. In both groups, significant improvements were achieved
in all parameters (p<0.05) except sleep disturbance, fatigue and skinfold
tenderness in the placebo laser group (p>0.05). It was found that there was
no significant difference between the two groups with respect to all
parameters before therapy whereas a significant difference was observed in
parameters as pain, muscle spasm, morning stiffness and tender point numbers
in favour of laser group after therapy (p<0.05). None of the participants
reported any side effects. Our study suggests that laser therapy is
effective on pain, muscle spasm, morning stiffness, and total tender point
number in fibromyalgia and suggests that this therapy method is a safe and
effective way of treatment in the cases with fibromyalgia
(8) Schlienger JL,
Perrin AE, Grunenberger F, Goichot B. [Hormonal perturbations in
fibromyalgia]. Ann Endocrinol (Paris) 2001; 62(6):542-548.
Abstract: Fibromyalgia is a syndrome characterized by chronic
musculoskeletal pain and fatigue without biological detectable disturbances.
The mechanisms of this disease are unknown. It has been postulated that it
can be the consequence of a chronic stress mediated mainly through the
hypothalamo-pituitary-adrenal axis and the sympathetic nervous system. These
fields have been extensively studied. Results were scattered and non
convincing. A reduction of growth hormone and IGF-1 levels decribed in a
third of patients has led to a double blind random clinical trial with
biogenetic growth hormone. Results were equivocal . Other hormonal systems
are grossly normals and circadian rythms are unaltered. Despite some
arguments in favour of a CRH neurons hyperactivity, these results are not
able to consolide a particular physiopathological mechanism and to argument
for a new therapeutic approach. Many of the abnormalies may be the
consequence of psychological disturbances
(9) Valim V,
Oliveira LM, Suda AL, Silva LE, Faro M, Neto TL et al. Peak oxygen uptake
and ventilatory anaerobic threshold in fibromyalgia. J Rheumatol 2002;
29(2):353-357.
Abstract: OBJECTIVE: To compare maximum oxygen uptake and anaerobic
threshold in patients with fibromyalgia (FM) and healthy sedentary controls
matched by sex, age, weight, and body mass index. METHODS: Fifty women with
FM aged 18-60 years and 50 healthy sedentary controls were studied. All were
submitted to a maximum treadmill incremental test. Expired gas, ventilatory
anaerobic threshold, and maximum oxygen uptake (VO2max) were evaluated. The
influence of FM on quality of life was evaluated by questionnaires: the
Fibromyalgia Impact Questionnaire and the Medical Outcomes Study Short-Form
(SF-36). RESULTS: In patients with FM, the anaerobic threshold and peak
oxygen uptake were significantly reduced. Maximum heartbeat rate was
significantly lower in FM, indicating submaximum effort. Linear regression
data showed a correlation between peak VO2 and the "Role-physical" domain of
the SF-36. No such correlations were noted with anaerobic threshold.
CONCLUSION: These results confirm the hypothesis of lower physical fitness
in patients with FM. Considering that patients with FM do not achieve a
maximum effort, ventilatory anaerobic threshold should be considered as a
better fitness index than VO2max
(10) Staud R.
Somatization does not fit all fibromyalgia patients: Comment on the article
by Winfield. Arthritis Rheum 2002; 46(2):564-565.
(11) Wassem R,
McDonald M, Racine J. Fibromyalgia: patient perspectives on symptoms,
symptom management, and provider utilization. Clin Nurse Spec 2002;
16(1):24-28.
Abstract: Two surveys of individuals with fibromyalgia were conducted to
assess the frequency and prevalence of symptoms (N = 99) as well as
healthcare providers, medications, and self-care activities used to manage
one's fibromyalgia (N = 54). The pervasiveness of symptoms was striking,
with 24 various symptoms ranging from cognitive to intestinal problems
occurring in at least 75% of the respondents. Significant correlations were
present between health status and both physical (P = .002) and psychological
(P =.008) symptoms. There was also a significant correlation between the
total number of symptoms and the degree of life disruption attributed to
fibromyalgia (P =.015). A variety of healthcare professionals were seen,
with internists, family physicians, and rheumatologist most frequently used.
Although at least 80% of the respondents reported difficulty with anxiety,
confusion, irritability, depression, and cognitive difficulties, less than
10% of the respondents reported seeing a psychiatrist. Most frequently used
medications were: amitriptyline, (fluoxetine HCl) Prozac, ibuprofen
(Motrin), sertraline HCI (Zoloft), and zolpidem (Ambein). Self-care
activities used with the most success were walking, stretching, and
exercising. These studies indicate the need for more research and support
for healthcare providers as well as patients with fibromyalgia
(12) Holman AJ. Is
hypermobility a factor in fibromyalgia? J Rheumatol 2002; 29(2):396-398.
(13) Klein R, Berg
PA. Diagnostic relevance of antibodies to serotonin and phospholipids in
fibromyalgia syndrome. J Rheumatol 2002; 29(2):395-396.
(14) Gur A,
Karakoc M, Nas K, Remzi, Cevik, Denli A et al. Cytokines and depression in
cases with fibromyalgia. J Rheumatol 2002; 29(2):358-361.
Abstract: OBJECTIVE: Fibromyalgia (FM) is a chronic, painful musculoskeletal
disorder characterized by widespread pain, pressure, hyperalgesia, morning
stiffness, and an increased incidence of depressive symptoms. The etiology,
however, has remained elusive. The aim of the present study was to examine
the inflammatory response system in FM and to investigate the effect of
depression level on serum cytokines. METHODS: Serum interleukin-1 (IL-I),
IL-2 receptor (IL-2r), IL-6, and IL-8 and the Hamilton Depression Rating
Scale (HDRS) score were determined in 32 healthy volunteers and in 81
patients with FM, classified according to the American College of
Rheumatology criteria. RESULTS: In our study, serum IL-1 and IL-6 were not
statistically significant, but serum IL-8, IL2r, and HDRS score were
significantly higher in patients with FM than the control group (p < 0.01).
In addition, in patients with FM, IL-8 was found to be related to pain
intensity (r = 0.35; p < 0.01). CONCLUSION: IL-8 may play an important role
in the occurrence of pain in FM
(15) Paulson M,
Danielson E, Soderberg S. Struggling for a tolerable existence: the meaning
of men's lived experiences of living with pain of fibromyalgia type. Qual
Health Res 2002; 12(2):238-249.
Abstract: Chronic pain is a major health problem in Sweden because of its
consequences in daily life. Fourteen men with fibromyalgia-type pain were
interviewed regarding their experiences. A phenomenological hermeneutic
method was used to interpret the transcribed interviews. Three major themes
emerged: experiencing the body as an obstruction, being a different man, and
striving to endure. Overall, the meaning of men's lived experience of
chronic pain was experienced as change in the body, self, and relationships.
Striving to live life required achieving balance during both calm and
difficult phases of the illness-- struggling for a tolerable existence.
Information from this study could provide guidelines for health care staff
members to give empathic and supportive care to men living with a long-term
illness
(16) Asbring P,
Narvanen AL. Women's experiences of stigma in relation to chronic fatigue
syndrome and fibromyalgia. Qual Health Res 2002; 12(2):148-160.
Abstract: Chronic fatigue syndrome and fibromyalgia are characterized by
being difficult to diagnose and having an elusive etiology and no clear-cut
treatment strategy. The question of whether these illnesses are stigmatizing
was investigated through interviews with 25 women with these illnesses. The
women experienced stigmatization primarily before receiving a diagnosis, and
the diffuse symptomatology associated with the illnesses were significant
for stigmatization. Stigma consisted of questioning the veracity, morality,
and accuracy of patient symptom descriptions and of psychologizing symptoms.
Coping with stigma was also explored and found to comprise both withdrawal
and approach strategies, depending on the individual's circumstances and
goals
(17) Fors EA,
Sexton H. Weather and the pain in fibromyalgia: are they related? Ann Rheum
Dis 2002; 61(3):247-250.
Abstract: OBJECTIVES: To examine the association between fibromyalgic pain
and weather to determine the nature of their interrelationship. METHODS: The
daily pain ratings of 55 female patients previously diagnosed with
fibromyalgia were recorded on visual analogue scales (VAS) over 28 days.
These ratings were then related to the official weather parameters and a
composite weather variable using time series methodology. Effect sizes r
were calculated from the t values and df. RESULTS: A composite weather
variable did not significantly predict changes in pain, either the same day
(t=-1.15, df=1483, p=0.25) or on the next day (t=-1.55, df=1483,
p=0.12)-that is, the weather was not a factor for changes in the subjective
pain of FM. Patients' pain did not predict weather change in this sample,
and neither same day (t=-0. 69, df=1483, p<0.49) nor previous day pain
(t=-1.31, df=1483, p<0.19) predicted weather changes. A post hoc exploratory
analysis showed that those with <10 years of fibromyalgia experienced
significantly greater weather sensitivity to pain (t=- 2.73, df=389,
p<0.006) than those with longer illness. CONCLUSION: A statistically
significant relationship between fibromyalgic pain and the weather was not
found in this sample, although it is possible that a group of patients with
less chronic fibromyalgia might be weather sensitive
(18) Bliddal H,
Moller HJ, Danneskiold-Samsoe B. [Semiobjective and real pain in
fibromyalgia]. Ugeskr Laeger 2002; 164(3):356-357.
(19) Buskila D,
Press J. Neuroendocrine mechanisms in fibromyalgia-chronic fatigue. Best
Pract Res Clin Rheumatol 2001; 15(5):747-758.
Abstract: Fibromyalgia and chronic fatigue syndrome are poorly understood
disorders that share similar demographic and clinical characteristics.
Because of the clinical similarities between both disorders it was suggested
that they share a common pathophysiological mechanism, namely, central
nervous system dysfunction. This chapter presents data demonstrating
neurohormonal abnormalities, abnormal pain processing and autonomic nervous
system dysfunction in fibromyalgia and chronic fatigue syndrome. The
possible contribution of the central nervous system dysfunction to the
development and symptomatology of these conditions is discussed. The chapter
concludes by reviewing the effect of current treatments and emerging
therapeutic modalities in fibromyalgia and chronic fatigue syndrome
(20) Chester AC.
Surgery for fibromyalgia. Cleve Clin J Med 2002; 69(1):89.
(21) Heffez DS.
Surgery for fibromyalgia. Cleve Clin J Med 2002; 69(1):89-91.
(22) Kohl F.
Somatoforme Schmerzstorung und Fibromyalgie Zur Problematik ihrer
gutachterlichen Bewertung im Rahmen des Schwerbehindertengesetzes (SchwbG)
Somatoform Pain Disorder and Fibromyalgia - difficulties and problems of
their judgement in german consultant praxis. Schmerz 2001; 15(3):192-196.
Abstract: Zusammenfassung. Durch verschiedene Entwicklungen in Medizin und
Gesellschaft haben somatoforme Schmerzstorungen und Fibromyalgie- Syndrome
in den letzten 2 Jahrzehnten erheblich an arztlicher und auch an
sozialrechtlicher Bedeutung gewonnen. Gerade dem gutachterlich Tatigen
begegnen zunehmend komplexere Fragestellungen, die in den gangigen
Leitlinien und auch den amtlichen Bewertungsrichtlinien nicht erwahnt werden
oder denen nicht ausreichend differenziert Rechnung getragen wird. Anhand
der Kasuistik eines in mancher Hinsicht "typischen Falles" des kombinierten
Vorliegens von somatoformer Schmerzstorung und Fibromyalgie sollen
charakteristische und haufig gesehene Aspekte dieser Konstellation
thematisiert und nach Losungswegen der bestimmungsgemassen Beurteilung
gesucht werden, die den rechtlichen Leitlinien der Sozialgesetzgebung und
der veroffentlichten Anhaltspunkte entsprechen. Dabei zeigt sich zum einen
die Problematik, dass diese oftmals in Komorbiditat zusammen auftretenden
Storungsbilder breite definitorische und symptomatische Uberlappungsbereiche
zeigen konnen, wobei eine an biologischen Aussenkriterien sich orientierende
Krankheitsdefinition in beiden Fallen (noch) nicht moglich ist. Zum Zweiten
sind in den vorliegenden "Anhaltspunkten" und den erganzenden
Literaturstellen keine ausreichend prazisen Vorgaben zu erkennen, zumindest
nicht solche, die dem Gutachter eine einfache Orientierung erlauben. Diese
Konstellation erfordert daher eine differenzierte Diskussion sowohl des
Krankheitsbildes als auch der bestimmungsgemass zugrunde zu legenden
Beurteilungskriterien, um zu einer sowohl dem individuellen Gesundheits- und
Funktionszustand als auch den sozialrechtlichen Kriterien genugenden
Bewertung zu kommen. Offene Fragen und gutachterliche Losungsalternativen
werden abschliessend diskutiert. In the last 20 years the fibromyalgia
syndrome and the somatoform pain disorder became more and more important in
clinical medicine and in legal affairs. The consultant meets progressive
more specific questions, which are not sufficiant mentioned in the
medico-legal recommendations and at least national "guide-lines" of medical
societies. Methods: By an casuistic approach wie try to show the
implications of the often seen comorbidity of these two common disorders (i.
e. the fibromyalgia syndrome and the somatoform pain disorder) both in legal
and in medical perspectives. Results: At the moment the medico-legal
recommendations and the national "guide-lines" of medical societies are
often not sufficiant to decide many of the the legal implications and
consultant questiones that result from the comorbidity ot these often seen
"modern disorders". Therefore we try to develop in an single case the
solucion principles of appropriate judgement for the functional effects of
comorbidity with fibromyalgia syndrome and the somatoform pain disorder.
Conclusions: Because of the wide spectrum of comorbid symptoms between these
both disorders one must analyse any specific case very exactly and proove
the individual functional implications of the comorbidity in correlation to
the degree of impairement. We try to show in an casuistic presentation the
possibilities of judgement according the appointments of german law
(23) Dohrenbusch
R. [Are patients with fibromyalgia "hypervigilant"?]. Schmerz 2001;
15(1):38-47.
Abstract: INTRODUCTION: Clinical and experimental studies suggest that a
generalized style of hypervigilant information processing may influence the
pathogenesis of fibromyalgia (FM). This article deals with the question
whether perception and processing of sensory stimuli in patients suffering
from FM can be described in terms of "generalized hypervigilance". METHODS:
The components of hypervigilant stimulus processing were defined and
discussed with reference to the current literature. RESULTS: This literature
review indicates that perceptual thresholds are not reduced in the majority
of FM-patients. A strategy of hypervigilant information processing has
consistently been shown only for suprathreshold aversive stimuli or under
pressure to perform well. This is true for psychophysical as well as for
neurophysiological parameters. The results concerning information processing
of external stimuli cannot be transferred easily to the processing of
somatosensory stimuli. CONCLUSION: On the whole the existing studies argue
against the assumption of trait-like hypervigilant information processing in
FM- patients. A more appropriate explanation of the results is in terms of
the interaction of situational and personal factors
(24) Kurtze N,
Svebak S. Fatigue and patterns of pain in fibromyalgia: Correlations with
anxiety, depression and co-morbidity in a female county sample. Br J Med
Psychol 2001; 74 Part 4:523-537.
Abstract: This study explored the prevalence of fibromyalgia, the
relationship of anxiety and depression with two major symptoms (pain and
fatigue), and the role of co-morbidity. Participants were recruited from the
Nord- Trondelag Health Study (The HUNT Study) in Norway (N = 92 936). They
were females given the diagnosis of fibromyalgia by their doctor (N = 1
816), divided into one sample without (N = 977) and another with (N = 839)
co-morbidity. Owing to colinearity between anxiety and depression, extreme
groups were defined according to high vs. low anxiety and depression scores.
About four-fifths of the initial sample were excluded by this approach,
which permitted a two x two factorial split- plot ANCOVA for the assessment
of the relations of anxiety and depression with pain and fatigue. The
overall prevalence was 3.2%, which obscured a highly biased sex difference
with 5.2% for females and.9% for males. Results from the sample without
co-morbidity (N = 977) supported the idea of independent partial
correlations of anxiety and depression with pain and fatigue. A different
trend was indicated in the co-morbidity sample (N = 839) where fatigue was
only significantly associated with depression, whereas pain was associated
with anxiety. The idea of widespread pain was supported consistently only in
participants without co-morbidity who scored low on anxiety. Age, incident
pain and depression contributed to a discriminant function reflecting the
status of co-morbidity
(25) Heymann RE,
Helfenstein M, Feldman D. A double-blind, randomized, controlled study of
amitriptyline, nortriptyline and placebo in patients with fibromyalgia. An
analysis of outcome measures. Clin Exp Rheumatol 2001; 19(6):697-702.
Abstract: OBJECTIVE: To study the efficacy and tolerability of amitriptyline
and nortriptyline in a Brazilian population with fibromyalgia and to
evaluate the instruments used to measure the efficacy of the treatment.
METHODS: A total of 118 fibromyalgia patients were randomly assigned to 3
groups: amitriptyline (AM, n = 40), nortriptyline (NOR, n =38) and placebo
(PL, n = 40), and were blindly given 25 mg at bedtime of the assigned
treatment for 8 weeks. Clinical evaluation before and at the end of the
study included the number of tender points (NTP), FIQ score (FIQ), and
global improvement as reported by the patients on a verbal scale (VSGI).
RESULTS: The 3 groups were comparable at baseline for all the parameters
studied. After 8 weeks, the 3 groups improved in all parameters: (36.5% AM,
26.7% NOR and 24% PL patients improved on FIQ; 13.9% AM, 19.5% NOR and 8.57%
PL patients improved on NTP; 86.5% AM, 72.2% NOR and 57.6% PL patients
improved on VSGI). Only the AM group differed from the PL group on VSGI.
Side effects were noted among the groups, but none were serious (16 in the
AM group, 31 in the NOR group, and 25 in the PL group). CONCLUSION: All
three groups improved after treatment. Only the patient's subjective global
assessment of improvement differed between the AM patients and the PL group
(p < or = 0.03). In fibromyalgia, placebo groups are important in drug
trials. Different measures of therapeutic effect are not better than the
patient's self assessment
(26) Bradley LA,
McKendree-Smith NL. Central nervous system mechanisms of pain in
fibromyalgia and other musculoskeletal disorders: behavioral and psychologic
treatment approaches. Curr Opin Rheumatol 2002; 14(1):45-51.
Abstract: Pain is one of the most important and challenging consequences of
musculoskeletal disorders. This article examines the role of central nervous
system structures in the physiology of pain. It also describes the
neuromatrix, a construct that provides a framework for understanding the
interaction between physiologic mechanisms and psychosocial factors in the
development and maintenance of chronic pain. This construct suggests that
behavioral and psychologic interventions may alter the pain experience
primarily through their effects on emotional states and cognitive processes.
The literature on cognitive-behavioral interventions for patients with
rheumatoid arthritis and osteoarthritis indicates that they are
well-established treatments for these disorders. However, the efficacy of
these interventions for patients with fibromyalgia has not been established.
It is anticipated that the development of valid measures of readiness for
behavioral change may allow investigators to identify the patients with
musculoskeletal disorders who are most likely to benefit from
cognitive-behavioral intervention
(27) Hurtig IM,
Raak RI, Kendall SA, Gerdle B, Wahren LK. Quantitative sensory testing in
fibromyalgia patients and in healthy subjects: identification of subgroups.
Clin J Pain 2001; 17(4):316-322.
Abstract: OBJECTIVE: To determine perception and pain thresholds in patients
with fibromyalgia syndrome and in healthy controls, and to investigate
whether patients with fibromyalgia syndrome can be grouped with respect to
thermal hyperalgesia and whether these subgroups differ from healthy
controls and in clinical appearance. DESIGN: The authors conducted a
quasi-experimental clinical study. SUBJECTS: Twenty-nine women patients with
fibromyalgia syndrome and 21 healthy pain-free age-matched women
participated in the study. METHODS: Quantitative sensory testing using a
Thermotest instrument was performed on the dorsum of the left hand. Sleep
and pain intensity were rated using visual analog scales. RESULTS: Cold and
heat pain but not perception thresholds differed significantly between
patients with fibromyalgia syndrome and healthy subjects. Based on thermal
pain thresholds, two subgroups could be identified in fibromyalgia syndrome
using cluster analysis. CONCLUSION: Patients with fibromyalgia syndrome were
subgrouped by quantitative sensory testing (i.e., thermal pain thresholds).
Subgroups show clinical differences in pain intensities, number of tender
points, and sleep quality. Cold pain threshold was especially linked to
these clinical aspects
(28) Leibing E,
Ruger U, Schussler G. [Biographic risk factors and mental disorders in
fibromyalgia]. Z Psychosom Med Psychother 1999; 45(2):142-156.
Abstract: Patients with fibromyalgia are compared with rheumatoid arthritis
and coxarthrosis patients respecting biographic risk factors and comorbidity
(mental disorders). As expected, in fibromyalgia there are higher biographic
risk factors and more mental disorders than in the other groups. Moreover,
there is a positive relation between mental disorders and biographic risk
factors in fibromyalgia. Therefore patients with fibromyalgia are no uniform
group, but can be divided in at least two subgroups: One subgroup with high
biographic risk factors and mental disorders and another subgroup without
increased biographic risk factors and without comorbidity (mental
disorders). Consequences for psychosomatic theories are discussed
(29) Kurtze N,
Svebak S. Fatigue and patterns of pain in fibromyalgia: correlations with
anxiety, depression and co-morbidity in a female county sample. Br J Med
Psychol 2001; 74(Pt 4):523-537.
Abstract: This study explored the prevalence of fibromyalgia, the
relationship of anxiety and depression with two major symptoms (pain and
fatigue), and the role of co-morbidity. Participants were recruited from the
Nord- Trondelag Health Study (The HUNT Study) in Norway (N = 92,936). They
were females given the diagnosis of fibromyalgia by their doctor (N =
1,816), divided into one sample without (N = 977) and another with (N = 839)
co-morbidity. Owing to colinearity between anxiety and depression, extreme
groups were defined according to high vs. low anxiety and depression scores.
About four-fifths of the initial sample were excluded by this approach,
which permitted a two x two factorial split- plot ANCOVA for the assessment
of the relations of anxiety and depression with pain and fatigue. The
overall prevalence was 3.2%, which obscured a highly biased sex difference
with 5.2% for females and .9% for males. Results from the sample without
co-morbidity (N = 977) supported the idea of independent partial
correlations of anxiety and depression with pain and fatigue. A different
trend was indicated in the co-morbidity sample (N = 839) where fatigue was
only significantly associated with depression, whereas pain was associated
with anxiety. The idea of widespread pain was supported consistently only in
participants without co-morbidity who scored low on anxiety. Age, incident
pain and depression contributed to a discriminant function reflecting the
status of co-morbidity
(30) Gursel Y,
Ergin S, Ulus Y, Erdogan MF, Yalcin P, Evcik D. Hormonal responses to
exercise stress test in patients with fibromyalgia syndrome . Clin Rheumatol
2001; 20(6):401-405.
Abstract: Twenty patients with fibromyalgia syndrome (FMS) and 20 matched
healthy controls were subjected to an exercise stress test above their
anaerobic threshold. Serum samples for the measurement of growth hormone (GH),
insulin-like growth factor-1 (IGF-1), prolactin (PRL), adrenocorticotrophic
hormone (ACTH) and cortisol were taken prior to and after the test at 30-min
intervals. Compared to the controls, the patients with FMS displayed
significantly lower basal GH levels and slightly, though significantly,
higher prolactin levels. Following the exercise test there was a significant
increase in the mean GH level in the patient group (P = 0.0474) and a
significant decrease in the control group (P = 0.0286) 1 hour after the
exercise. A slight decrease in ACTH levels in the control group was observed
(P = 0.0002), but there was no significant change in FMS patients. Cortisol
levels were significantly lower in both groups after the exercise (P =
0.0001). These results suggest the possibility of a perturbation in hormonal
response to exercise in patients with FMS
(31) McGurk C,
Wilson D, Henry W. Diagnosing fibromyalgia. Practitioner 2001;
245(1629):1026-1030.
(32) Offenbacher
M, Schwarz M, Stucki G. [Fewer problems with fibromyalgia patients.
Prescriptions in therapy frustration]. MMW Fortschr Med 2001; 143(48):43-46.
(33) Rothschild
BM. Fibromyalgia: can one distinguish it from simulation? J Rheumatol 2001;
28(12):2762-2763.
(34) Oliver K,
Cronan TA, Walen HR, Tomita M. Effects of social support and education on
health care costs for patients with fibromyalgia. J Rheumatol 2001;
28(12):2711-2719.
Abstract: OBJECTIVE: The rising costs of health care are of great concern,
particularly for the chronically ill. Interventions that promote health
status and well being while teaching appropriate use of the health care
system have led to cost savings among patients with osteoarthritis. We
carried out social support and education interventions with patients with
fibromyalgia (FM) and assessed the effect on health care costs, psychosocial
variables, and health status. METHODS: Participants were 600 patients with
FM who were members of a health maintenance organization. They were randomly
assigned to one of 2 experimental groups (social support; social support and
education) or to a no- treatment control group. Assessments were conducted
at baseline and following a one year intervention. Health care cost data
were obtained directly from participants' medical records. RESULTS: Results
indicated significant reductions in all groups' costs of prescriptions,
laboratory tests, and visits to a nurse, nurse practitioner and/or
physicians' assistant. All groups also showed improvements on variables
assessing effect of FM, self-efficacy, depression, and knowledge of FM. The
social support and education group was less helpless after one year than the
other groups; differential changes for all other variables were not
significant. CONCLUSION: The study did not reveal differential changes in
health care costs among participants in the experimental and control groups.
These findings emphasize the importance of using objective health care
utilization data when calculating health care costs, as well as the value of
including a no-treatment control group to prevent erroneous conclusions
about treatment efficacy
(35) Gowans SE,
deHueck A, Voss S, Silaj A, Abbey SE, Reynolds WJ. Effect of a randomized,
controlled trial of exercise on mood and physical function in individuals
with fibromyalgia. Arthritis Rheum 2001; 45(6):519-529.
Abstract: OBJECTIVE: To evaluate the effect of exercise on mood and physical
function in individuals with fibromyalgia. METHODS: Subjects were randomly
assigned to an exercise (EX) or control (CTL) group. EX subjects
participated in 3 30-minute exercise classes per week for 23 weeks. Subjects
were tested at entry and at 6, 12, and 23 weeks. Tests included the Beck
Depression Inventory (BDI), 6-minute walk, State- Trait Anxiety Inventory (STAI),
Mental Health Inventory (MHI), Fibromyalgia Impact Questionnaire (FIQ),
Arthritis Self-Efficacy Scale (ASES), and a measure of tender points and
knee strength. RESULTS: Fifty subjects (27 EX, 23 CTL) completed the study,
and 31 (15 EX, 16 CTL) met criteria for efficacy analyses. In efficacy
analyses, significant improvements were seen for EX subjects in 6-minute
walk distances, BDI (total, cognitive/ affective), STAI, FIQ, ASES, and MHI
(3 of 5 subscales) scores. These effects were reduced but remained during
intent-to-treat analyses. CONCLUSION: Exercise can improve the mood and
physical function of individuals with fibromyalgia
(36) Brosschot JF,
Aarsse HR. Restricted emotional processing and somatic attribution in
fibromyalgia. Int J Psychiatry Med 2001; 31(2):127-146.
Abstract: OBJECTIVE: Medically unexplained symptoms or syndromes, such as
fibromyalgia (FM), might be partly caused or sustained by a mechanism
involving restricted emotional processing (REP) and the subsequent
attribution of emotional arousal to somatic or syndrome-consistent causes.
In this study, it was hypothesized that FM patients, compared to healthy
individuals, would be higher on trait measures of REP (defensiveness and
alexithymia), and would show affective-autonomic response dissociation, that
is, higher standardized scores of heart rate responses than affective
responses, during negative emotional stimulation. Additionally, FM patients
were expected to attribute their bodily symptoms more to somatic than to
psychological causes. METHOD: Emotional movie excerpts were shown to 16
female FM patients and 17 healthy women. Affective response and heart rate
were monitored continuously, while symptoms and their causal attributions
were measured before and after the excerpts. Repressor coping style and
alexithymia were measured, along with negative affectivity and habitual
attributions of somatic complaints. RESULTS: FM patients nearly all showed
the relatively uncommon combination of high defensiveness and high
anxiousness. Compared with healthy women FM patients were more alexithymic,
showed a higher level of affective-autonomic response dissociation, and
lower within-subject emotional variability. The groups showed opposite
attributional patterns, with FM patients attributing symptoms less to
psychological causes and more to somatic causes. There was no evidence of a
shift in these attributions caused by the emotional stimuli. CONCLUSIONS:
The results provide preliminary support for the hypotheses. Both at trait
and at state level, FM showed restricted emotional processing on most of the
parameters measured, and a high ratio of somatic to psychological symptom
attribution, coupled with high negative affectivity
(37) Wolak T,
Weitzman S, Harman-Boehm I, Friger M, Sukenik S. [Prevalence of fibromyalgia
in type 2 diabetes mellitus]. Harefuah 2001; 140(11):1006-9, 1120 , 1119.
Abstract: This study aimed to assess the prevalence of fibromyalgia and
other pain characteristics among patients with type 2 diabetes mellitus. We
assessed 137 patients with type 2 diabetes mellitus and a control group of
139 patients matched for age and sex that do not suffer from diabetes
mellitus. We examined 9 of 18 typical tender points and 4 control points
with a dolorimeter. There was no difference in the prevalence of
fibromyalgia among men in both groups. However, diabetic men had more tender
points than men in the control group and their threshold for pain at the
corresponding tender points was significantly lower compared to that of the
men in the control group. The diabetic men also reported more pain than
patients in the control group. Diabetic women, on the other hand, had a
significantly higher prevalence of fibromyalgia than women in the control
group: 23.3% versus 10.6% respectively (p = 0.043). There was no significant
difference in the number of tender points and the pain threshold in the two
groups of women. Diabetic women reported more pain than the women in the
control group. In both diabetic men and women the number of tender points
and dolorimeter count directly correlated with the duration of diabetes
(38) Schaller JL,
Behar D. Modafinil in fibromyalgia treatment. J Neuropsychiatry Clin
Neurosci 2001; 13(4):530-531.
(39) Vasey FB,
Mills CR, Wells AF. Silicone breast implants and fibromyalgia. Plast
Reconstr Surg 2001; 108(7):2165-2168.
(40) Gursoy S,
Erdal E, Herken H, Madenci E, Alasehirli B. Association of T102C
polymorphism of the 5-HT2A receptor gene with psychiatric status in
fibromyalgia syndrome. Rheumatol Int 2001; 21(2):58-61.
Abstract: Serotonin (5-HT) is a key neurotransmitter in the central nervous
system. It is suggested that serotonergic dysfunction may be involved in the
pathophysiology of fibromyalgia syndrome (FS). In this study, we aimed to
investigate T102C polymorphism of the 5-HT2A receptor gene in FS.
Fifty-eight patients with FS and 58 unrelated healthy volunteer controls
were included in the study. In both groups, the C/C, C/T, and T/T genotypes
of the 5-HT gene were represented in 31% (22.4% in controls), 50% (53.4%),
and 19% (24.1%), respectively. The 5-HT2A receptor gene polymorphism results
were not significantly different between patients and controls (chi squared
test, P>0.05). There was a significant correlation between patients with the
T/T genotype and the subgroup according to the SCL-90-R test, (analysis of
variance, P<0.05). We also saw that patients with the T/T genotype had the
lowest pain threshold. CONCLUSION. T102C polymorphism of the 5-HT2A receptor
gene is not associated with the etiology of FS. Our results also indicate
that the T/T genotype may be responsible for psychiatric symptoms of FS
(41) Bliddal H,
Moller HJ, Schaadt ML, Danneskiold-Samsoe B. [Biochemical changes in
fibromyalgia. Can serum hyaluronic acid be used diagnostically?]. Ugeskr
Laeger 2001; 163(45):6284-6286.
Abstract: AIM: To assess the levels of hyaluronic acid (HA) in Danish
patients with fibromyalgia (FM). METHODS: Serum levels of HA were determined
in 53 patients with established FM and 55 control samples with a radiometric
assay (Pharmacia). Values were correlated to clinical parameters of disease
severity (duration of disease, tender point scales, visual analogue scales).
RESULTS: There were no differences in the HA levels of patients and
controls. In all the patients, except one, values were within the reference
intervals. Nor was there an association between HA levels and clinical
findings. CONCLUSIONS: Patients with FM do not generally have increased
serum levels of HA, and other serum measurements have not been helpful in
the diagnosis of FM. Some biochemical changes have been described in FM,
however, and these have mainly been observed in the spinal fluid
(42) Parker AJ,
Wessely S, Cleare AJ. The neuroendocrinology of chronic fatigue syndrome and
fibromyalgia. Psychol Med 2001; 31(8):1331-1345.
Abstract: BACKGROUND: Disturbance of the HPA axis may be important in the
pathophysiology of chronic fatigue syndrome (CFS) and fibromyalgia. Symptoms
may be due to: (1) low circulating cortisol; (2) disturbance of central
neurotransmitters; or (3) disturbance of the relationship between cortisol
and central neurotransmitter function. Accumulating evidence of the complex
relationship between cortisol and 5-HT function, make some form of
hypothesis (3) most likely. We review the methodology and results of studies
of the HPA and other neuroendocrine axes in CFS. METHOD: Medline, Embase and
Psychlit were searched using the Cochrane Collaboration strategy. A search
was also performed on the King's College CFS database, which includes over
3000 relevant references, and a citation analysis was run on the key paper (Demitrack
et al. 1991). RESULTS: One-third of the studies reporting baseline cortisol
found it to be significantly low, usually in one-third of patients.
Methodological differences may account for some of the varying results. More
consistent is the finding of reduced HPA function, and enhanced 5-HT
function on neuroendocrine challenge tests. The opioid system, and arginine
vasopressin (AVP) may also be abnormal, though the growth hormone (GH) axis
appears to be intact, in CFS. CONCLUSIONS: The significance of these
changes, remains unclear. We have little understanding of how neuroendocrine
changes relate to the experience of symptoms, and it is unclear whether
these changes are primary, or secondary to behavioural changes in sleep or
exercise. Longitudinal studies of populations at risk for CFS will help to
resolve these issues
(43) Brown GT,
Delisle R, Gagnon N, Sauve AE. Juvenile fibromyalgia syndrome: proposed
management using a cognitive- behavioral approach. Phys Occup Ther Pediatr
2001; 21(1):19-36.
Abstract: In recent years, fibromyalgia has become an increasingly
recognized chronic syndrome. Although it occurs more frequently in adults,
it is also seen among school-age children and adolescents. In such cases, it
is known as juvenile fibromyalgia syndrome (JFS). The widespread pain and
other possible symptoms associated with JFS can have a negative impact on
the occupational performance and developmental tasks of children and
adolescents. As experts in the areas of occupational performance, daily
functional skills, and child development, occupational therapists have a
potential role to play in the assessment and management of children and
adolescents with JFS. To date, however, no occupational therapy management
approach for clients with JFS has been documented in the professional
literature. In this paper, we outline the clinical features of JFS,
pertinent assessment areas, and potential management strategies using a
cognitive-behavioral approach
(44) Farber L,
Stratz TH, Bruckle W, Spath M, Pongratz D, Lautenschlager J et al.
Short-term treatment of primary fibromyalgia with the 5-HT3-receptor
antagonist tropisetron. Results of a randomized, double-blind, placebo-
controlled multicenter trial in 418 patients. Int J Clin Pharmacol Res 2001;
21(1):1-13.
Abstract: We investigated the efficacy and tolerability of short-term
treatment with tropisetron, a selective, competitive 5-HT3-receptor
antagonist in fibromyalgia. The trial was designed as a prospective,
multicenter, double-blind, parallel-group, dose-finding study. We randomly
assigned 418 patients suffering from primary fibromyalgia to receive either
placebo, 5 mg, 10 mg or 15 mg tropisetron once daily for 10 days. Clinical
response was measured by changes in pain score, visual analog scale, tender
point count and ancillary symptoms. Responders were prospectively defined as
patients showing a 35% or higher reduction in pain score. Treatment with 5
mg tropisetron resulted in a significantly higher response rate (39.2%) than
placebo (26.2%) (p < 0.05). In the visual analog scale, the group
administered 5 mg tropisetron showed a significant improvement (p < 0.05)
and the group administered 10 mg tropisetron showed a nonsignificant
clinical benefit. The number of painful tender points was significantly
reduced (p = 0.002) in the 5 mg tropisetron group. Regarding ancillary
symptoms, the 5 mg tropisetron group showed a significant improvement (p <
0.05) in sleep and dizziness. The patients' overall assessment of efficacy
was significantly higher for 5 mg (p = 0.016) and 10 mg (p = 0.002)
tropisetron than for placebo. The safety and tolerability of tropisetron was
good; gastrointestinal tract symptoms were the most frequently reported
adverse events. Short-term treatment of fibromyalgia patients with 5 mg
tropisetron for 10 days proved to be efficacious and well tolerated. In this
study a bell-shaped dose- response curve was seen
(45) Wigley RD,
Page B, Chambers EM. Hyaluronic acid serum levels in fibromyalgia,
nonspecific arm disorder, and controls. J Rheumatol 2001; 28(11):2563.
(46) Huisman AM,
White KP, Algra A, Harth M, Vieth R, Jacobs JW et al. Vitamin D levels in
women with systemic lupus erythematosus and fibromyalgia. J Rheumatol 2001;
28(11):2535-2539.
Abstract: OBJECTIVE: Many patients with systemic lupus erythematosus (SLE)
and fibromyalgia (FM) may spend less time exposed to the sun than healthy
individuals and thus might have low vitamin D levels. It is known that
hydroxychloroquine (HCQ) inhibits conversion of 25(OH)- to 1,25(OH)2-
vitamin D both in vitro and in patients with sarcoidosis. We assessed winter
serum 25(OH)- and 1,25(OH)2-vitamin D levels in patients with SLE and FM.
METHODS: We recruited 25 consecutive female SLE and 25 female FM patients in
London, Ontario, between January and March 2000. Subjects completed a brief
questionnaire. Serum levels of 25(OH)-, 1,25(OH)2-vitamin D, and parathyroid
hormone (PTH) were measured. RESULTS: In SLE patients mean 25(OH)-vitamin D
was 46.5 nmol/l and mean 1,25(OH)2-vitamin D was 74.4 pmol/l. In FM patients
these means were 51.5 nmol/l and 90.1 pmol/l, respectively. Serum
25(OH)-vitamin D levels did not significantly differ between SLE and FM
patients, nor after adjusting for age and vitamin D, milk consumption, and
sun block use. In 14 of the SLE patients and 12 of the FM patients
25(OH)-vitamin D levels < 50 nmol/l were found. SLE patients not using
vitamin D supplements had lower 25(OH)-vitamin D levels than those who did.
1,25(OH)2-vitamin D tended to be lower in the SLE compared to the FM
patients. This difference could be attributed to HCQ use: HCQ users (n = 17)
had lower 1,25(OH)2-vitamin D levels than nonusers (n = 33); the mean
adjusted difference was 24.4 pmol/l (95% CI 2.8-49.9). CONCLUSION: Half the
SLE and FM patients had 25(OH)-vitamin D levels < 50 nmol/l, a level at
which PTH stimulation occurs. Our data suggest that in SLE patients HCQ
might inhibit conversion of 25(OH)-vitamin D to 1,25(OH)2- vitamin D
(47) Moldofsky HK.
Disordered sleep in fibromyalgia and related myofascial facial pain
conditions . Dent Clin North Am 2001; 45(4):701-713.
Abstract: Myofascial pain and fibromyalgia have a recognized relationship to
sleep disturbances. Understanding the comorbidity of these entities helps
the practitioner, physician and dentist alike, be better prepared to manage
the causative factors related to these conditions rather than treating only
the symptoms. The increasing recognition of the coexistence of fibromyalgia,
myofascial pain in the head and neck region, and the presence of
temporomandibular disorders further increases the need for the dentist to be
aware of sleep as a contributory factor from the diagnostic and the
therapeutic aspects. This awareness results in more comprehensive management
and an improved opportunity for optimal patient management as well as
improved sleep and diminished pain levels
(48) Jacobs JW,
Geenen R. Are antidepressant drugs efficacious in the treatment of
fibromyalgia? West J Med 2001; 175(5):314.
(49) Cohen H,
Neumann L, Kotler M, Buskila D. Autonomic nervous system derangement in
fibromyalgia syndrome and related disorders. Isr Med Assoc J 2001;
3(10):755-760.
Abstract: Fibromyalgia syndrome is a chronic, painful musculoskeletal
disorder of unknown etiology and/or pathophysiology. During the last decade
many studies have suggested autonomic nervous system involvement in this
syndrome, although contradictory results have been reported. This review
focuses on studies of the autonomic nervous system in fibromyalgia syndrome
and related disorders, such as chronic fatigue syndrome and irritable bowel
syndrome on the one hand and anxiety disorder on the other, and highlights
techniques of dynamic assessment of heart rate variability. It raises the
potentially important prognostic implications of protracted autonomic
dysfunction in patient populations with fibromyalgia and related disorders,
especially for cardiovascular morbidity and mortality
(50) Kirnap M,
Colak R, Eser C, Ozsoy O, Tutus A, Kelestimur F. A comparison between
low-dose (1 microg), standard-dose (250 microg) ACTH stimulation tests and
insulin tolerance test in the evaluation of hypothalamo-pituitary-adrenal
axis in primary fibromyalgia syndrome. Clin Endocrinol (Oxf) 2001;
55(4):455-459.
Abstract: OBJECTIVE: Primary fibromyalgia syndrome (PFS) is a nonarticular
rheumatological syndrome characterized by disturbances in the hypothalamo-pituitary-adrenal
(HPA) axis. The site of the defect in the HPA axis is a matter of debate.
Our aim was to evaluate the HPA axis by the insulin-tolerance test (ITT),
standard dose (250 microg) ACTH test (SDT) and low dose (1 microg) ACTH test
(LDT) in patients with PFS. DESIGN AND PATIENTS: Sixteen patients (13
female, three male) with PFS were included in the study. Sixteen healthy
subjects (12 female, four male) served as matched controls. ACTH stimulation
tests were carried out by using 1 microg and 250 microg intravenous (i.v.)
ACTH as a bolus injection after an overnight fast, and blood samples were
drawn at 0, 30 and 60 min. The ITT was performed by using i.v. soluble
insulin, and serum glucose and cortisol levels were measured before and
after 30, 60, 90 and 120 min. The 1 microg and 250 microg ACTH stimulation
tests and the ITT were performed consecutively. RESULTS: Peak cortisol
responses to both the low dose test (LDT) and standard dose test (SDT) (589
+/- 100 nmol/l; 777 +/- 119 nmol/l, respectively) were lower in the PFS
group than in the control group (1001 +/- 370 nmol/l; 1205 +/- 386 nmol/l,
respectively) (P < 0.0001). Peak cortisol responses to ITT (730 +/- 81 nmol/l)
in the PFS group were lower than in the control group (1219 +/- 412 nmol/l)
(P < 0.0001). Six of the 16 patients with PFS had peak cortisol responses to
LDT lower than the lowest peak cortisol response of 555 nmol/l obtained in
healthy subjects after LDT. There was a significant difference between the
peak cortisol responses to LDT (589 +/- 100 nmol/l) and peak cortisol
responses to ITT (730 +/- 81 nmol/l) in the PFS group (P < 0.0001). Peak
cortisol responses to SDT (777 +/- 119 nmol/l) were similar to peak cortisol
responses to ITT (730 +/- 81 nmol/l) in the PFS group. CONCLUSION: We
conclude that the perturbation of the HPA axis in PFS is characterized by
underactivation of the HPA axis. Some patients with PFS may have subnormal
adrenocortical function. LDT is more sensitive than SDT or ITT in the
investigation of the HPA axis to determine the subnormal adrenocortical
function in patients with PFS
(51) Viitanen JV.
Feasibility of fitness tests in subjects with chronic pain (fibromyalgia):
discordance between cycling and 2-km walking tests. Rheumatol Int 2001;
21(1):1-5.
Abstract: Altogether, 69 out of 98 fibromyalgia (FMS) patients who attended
a 2- week multidisciplinary inpatient course and a 1-week control period 3
months later completed 2-km walking tests and stepwise-increased cycling
tests at entry and after 3 months. The purpose was to compare the
feasibility of the two fitness tests for assessment of FMS patients. The
results showed a substantially lower fitness level in the results of the
2-km walking test than in the cycling test in the same patients: mean
maximum VO2 was 28.5 ml/kg per min vs 34.6 ml/kg per min, respectively. At
entry and after the 3-month training period, the correlations between the
two tests were very poor, i.e., with Spearman's r coefficients of 0.37 and
0.34, respectively (P < 0.01), intraclass correlation coefficients (ICC)
0.20 (95% CI -0.29 to 0.50) and 0.47 (95% CI 0.15 to 0.67), reliability
coefficients (alpha) 0.54 and 0.47, and Kendal-T coefficients 0.32 and 0.41
for ordinal correlation of the test results. The results did not correlate
with pain, which remained at initial levels for the 3 months of follow-up.
Principally, these tests should both measure the same property, i.e., the
fitness of fibromyalgia syndrome (FMS) patients, but the results differed
substantially. The 2-km walking test showed a markedly lower fitness level
than the cycling test in the same patients. The primary explanation for this
difference might be difficulties in controlling test performance. especially
in walking. The 2-km walking test would not appear recommendable for
subjects with chronic pain syndrome, e.g., fibromyalgia
(52) Brady DM,
Schneider MJ. Fibromyalgia syndrome: a new paradigm for differential
diagnosis and treatment. J Manipulative Physiol Ther 2001; 24(8):529-541.
(53) Galeotti N,
Ghelardini C, Zoppi M, Bene ED, Raimondi L, Beneforti E et al. A reduced
functionality of Gi proteins as a possible cause of fibromyalgia. J
Rheumatol 2001; 28(10):2298-2304.
Abstract: OBJECTIVE: The etiopathogenesis of fibromyalgia (FM), a syndrome
characterized by widespread pain and hyperalgesia, is still unknown. Since
the involvement of Gi proteins in the modulation of pain perception has been
widely established, the aim of the present study was to determine whether an
altered functionality of the Gi proteins occurred in patients with FM.
METHODS: Patients with FM and other painful diseases such as neuropathic
pain, rheumatoid arthritis (RA), and osteoarthritis, used as reference
painful pathologies, were included in the study. The functionality,
evaluated as capability to inhibit forskolin-stimulated adenylyl cyclase
activity, and the level of expression of Gi proteins were investigated in
peripheral blood lymphocytes. RESULTS: Patients with FM showed a
hypofunctionality of the Gi protein system. In contrast, unaltered Gi
protein functionality was observed in patients with neuropathic pain, RA,
and osteoarthritis. Patients with FM also showed basal cAMP levels higher
than controls. The reduced activity of Gi proteins seems to be unrelated to
a reduction of protein levels since only a slight reduction (about 20- 30%)
of the Gi3alpha subunit was observed. CONCLUSIONS: Gi protein
hypofunctionality is the first biochemical alteration observed in FM that
could be involved in the pathogenesis of this syndrome. In the complete
absence of laboratory diagnostic tests, the determination of an increase in
cAMP basal levels in lymphocytes, together with the assessment of a Gi
protein hypofunctionality after adenylyl cyclase stimulation, may lead to
the biochemical identification of patients with FM
(54) Donaldson MS,
Speight N, Loomis S. Fibromyalgia syndrome improved using a mostly raw
vegetarian diet: An observational study. BMC Complement Altern Med 2001;
1(1):7.
Abstract: BACKGROUND: Fibromyalgia engulfs patients in a downward,
reinforcing cycle of unrestorative sleep, chronic pain, fatigue, inactivity,
and depression. In this study we tested whether a mostly raw vegetarian diet
would significantly improve fibromyalgia symptoms. METHODS: Thirty people
participated in a dietary intervention using a mostly raw, pure vegetarian
diet. The diet consisted of raw fruits, salads, carrot juice, tubers, grain
products, nuts, seeds, and a dehydrated barley grass juice product. Outcomes
measured were dietary intake, the fibromyalgia impact questionnaire (FIQ),
SF-36 health survey, a quality of life survey (QOLS), and physical
performance measurements. RESULTS: Twenty-six subjects returned dietary
surveys at 2 months; 20 subjects returned surveys at the beginning, end, and
at either 2 or 4 months of intervention; 3 subjects were lost to follow-up.
The mean FIQ score (n = 20) was reduced 46% from 51 to 28. Seven of the 8
SF-36 subscales, bodily pain being the exception, showed significant
improvement (n = 20, all P for trend < 0.01). The QOLS, scaled from 0 to 7,
rose from 3.9 initially to 4.9 at 7 months (n = 20, P for trend 0.000001).
Significant improvements (n = 18, P < 0.03, paired t-test) were seen in
shoulder pain at rest and after motion, abduction range of motion of
shoulder, flexibility, chair test, and 6-minute walk. 19 of 30 subjects were
classified as responders, with significant improvement on all measured
outcomes, compared to no improvement among non-responders. At 7 months
responders' SF-36 scores for all scales except bodily pain were no longer
statistically different from norms for women ages 45-54. CONCLUSION: This
dietary intervention shows that many fibromyalgia subjects can be helped by
a mostly raw vegetarian diet
(55) Al Allaf AW,
Khan F, Moreland J, Belch JJ, Pullar T. Investigation of cutaneous
microvascular activity and flare response in patients with fibromyalgia
syndrome. Rheumatology (Oxford) 2001; 40(10):1097-1101.
Abstract: OBJECTIVES: To assess microvascular activity in the skin of
patients with fibromyalgia syndrome (FMS) as compared with normal controls.
METHODS: Fifteen patients, who fulfilled the American College of
Rheumatology criteria for FMS, and 15 age- and sex-matched healthy controls,
were studied. The microvascular activity of the skin overlying the trapezius
muscle was quantified using iontophoresis of acetylcholine as an
endothelial-dependent vasodilator and sodium nitroprusside as an
endothelial-independent vasodilator. We also studied the flare response by
iontophoresing acetylcholine continuously for 10 min to stimulate a ring of
nociceptor c-fibre endings in the skin. RESULTS: There was no significant
difference in cutaneous vascular responses to short-duration iontophoresis
of acetylcholine and sodium nitroprusside at the three different doses used.
The area under the curve (AUC) (mean+/-s.e.m.) for acetylcholine baseline,
20, 40, and 80 s were 6+/-0.7, 23+/-6, 45+/-7 and 66+/-10 AU for patients
and 11+/- 4, 24+/-3, 49+/-7 and 62+/-12 AU for controls, respectively
(P=0.2, 0.9, 0.7, 0.8, respectively). The corresponding figures for sodium
nitroprusside were 5+/-1, 18+/-7, 51+/-14 and 68+/-14 AU for patients and
8+/-3, 13+/-2, 39+/-5 and 61+/-9 AU for controls, respectively (P=0.2, 0.5,
0.4, 0.7, respectively). There was also no significant difference in the
flare response in patients with FMS as compared with control subjects
(119+/-15 and 131+/-13 AU, respectively; P=0.57). CONCLUSION: There are no
significant differences in cutaneous microvascular reactivity between
patients with FMS and control subjects
(56) Walen HR,
Cronan PA, Bigatti SM. Factors associated with healthcare costs in women
with fibromyalgia. Am J Manag Care 2001; 7 Spec No:SP39-SP47.
Abstract: OBJECTIVE: To examine how women with high and low healthcare costs
differ by using the Anderson Health Behavior Model of Utilization as a
theoretical framework. STUDY DESIGN: One-year longitudinal design. PATIENTS
AND METHODS: A total of 537 female health maintenance organization members
with fibromyalgia participating in a study examining the effects of social
support and education on health status and healthcare use were divided into
2 groups using a median split on health costs. Predisposing variables
(demographic variables, self- efficacy, depression, and social support),
enabling characteristics (income), and need variables (health status,
perceived health status, disease severity, duration of symptoms, and
comorbidity) were measured. Patients completed a battery of questionnaires
at baseline assessment, and healthcare costs were assessed 1 year before and
1 year after baseline assessment. Healthcare data were collected from
medical records. Healthcare costs were estimated by multiplying the number
of each type of healthcare contact by the most recent national average cost
figures. RESULTS: Multivariate analysis of covariance controlling for costs
during the year before baseline assessment was performed. Low- cost patients
had fewer comorbid conditions, better health status, higher self-perceived
health status, less disease severity, greater self-efficacy for functioning,
lower depression scores, and higher social support scores. Chi2 analyses
revealed no significant differences between groups on marital status but a
significant difference in income: low-cost patients were more likely to
report higher incomes. CONCLUSIONS: There were several significant
differences between people with higher and lower healthcare costs. Although
effect sizes were small, many variables may be responsive to intervention
(57) Eisinger J.
[Fibromyalgia: non-entity or double agent?]. Rev Med Interne 2001;
22(9):809-811.
(58) Kahn MF.
[Fibromyalgia: the pros for a cease-fire between supporters of the
psychosomatic-social and those of the all biochemical aspects]. Rev Med
Interne 2001; 22(9):807-808.
(59) Patient
information. Living with fibromyalgia. Cleve Clin J Med 2001; 68(10):837.
(60) Clauw DJ.
Elusive syndromes: treating the biologic basis of fibromyalgia and related
syndromes. Cleve Clin J Med 2001; 68(10):830, 832-830, 834.
Abstract: Newer theories suggest that patients with fibromyalgia have a
biologic predisposition to perceiving pain with more sensitivity than people
without fibromyalgia. Several biologic triggers are implicated as possibly
initiating or worsening the symptoms of fibromyalgia. Treatments to manage
pain, help with sleep, and, when needed, treat cognitive disturbances show
some success
(61) Van
Houdenhove B, Neerinckx E, Onghena P, Lysens R, Vertommen H. Premorbid
"overactive" lifestyle in chronic fatigue syndrome and fibromyalgia. An
etiological factor or proof of good citizenship? J Psychosom Res 2001;
51(4):571-576.
Abstract: OBJECTIVE: In a former study, we have shown that patients
suffering from chronic fatigue syndrome (CFS) or chronic pain, when
questioned about their premorbid lifestyle, reported a high level of
"action- proneness" as compared to control groups. The aim of the present
study was to control for the patients' possible idealisation of their
previous attitude towards action. METHODS: A validated Dutch self- report
questionnaire measuring "action-proneness" (the HAB) was completed by 62
randomly selected tertiary care CFS and fibromyalgia (FM) patients, as well
as by their significant others (SOs). RESULTS: HAB scores of the patients
and those of the SOs were very similar and significantly higher than the
norm values. Whether or not the SO showed sympathy for the patient's illness
did not influence the results to a great extent. SOs with a negative
attitude towards the illness even characterized the patients as more
"action-prone." CONCLUSIONS: These results provide further support for the
hypothesis that a high level of "action-proneness" may play a predisposing,
initiating and/or perpetuating role in CFS and FM
(62) Granot M,
Buskila D, Granovsky Y, Sprecher E, Neumann L, Yarnitsky D. Simultaneous
recording of late and ultra-late pain evoked potentials in fibromyalgia.
Clin Neurophysiol 2001; 112(10):1881-1887.
Abstract: OBJECTIVE: To characterize laser evoked potentials (LEP), pain
psychophysics and local tissue response in fibromyalgia patients. METHODS:
LEP were recorded in 14 women with fibromyalgia in response to bilateral
stimulation of tender and control points in upper limbs by 4 blocks of 20
stimuli at each point. Subsequently, heat pain thresholds were measured and
supra-threshold magnitude estimations of heat pain stimuli were obtained on
a visual analogue scale. Finally, the extent of the local tissue response
induced by the previous stimuli was evaluated. RESULTS: Laser stimuli
elicited two long latency waves: A late wave (mean latency 368.9+/-66.9 ms)
in most patients (13/14) from stimuli at all points, and an ultra-late wave
(mean latency 917.3+/- 91.8 ms) in 78.5% of the patients at the control
points and in 71.4% at the tender points. Amplitude of ultra-late waves was
higher at the tender points (20.67+/-11.1 microV) than at the control points
(10.47+/- 4.1 microV) (P=0.016). Pain thresholds were lower in the tender
(41.2+/- 2.7 degrees C) than the control points (43.9+/-3.2 degrees C)
(P=0.008). Local tissue response was significantly more intense at tender
than control points (P=0.004). CONCLUSIONS: Ultra-late laser evoked
potentials can be recorded simultaneously with late potentials. Our findings
are compatible with presence of peripheral C-fiber sensitization, mostly at
tender points, probably combined with generalized central sensitization of
pain pathways in fibromyalgia
(63) Park DC,
Glass JM, Minear M, Crofford LJ. Cognitive function in fibromyalgia
patients. Arthritis Rheum 2001; 44(9):2125-2133.
Abstract: OBJECTIVE: To evaluate fibromyalgia (FM) patients for the presence
of cognitive deficits and to test the hypothesis that abnormalities would
fit a model of cognitive aging. METHODS: We studied 3 groups of patients: FM
patients without concomitant depression and in the absence of medications
known to affect cognitive function (n = 23), age- and education-matched
controls (n = 23), and education-matched older controls who were
individually matched to be 20 years older (+/- 3 years) than the FM patients
(n = 22). We measured speed of information processing, working memory
function, free recall, recognition memory, verbal fluency, and vocabulary.
We correlated performance on cognitive tasks with FM symptoms, including
depression, anxiety, pain, and fatigue. We also determined if memory
complaints were correlated with cognitive performance. RESULTS: As expected,
older controls performed more poorly than younger controls on speed of
processing, working memory, free recall, and verbal fluency. FM patients
performed more poorly than age-matched controls on all measures, with the
exception of processing speed. FM patients performed much like older
controls, except that they showed better speed of processing and poorer
vocabulary. Impaired cognitive performance in FM patients correlated with
pain complaints, but not with depressive or anxiety symptoms. FM patients
reported more memory problems than did the older and younger controls, and
these complaints correlated with poor cognitive performance. CONCLUSION:
Cognitive impairment in FM patients, particularly memory and vocabulary
deficits, are documented in the study. Nevertheless, the intact performance
on measures of information processing speed suggests that the cognitive
deficits are not global. FM patients' complaints about their memory are
likely to be legitimate, since their memory function is not age appropriate
(64) Peres MF,
Young WB, Kaup AO, Zukerman E, Silberstein SD. Fibromyalgia is common in
patients with transformed migraine. Neurology 2001; 57(7):1326-1328.
Abstract: Fibromyalgia (FM) and transformed migraine (TM) are common chronic
pain disorders. The authors estimated the prevalence of FM in 101 patients
with TM, and analyzed its relationship to depression, anxiety, and insomnia.
FM was diagnosed in 35.6% of cases. Patients with FM had more insomnia, were
older, and had headaches that were more incapacitating than patients without
FM. Insomnia and depression predicted FM in patients with TM
(65) Maquet D,
Croisier JL, Crielaard JM. [What happens to the fibromyalgia syndrome?]. Ann
Readapt Med Phys 2001; 44(6):316-325.
Abstract: OBJECTIVE: To realize a clarification about fibromyalgia,
attempting to consider diagnostic criteria, prevalence, pathophysiology and
therapeutic approach. METHOD: A systematic literature search was conducted
to select articles about fibromyalgia and connected diseases. The database
are Premedline, Medline and Medlineplus. RESULTS: Fifty- eight articles
about fibromyalgia and twelve articles about connected diseases were
selected to realize this review of literature. DISCUSSION: Fibromyalgia
constitutes a syndrome characterized by widespread musculo-skeletal pain,
present above the waist and below the waist and in the axial skeleton.
Widespread pain must have been present for at least three months. "Spasmophilie",
chronic fatigue syndrome and myofascial syndrome represent diseases
connected with fibromyalgia: differential diagnosis must be established.
Researches related to fibromyalgia suggest a reduction of muscular
performances associated with histological and biochemical anomalies.
Patients are characterized by shorter and nonrestorative sleep.
Psychological, neuroendocrine and central alterations appear often
associated with fibromyalgia. The reduction of pressure tolerance and pain
thresholds may be linked to the alterations of neuroendocrine substances.
Literature recommend a multidisciplinary therapeutic approach in management
of fibromyalgia. CONCLUSION: The pathophysiologic mechanisms in fibromyalgia
appear multiple and interdependent. With the aim to optimizing treatment,
investigations are necessary to determine biochemical repercussions of
various therapeutic approaches
(66) Mengshoel AM,
Haugen M. Health status in fibromyalgia--a followup study. J Rheumatol 2001;
28(9):2085-2089.
Abstract: OBJECTIVE: To examine symptoms, physical function, and nutritional
status in patients with fibromyalgia (FM) after 6 to 8 years. METHODS: Of 51
women with FM initially included in exercise and patient education programs
6 and 8 years ago, 33 agreed to participate. Median (range) age was 45.5
years (33-64) and symptom duration 18 years (8- 46). Symptoms (visual analog
scales), cardiovascular capacity (Aastrand's test), and restriction on daily
activities (Fibromyalgia Impact Questionnaire) were measured. Employment
status and experience of coping with everyday life were addressed in an
interview. Nutritional status was evaluated by anthropometric measurements
and dietary intake. RESULTS: All the 33 participants had widespread chronic
pain, and 79% had enough tender points to satisfy the FM classification
criteria. Compared with initital data there were significant reductions in
the number of tender points (p = 0.004) in the exercise group, and in
fatigue (p = 0.008) and pain (p = 0.5) in the patient education group.
Cardiovascular capacity was within normal limits in 33% of the participants.
Currently, 26 performed regular physical activity and of these, 10 were
engaged in organized exercise. Seventy-two percent reported regular use of
dietary supplements and attached importance to a healthy diet. Still, there
was a significant increase in weight and body fat, and 24% were obese (BMI >
30). The coping strategies adopted were adjustments to the new situation and
distraction from symptoms. CONCLUSION: No worsening of symptoms and no
change in employment status, as well as frequent participation in physical
activities, suggests a benign longterm outcome in these patients with FM
(67) Affleck G,
Tennen H, Zautra A, Urrows S, Abeles M, Karoly P. Women's pursuit of
personal goals in daily life with fibromyalgia: a value-expectancy analysis.
J Consult Clin Psychol 2001; 69(4):587-596.
Abstract: Eighty-nine women with fibromyalgia completed the Life Orientation
Test, identified health and social goals, and answered questions from the
Goal Systems Assessment Battery (P. Karoly & L. Ruehlman, 1995) about their
valuation of, and self-efficiency in attaining, each goal. For 30 days, they
responded to palm-top computer interviews about their pain and fatigue and
rated their goal effort, goal progress, and pain- and fatigue-related goal
barriers. Goal barriers increased and goal efforts and progress decreased on
days with greater pain and fatigue; goals valued more highly were pursued
more effortfully and successfully; more optimistic individuals were less
likely to perceive goal barriers and, on days that were more fatiguing than
usual, were less likely to reduce their effort and to retreat from progress
in achieving their health goal; and more pessimistic individuals perceived
greater goal barriers on days that were less painful than usual
(68) van West D,
Maes M. Neuroendocrine and immune aspects of fibromyalgia. BioDrugs 2001;
15( 8):521-531.
Abstract: Fibromyalgia is a form of non-articular rheumatism characterised
by long term (>3 months) and widespread musculoskeletal aching, stiffness
and pressure hyperalgesia at characteristic soft tissue sites, called soft
tissue tender points. The biophysiology of fibromyalgia, however, has
remained elusive and the treatment remains mainly empirical. This article
reviews the neuroendocrine-immune pathophysiology of fibromyalgia. There is
no major evidence that fibromyalgia is accompanied by activation of the
inflammatory response system, by immune activation or by an inflammatory
process. There is some evidence that fibromyalgia is accompanied by some
signs of immunosuppression, suggesting that immunomodifying drugs could have
potential in the treatment of fibromyalgia. Recent trials with cytokines,
such as interferon-alpha, have been undertaken in patients with
fibromyalgia. Immunotherapy with these agents, however, may induce symptoms
reminiscent of fibromyalgia and depression in a considerable number of
patients. Lowered serum activity of prolyl endopeptidase (PEP), a cytosolic
endopeptidase that cleaves peptide bonds on the carboxyl side of proline in
proteins of relatively small molecular mass, may play a role in the
biophysiology of fibromyalgia through diminished inactivation of algesic and
depression-related peptides, e.g. substance P. Trials with PEP agonists
could be worthwhile in fibromyalgia. The muscle energy depletion hypothesis
of fibromyalgia is supported by findings that this condition is accompanied
by lowered plasma levels of branched chain amino acids (BCAAs), i.e. valine,
leucine and isoleucine. Since there is evidence that BCAA supplementation
decreases muscle catabolism and has ergogenic values, a supplemental trial
with BCAAs in fibromyalgia appears to be justified
(69) Lubrano E,
Iovino P, Tremolaterra F, Parsons WJ , Ciacci C, Mazzacca G. Fibromyalgia in
patients with irritable bowel syndrome. An association with the severity of
the intestinal disorder. Int J Colorectal Dis 2001; 16(4):211-215.
Abstract: Fibromyalgia (FM) syndrome and irritable bowel syndrome (IBS) are
functional disorders in which altered somatic and or visceral perception
thresholds have been found. The aim of this study was to evaluate the
prevalence of FM in a group of patients with IBS and the possible
association of FM with patterns and severity of the intestinal disorder. One
hundred thirty consecutive IBS patients were studied. The IBS was divided
into four different patterns according to the predominant bowel symptom and
into three levels of severity using a functional severity index. All
patients underwent rheumatological evaluation for number of positive tender
points, number of tender and swollen joints, markers of inflammation, and
presence of headache and weakness. Moreover, patients' assessments of
diffuse pain, mood and sleep disturbance, anxiety, and fatigue were also
measured on a visual analogue scale. The diagnosis of FM was made based on
American College of Rheumatology classification criteria. Nonparametric
tests were used for statistical analysis. Fibromyalgia was found in 20% of
IBS patients. No statistical association was found between the presence of
FM and the type of IBS but a significant association was found between the
presence of FM and severity of the intestinal disorder. The presence of FM
in IBS patients seems to be associated only with the severity of IBS. This
result confirms previous studies on the association between the two
syndromes
(70) Gervais RO,
Russell AS, Green P, Allen LM, III, Ferrari R, Pieschl SD. Effort testing in
patients with fibromyalgia and disability incentives. J Rheumatol 2001;
28(8):1892-1899.
Abstract: OBJECTIVE: To examine whether symptom exaggeration is a factor in
complaints of cognitive dysfunction using 2 new validated instruments in
patients with fibromyalgia (FM). METHODS: Ninety-six patients with FM and 16
patients with rheumatoid arthritis (RA) were administered 2 effort or
symptom validity tests designed to detect exaggerated memory complaints as
part of a battery of psychological tests and self-report questionnaires.
RESULTS: A large percentage of patients with FM who were on or seeking
disability benefits failed the effort tests. Only 2 patients with FM who
were working and/or not claiming disability benefits and no patient with RA
scored below the cutoffs for exaggeration of memory difficulties.
CONCLUSION: This study illustrates the importance of assessing for
exaggeration of cognitive symptoms and biased responding in patients with FM
presenting for disability related evaluations
(71) Poyhia R, Da
Costa D, Fitzcharles MA. Previous pain experience in women with fibromyalgia
and inflammatory arthritis and nonpainful controls. J Rheumatol 2001;
28(8):1888-1891.
Abstract: OBJECTIVE: To examine the frequency of commonly occurring pain and
adverse experiences throughout life by self-report in women with
fibromyalgia (FM) and chronic inflammatory arthritis (IA) and nonpainful
healthy women. METHODS: Fifty-one patients with FM and 44 with IA and 52
nonpainful healthy controls were consecutively interviewed in a tertiary
clinic setting regarding the occurrence of lifetime common pain experience
and adverse events, as well as a family history of FM and/or a childhood
pain environment. RESULTS: Patients with FM reported significantly more
irritable bowel syndrome, migraine headaches, severe menstrual pain,
physical and psychological trauma affecting well being, family history of
FM, and family pain environment than subjects with IA or controls. Both
patient groups had more adult hospitalizations and surgeries than the
controls. CONCLUSION: Patients with FM report a high rate of varied pain and
adverse experiences throughout life. This real or perceived experience of
pain supports the concept that FM is a lifetime disorder of pain processing
(72) Azad KA, Alam
MN, Haq SA, Nahar S, Chowdhury MA, Ali SM et al. Vegetarian diet in the
treatment of fibromyalgia. Bangladesh Med Res Counc Bull 2000; 26(2):41-47.
Abstract: Brain tryptophan is low in fibromyalgia. Intake of protein rich in
large neutral amino acids is reported to lower brain tryptophan. This study
was undertaken to assess whether any reduction of such proteins by exclusion
of animal protein from the diet reduced pain and morbidity in fibromyalgia
patients. It was an open, randomized controlled trial. 37 subjects with
fibromyalgia were enrolled in the vegetarian diet and 41 in the
amitriptyline groups. The outcome was assessed with the help of frequencies
of fatigue, insomnia & non-restorative sleep, pain score on a 10-point VAS
and tender point count. Fatigue, insomnia and non- restorative sleep were
present in 41, 26 and 32 subjects before and in 3, 0 and 0 subjects
respectively at six weeks of treatment in the amitriptyline group. The pain
score and tender point count were 6.2 +/- 1.9 & 16.1 +/- 2.3 before and 2.3
+/- 1.3 & 6.4 +/- 3.0 after treatment. All these differences were
significant (P < 0.001). In the vegetarian diet group, fatigue, insomnia and
non-restorative sleep were present in 36, 24 and 27 subjects before and in
34, 29 and 29 subjects at six weeks of treatment. The pain score and tender
point count were 5.7 +/- 1.8 and 15.7 +/- 2.4 before and 5.0 +/- 1.8 & 14.7
+/- 3.6 after treatment. All these differences were insignificant except
that in the pain score. The decrease in the pain score, though significant,
was much smaller than that in the amitriptyline group. So, it may be
concluded that vegetarian diet is a poor option in the treatment of
fibromyalgia
(73) Kersh BC,
Bradley LA, Alarcon GS, Alberts KR, Sotolongo A, Martin MY et al.
Psychosocial and health status variables independently predict health care
seeking in fibromyalgia. Arthritis Rheum 2001; 45(4):362-371.
Abstract: OBJECTIVE: To determine whether variables derived from the self-
regulatory model of health and illness behavior accurately predict status as
a patient or nonpatient with fibromyalgia (FM). METHODS: Subjects were 79
patients who met American College of Rheumatology (ACR) criteria for FM and
39 community residents who met ACR criteria for FM but had not sought
medical care for their symptoms (nonpatients). Subjects were administered 14
measures that produced 6 domains of variables: background demographics and
pain duration; psychiatric morbidity; and personality, environmental,
cognitive, and health status factors. These domains were entered in 4
different hierarchical logistic regression analyses to predict status as
patient or nonpatient. RESULTS: The full regression model was statistically
significant (P < 0.0001) and correctly identified 90.7% of the subjects with
a sensitivity of 92.4% and a specificity of 87.2%. The best individual
predictors of group status were self-reports of self- efficacy, negative
affect, recent stressful events, and perceived pain. Relative to nonpatients,
patients reported higher levels of negative affect and perceived pain and a
greater number of recent stressful experiences, as well as lower levels of
self-efficacy. CONCLUSION: Consistent with the self-regulatory model of
health and illness behavior, psychosocial and health status variables
predict health care- seeking behavior in persons with FM independently of
background demographics and psychiatric morbidity. These variables may
influence the severity of symptoms experienced by persons with this disorder
as well as their health care-seeking behavior, but they are not necessary to
produce abnormal pain sensitivity in FM
(74) Poyhia R, Da
Costa D, Fitzcharles MA. Pain and pain relief in fibromyalgia patients
followed for three years. Arthritis Rheum 2001; 45(4):355-361.
Abstract: OBJECTIVE: To examine the natural clinical course of pain in
fibromyalgia (FM) and patients' reports of the use of interventions for pain
relief. METHODS: This prospective 3-year study examined pain, and the
treatment thereof, in a cohort of 82 women with FM, of whom 59 (72%) were
reassessed on 3 subsequent occasions. Pain was measured by the following
parameters: visual analog scale (VASpain), tender point count (TP), and the
occurrence of widespread pain (WP). Function was assessed by the Health
Assessment Questionnaire and the Fibromyalgia Impact Questionnaire, and
depression and anxiety by the Arthritis Impact Measurement Scales. All
treatments for FM were recorded, and patients identified the treatment that
they believed had helped their symptoms of FM. RESULTS: Pain reporting as
measured by all parameters decreased significantly for the whole group over
the duration of the study. The mean VASpain decreased from 66 to 55, the
mean TP count decreased from 13.5 to 10.5, and the number of patients with
WP decreased from 100% to 63%. VASpain correlated positively with TP and WP.
One third of patients experienced a reduction in pain by at least 30% from
baseline as well as a better outcome in overall status of FM. There was a
decline in the use of prescribed medications, whereas the use of alternative
products increased. Physical treatment modalities were more often perceived
to be of benefit than prescribed medications. CONCLUSION: We have observed a
spontaneous improvement in pain reporting and less medication use in FM
patients, suggesting that the course of this condition may be more favorable
than has previously been reported
(75) Kiser RS,
Cohen HM, Freedenfeld RN, Jewell C, Fuchs PN. Olanzapine for the treatment
of fibromyalgia symptoms. J Pain Symptom Manage 2001; 22(2):704-708.
Abstract: Fibromyalgia is a chronic condition that is diagnosed primarily by
the presence of generalized pain along with tenderness on palpation of
certain body regions. Unfortunately, the pharmacological treatment of
fibromyalgia remains problematic. Two patients are described who highlight
the use of the atypical neuroleptic olanzapine for the control of symptoms
related to fibromyalgia. Prior to the use of olanzapine, both patients had
received a multitude of treatments, none of which greatly improved their
ability to function in daily activities. With olanzapine, both patients
reported a significant decrease in pain and marked improvement in daily
functioning. In one case, the pain returned during a period of time when
olanzapine was discontinued, an effect that was reversed when olanzapine was
reintroduced. The paucity of serious side effects (i.e., extrapyramidal
signs) with the atypical neuroleptic olanzapine strongly favors further
exploration and use of this drug for the treatment of fibromyalgia symptoms
(76) Davis MC,
Zautra AJ, Reich JW. Vulnerability to stress among women in chronic pain
from fibromyalgia and osteoarthritis. Ann Behav Med 2001; 23(3):215-226.
Abstract: In two investigations, we studied vulnerability to the negative
effects of stress among women in chronic pain from 2 types of
musculoskeletal illnesses, fibromyalgia syndrome (FMS) and osteoarthritis
(OA). In Study 1, there were 101 female participants 50 to 78 years old: 50
had FMS, 29 had OA knee pain and were scheduled for knee surgery, and 22 had
OA but were not planning surgery. Cross-sectional analyses showed that the
three groups were comparable on demographic variables, personality
attributes, negative affect, active coping, and perceived social support. As
expected, FMS and OA surgery women reported similar levels of bodily pain,
and both groups scored higher than OA nonsurgery women. However, women with
FMS reported poorer emotional and physical health, lower positive affect, a
poorer quality social milieu, and more frequent use of avoidant coping with
pain than did both groups of women with OA. Moreover, the perception and use
of social support were closely tied to perceived social stress only among
the FMS group. In Study 2, we experimentally manipulated negative mood and
stress in 41 women 37 to 74 years old: 20 women had FMS, and 21 women had
OA. Participantsfrom each group were randomly assigned to either a negative
mood induction or a neutral mood (control) condition, and then all
participants discussed a stressful interpersonal eventfor 30 min.
Stress-related increases in pain were exacerbated by negative mood induction
among women with FMS but not women with OA, and pain during stress was
associated with decreases in positive affect in women with FMS but not women
with OA. These findings suggest that among women with chronic pain, those
with FMS may be particularly vulnerable to the negative effects of social
stress. They have fewer positive affective resources, use less effective
pain-coping strategies, and have more constrained social networks than their
counterparts with OA, particularly those who experience similar levels
ofpain. They also seem to experience more prolonged stress-related increases
in pain under certain circumstances, all of which may contribute to a
lowering of positive affect and increased stress reactivity over time
(77) Nicassio PM.
Perspectives on stress in fibromyalgia. Ann Behav Med 2001; 23(3):147-148.
(78) Gogoleva EF.
[New approaches to diagnosis and treatment of fibromyalgia in spinal
osteochondrosis]. Ter Arkh 2001; 73(4):40-45.
Abstract: AIM: To compare effectiveness of manual and bioresonance therapies
for fibromyalgia (FM) in spinal osteochondrosis (SO). MATERIAL AND METHODS:
The trial enrolled 60 FM patients with x-ray diagnosis of SO. In addition to
routine clinical examination all the patients have undergone kinesthetic
study with estimation of the muscular syndrome index, brain echoscopy,
neurological examination, electropuncture diagnosis. Group 1 patients
received manual therapy (MT) and point massage (PM); group 2 patients
received MT, PM and bioresonance therapy (BRT). The treatment took 5-6
weeks. The examinations were made before the treatment and 1-1.5 months
after it. RESULTS: The response was observed in both the groups, but in
group 2 it occurred more frequently and earlier, was higher and longer. BRT
produces no side effects, has no contraindications, acts on the body
systemically. It is rather effective against symptoms of neurocirculatory
dystonia frequently diagnosed in FM patients
(79) Anders C,
Sprott H, Scholle HC. Surface EMG of the lumbar part of the erector trunci
muscle in patients with fibromyalgia. Clin Exp Rheumatol 2001; 19(
4):453-455.
Abstract: OBJECTIVE: To determine differences supposed in EMG parameters of
the erector trunci region between patients with fibromyalgia and healthy
subjects during defined investigation situations. METHODS: During sitting
and standing in upright position surface EMG (SEMG) from 15 subjects with
fibromyalgia and 10 healthy controls was performed using a 16-channel
technique where the electrodes were applied in a well- defined grid pattern
(gain 5000, 3 db points at 5 Hz and 700 Hz respectively). SEMG
quantification was done by Fourier algorithm using 512 measurement points
for calculation. RESULTS: An increased EMG amplitude could be recorded
during rest in fibromyalgia patients compared with controls. Spatial
amplitude differences (frequency range 100-500 Hz) in the low back region
were significantly (p < 0.01) decreased in the patients' group during
sitting. CONCLUSION: It is the first time that a decreased difference in EMG
amplitude of different parts within a certain muscle could be proven in
patients with fibromyalgia. As far as is known from the literature this
result seems to be a uniquefinding in fibromyalgia patients
(80) Buchard PA.
[Can we still give a fibromyalgia diagnosis?]. Rev Med Suisse Romande 2001;
121(6):443-447.
Abstract: This article is an attempt at a critical analysis of the
fibromyalgia concept. The author applies himself to describing how the
profile of this syndrome, associating chronic widespread pain to allodynia,
became more and more precise, until it obtained the status of disease. He
emphasizes that the concept lost its initial meaning when the criteria,
resulting from an ambitious scientific methodology, were used to establish a
diagnosis on an individual scale. He comes to the conclusion that after a
century of existence, fibromyalgia does not possess any specific quality
that would distinguish it from other chronic widespread pain syndromes to
make it a pure nosological entity. It is an artificial construct that adds
nothing to the understanding of a pain phenomenon and allows no rational
therapeutic approach
(81) Thomas AW,
White KP, Drost DJ, Cook CM, Prato FS. A comparison of rheumatoid arthritis
and fibromyalgia patients and healthy controls exposed to a pulsed (200
microT) magnetic field: effects on normal standing balance. Neurosci Lett
2001; 309(1):17-20.
Abstract: Specific weak time varying pulsed magnetic fields (MF) have been
shown to alter animal and human behaviors, including pain perception and
postural sway. Here we demonstrate an objective assessment of exposure to
pulsed MF's on Rheumatoid Arthritis (RA) and Fibromyalgia (FM) patients and
healthy controls using standing balance. 15 RA and 15 FM patients were
recruited from a university hospital outpatient Rheumatology Clinic and 15
healthy controls from university students and personnel. Each subject stood
on the center of a 3-D forceplate to record postural sway within three
square orthogonal coil pairs (2 m, 1.75 m, 1.5 m) which generated a
spatially uniform MF centered at head level. Four 2-min exposure conditions
(eyes open/eyes closed, sham/MF) were applied in a random order. With eyes
open and during sham exposure, FM patients and controls appeared to have
similar standing balance, with RA patients worse. With eyes closed, postural
sway worsened for all three groups, but more for RA and FM patients than
controls. The Romberg Quotient (eyes closed/eyes open) was highest among FM
patients. Mixed design analysis of variance on the center of pressure (COP)
movements showed a significant interaction of eyes open/closed and sham/MF
conditions [F=8.78(1,42), P<0.006]. Romberg Quotients of COP movements
improved significantly with MF exposure [F=9.5(1,42), P<0.005] and COP path
length showed an interaction approaching significance with clinical
diagnosis [F=3.2(1,28), P<0.09]. Therefore RA and FM patients, and healthy
controls, have significantly different postural sway in response to a
specific pulsed MF
(82) Stahl SM.
Fibromyalgia: the enigma and the stigma. J Clin Psychiatry 2001;
62(7):501-502.
(83) Wolfe CV.
Disability evaluation of fibromyalgia. Phys Med Rehabil Clin N Am 2001;
12(3):709-718.
Abstract: These cases represent individuals who feel they have a severe
impairment and are "disabled." They have been labeled with fibromyalgia.
They are truly distressed. Their symptoms, their courses, are more chronic
and refractory than those of medically ill patients, and they are high users
of medical services, laboratory investigations, and surgical procedures.
These patients see multiple providers simultaneously and frequently switch
physicians. They are difficult to care for, and they reject psychosocial
factors as an influence on their symptoms. Such persons "see themselves as
victims worthy of a star appearance on the Oprah Winfrey show. A sense of
bitterness emerges...." Shorter, a historian, believes that fibromyalgia is
"heaven-sent to doctors as a diagnostic label for pain patients who display
an important neurotic component in their illness. Our culture increasingly
encourages patients to conceive vague and nonspecific symptoms as evidence
of real disease and to seek specialist help for them; and the rising
ascendancy of the media and the breakdown of the family encourage patients
to acquire the fixed belief that they have a given illness...." Regarding
the finding of "disability," this is a social construct, and many authors
believe it is society and the judicial system who must decide who can work.
To remain objective, the physician should report the objective clinical
information. Physicians need not and should not sit in judgment of the
veracity of another human being
(84) Nishikai M,
Tomomatsu S, Hankins RW, Takagi S, Miyachi K, Kosaka S et al. Autoantibodies
to a 68/48 kDa protein in chronic fatigue syndrome and primary fibromyalgia:
a possible marker for hypersomnia and cognitive disorders. Rheumatology
(Oxford) 2001; 40(7):806-810.
Abstract: OBJECTIVE: To identify antinuclear antibodies (ANA) specific for
chronic fatigue syndrome (CFS), and in related conditions such as
fibromyalgia (FM) or psychiatric disorders. METHODS: One hundred and
fourteen CFS patients and 125 primary and secondary FM patients were
selected based on criteria advocated by the Centers for Disease Control and
Prevention and by the American College of Rheumatology, respectively. As
controls, healthy subjects and patients with either various psychiatric
disorders or diffuse connective tissue diseases were included.
Autoantibodies were examined by immunoblot utilizing HeLa cell extracts as
the antigen. RESULTS: Autoantibodies to a 68/48 kDa protein were present in
13.2 and 15.6% of patients with CFS and primary FM, respectively. In
addition, autoantibodies to a 45 kDa protein were found in 37.1 and 21.6% of
the patients with secondary FM and psychiatric disorders, respectively.
Meanwhile, these two autoantibodies were not found at all in connective
tissue disease patients without FM, nor in healthy subjects (P<0.05). As a
group, the anti-68/48 kDa-positive CFS patients presented more frequently
with hypersomnia (P<0.005), short-term amnesia (P<0.07) or difficulty in
concentration (P<0.05) than those CFS patients without the antibodies.
CONCLUSIONS: The presence of the anti-68/48 kDa protein antibodies in a
portion of both CFS and primary FM patients suggests the existence of a
common immunological background. These antibodies may find utility as
possible markers for a clinicoserological subset of CFS/FM patients with
hypersomnia and cognitive complaints
(85) Wallace DJ,
Linker-Israeli M, Hallegua D, Silverman S, Silver D, Weisman MH. Cytokines
play an aetiopathogenetic role in fibromyalgia: a hypothesis and pilot
study. Rheumatology (Oxford) 2001; 40(7):743-749.
Abstract: OBJECTIVE: To measure soluble factors having a possible role in
fibromyalgia (FM) and compare the profiles of patients with recent onset of
the syndrome with patients with chronic FM. METHODS: The production of
cytokines, cytokine-related molecules, and a CXC chemokine, interleukin
(IL)-8, was examined. Fifty-six patients with FM (23 with <2 yr and 33 with
>2 yr of symptoms) were compared with age- and sex-matched healthy controls.
Cytokines and cytokine-related molecules were measured in sera and in
supernatants of peripheral blood mononuclear cells (PBMC) that were
incubated with and without lectins and phorbol myristate acetate (PMA).
RESULTS: No differences between FMS and controls were found by measuring
IL-1beta, IL-2, IL-10, serum IL-2 receptor (sIL-2R), interferon gamma (IFN-gamma),
and tumour necrosis factor alpha (TNF-alpha). Levels of IL-1R antibody
(IL-1Ra) and IL-8 were significantly higher in sera, and IL-1Ra and IL-6
were significantly higher in stimulated and unstimulated FM PBMC compared
with controls. Serum IL-6 levels were comparable to those in controls, but
were elevated in supernatants of in vitro-activated PBMC derived from
patients with >2 yr of symptoms. In the presence of PMA, there were
additional increases in IL-1Ra, IL-8 and IL-6 over control values.
CONCLUSIONS: In patients with FM we found increases over time in serum
levels and/or PBMC-stimulated activity of soluble factors whose release is
stimulated by substance P. Because IL-8 promotes sympathetic pain and IL-6
induces hyperalgesia, fatigue and depression, it is hypothesized that they
may play a role in modulating FM symptoms
(86) Asherson RA,
Pascoe L. The use of botulinum toxin-A in the treatment of patients with
fibromyalgia. J Rheumatol 2001; 28(7):1740.
(87) Pall ML.
Common etiology of posttraumatic stress disorder, fibromyalgia, chronic
fatigue syndrome and multiple chemical sensitivity via elevated nitric
oxide/peroxynitrite. Med Hypotheses 2001; 57( 2):139-145.
Abstract: Three types of overlap occur among the disease states chronic
fatigue syndrome (CFS), fibromyalgia (FM), multiple chemical sensitivity
(MCS) and posttraumatic stress disorder (PTSD). They share common symptoms.
Many patients meet the criteria for diagnosis for two or more of these
disorders and each disorder appears to be often induced by a relatively
short-term stress which is followed by a chronic pathology, suggesting that
the stress may act by inducing a self-perpetuating vicious cycle. Such a
vicious cycle mechanism has been proposed to explain the etiology of CFS and
MCS, based on elevated levels of nitric oxide and its potent oxidant
product, peroxynitrite. Six positive feedback loops were proposed to act
such that when peroxynitrite levels are elevated, they may remain elevated.
The biochemistry involved is not highly tissue-specific, so that variation
in symptoms may be explained by a variation in nitric oxide/peroxynitrite
tissue distribution. The evidence for the same biochemical mechanism in the
etiology of PTSD and FM is discussed here, and while less extensive than in
the case of CFS and MCS, it is nevertheless suggestive. Evidence supporting
the role of elevated nitric oxide/peroxynitrite in these four disease states
is summarized, including induction of nitric oxide by common apparent
inducers of these disease states, markers of elevated nitric oxide/peroxynitrite
in patients and evidence for an inductive role of elevated nitric oxide in
animal models. This theory appears to be the first to provide a mechanistic
explanation for the multiple overlaps of these disease states and it also
explains the origin of many of their common symptoms and similarity to both
Gulf War syndrome and chronic sequelae of carbon monoxide toxicity. This
theory suggests multiple studies that should be performed to further test
this proposed mechanism. If this mechanism proves central to the etiology of
these four conditions, it may also be involved in other conditions of
currently obscure etiology and criteria are suggested for identifying such
conditions
(88) Bayne R.
Diagnosis of fibromyalgia. CMAJ 2001; 164(12):1661.
(89) Magaldi M,
Moltoni L, Biasi G, Marcolongo R. Role of intracellular calcium ions in the
physiopathology of fibromyalgia syndrome. Boll Soc Ital Biol Sper 2000;
76(1-2):1-4.
Abstract: Calcium ions have a key role in the physiology of muscular
contraction: changes in calcium ion concentration may be involved in the
pathogenesis of fibromyalgia. Although, since the plasmatic level of calcium
in fibromyalgia patients is always in the normal range, it seemed
interesting to evaluate the intracellular calcium concentration. The study
was carried out on two groups of subjects: 70 affected by fibromyalgia and
40 healthy controls. The results obtained show that in fibromyalgia patients
the intracellular calcium concentration is significantly reduced in
comparison to that of healthy controls: the reduced intracellular calcium
concentration seems to be a peculiar characteristic of fibromyalgia patients
and may be potentially responsible for muscular hypertonus. The effective
role of this anomaly in the physiopathology of fibromyalgia and the
potential role of drugs active on the calcium homeostasis are still to be
confirmed
(90) Stratz T,
Farber L, Varga B, Baumgartner C, Haus U, Muller W. Fibromyalgia treatment
with intravenous tropisetron administration. Drugs Exp Clin Res 2001;
27(3):113-118.
Abstract: A prospective, randomized, placebo-controlled, multicenter,
double- blind trial in fibromyalgia patients demonstrated that peroral daily
treatment with 5 mg tropisetron for 10 days produced a significant reduction
in pain and other symptoms. The aim of the present study was to determine
whether intravenous administration of 2 mg tropisetron daily for a limited
period of time would produce quicker and more favorable results. In the
first cohort 18 fibromyalgia patients received a single intravenous
injection of 2 mg tropisetron. In the second cohort 24 fibromyalgia patients
were treated with 2 mg intravenous tropisetron daily for 5 days. Pain
intensity was measured with the visual analog scale and the pain score. Pain
at tender and control points (dolorimeter) as well as 17 ancillary symptoms
before and after treatment were evaluated. Pain intensity was followed-up by
means of a patient diary until recurrence. Dolorimetry revealed that a
single intravenous injection of 2 mg tropisetron significantly reduced pain
and enhanced pain threshold. These effects, however, lasted for only a few
days. Of 18 patients in the first cohort, only three showed no response to
therapy. Of the 24 patients in the second cohort, 23 showed pain reduction
when 2 mg tropisetron was administered daily for 5 days. Pain relief lasted
for 2 weeks to 2 months in 20 of these patients. Two patients stopped
filling in the pain diary. Twelve ancillary symptoms such as sleep
disturbances, fatigue, morning stiffness were also significantly improved by
the latter treatment. In the global assessment 16 out of 24 patients showed
significant improvement and seven showed slight improvement. Only one
patient experienced no improvement. Tolerability was good. In conclusion,
intravenous injection of 2 mg of the 5-hydroxytryptamine3 receptor
antagonist tropisetron once daily for 5 days produced a longer-lasting
therapeutic effect on fibromyalgia symptoms than did peroral daily treatment
with 5 mg of this drug. The results achieved are currently being evaluated
in a randomized, placebo-controlled, double-blind trial
(91) Sharma V,
Barrett C. Tryptophan for treatment of rapid-cycling bipolar disorder
comorbid with fibromyalgia. Can J Psychiatry 2001; 46(5):452-453.
(92) Elert J,
Kendall SA, Larsson B, Mansson B, Gerdle B. Chronic pain and difficulty in
relaxing postural muscles in patients with fibromyalgia and chronic whiplash
associated disorders. J Rheumatol 2001; 28(6):1361-1368.
Abstract: OBJECTIVE: To investigate if muscle tension according to the
surface electromyogram (EMG) of the shoulder flexors is increased in
consecutive patients with fibromyalgia (FM) or chronic whiplash associated
disorders (WAD). METHODS: A total of 59 consecutive patients with FM (n =
36) or chronic WAD (n = 23) performed 100 maximal isokinetic contractions
combined with surface electromyography of the trapezius and infraspinatus. A
randomized group of pain-free female (n = 27) subjects served as control
group. Peak torque initially (Pti) and absolute and relative peak torque at
endurance level (PTe, PTer) were registered as output variables, together
with the EMG level of unnecessary muscle tension, i.e., the signal amplitude
ratio (SAR). RESULTS: The patient groups had a higher level of unnecessary
tension initially and at the endurance level. The patients had lower
absolute output (PTi and PTe), but the relative levels (PTer) did not differ
comparing all 3 groups. Subjects with FM had significantly higher body mass
index (BMI) than the other groups. BMI did not influence the SAR but
correlated positively with PTi. CONCLUSION: The results confirmed earlier
findings that groups of patients with chronic pain have increased muscle
tension and decreased output during dynamic activity compared to pain-free
controls. However, the results indicated there is heterogeneity within
groups of patients with the same chronic pain disorder and that not all
patients with chronic pain have increased muscle tension
(93) Naschitz JE,
Rozenbaum M, Rosner I, Sabo E, Priselac RM, Shaviv N et al. Cardiovascular
response to upright tilt in fibromyalgia differs from that in chronic
fatigue syndrome. J Rheumatol 2001; 28(6):1356-1360.
Abstract: OBJECTIVE: To compare the cardiovascular response during postural
challenge of patients with fibromyalgia (FM) to those with chronic fatigue
syndrome (CFS). METHODS: Age and sex matched patients were studied, 38 with
FM, 30 with CFS, and 37 healthy subjects. Blood pressure (BP) and heart rate
(HR) were recorded during 10 min of recumbence and 30 min of head-up tilt.
Differences between successive BP values and the last recumbent BP, their
average, and standard deviation (SD) were calculated. Time curves of BP
differences were analyzed by computer and their outline ratios (OR) and
fractal dimensions (FD) were measured. HR differences were determined
similarly. Based on the latter measurements, each subject's discriminant
score (DS) was computed. RESULTS: For patients and controls average DS
values were: FM: -3.68 (SD 2.7), CFS: 3.72 (SD 5.02), and healthy controls:
-4.62 (SD 2.24). DS values differed significantly between FM and CFS (p <
0.0001). Subgroups of FM patients with and without fatigue had comparable DS
values. CONCLUSION: The DS confers numerical expression to the
cardiovascular response during postural challenge. DS values in FM were
significantly different from DS in CFS, suggesting that homeostatic
responses in FM and CFS are dissimilar. This observation challenges the
hypothesis that FM and CFS share a common derangement of the stress-response
system
(94) Smith JD,
Terpening CM, Schmidt SO, Gums JG. Relief of fibromyalgia symptoms following
discontinuation of dietary excitotoxins. Ann Pharmacother 2001;
35(6):702-706.
Abstract: BACKGROUND: Fibromyalgia is a common rheumatologic disorder that
is often difficult to treat effectively. CASE SUMMARY: Four patients
diagnosed with fibromyalgia syndrome for two to 17 years are described. All
had undergone multiple treatment modalities with limited success. All had
complete, or nearly complete, resolution of their symptoms within months
after eliminating monosodium glutamate (MSG) or MSG plus aspartame from
their diet. All patients were women with multiple comorbidities prior to
elimination of MSG. All have had recurrence of symptoms whenever MSG is
ingested. DISCUSSION: Excitotoxins are molecules, such as MSG and aspartate,
that act as excitatory neurotransmitters, and can lead to neurotoxicity when
used in excess. We propose that these four patients may represent a subset
of fibromyalgia syndrome that is induced or exacerbated by excitotoxins or,
alternatively, may comprise an excitotoxin syndrome that is similar to
fibromyalgia. We suggest that identification of similar patients and
research with larger numbers of patients must be performed before definitive
conclusions can be made. CONCLUSIONS: The elimination of MSG and other
excitotoxins from the diets of patients with fibromyalgia offers a benign
treatment option that has the potential for dramatic results in a subset of
patients
(95) Romera BM.
[Fibromyalgia]. Aten Primaria 2001; 27(8):579-580.
(96) Buskila D,
Neumann L, Odes LR, Schleifer E, Depsames R, Abu-Shakra M. The prevalence of
musculoskeletal pain and fibromyalgia in patients hospitalized on internal
medicine wards. Semin Arthritis Rheum 2001; 30(6):411-417.
Abstract: OBJECTIVES: To estimate the prevalence of nonarticular pain
complaints (chronic widespread pain, chronic localized pain, transient pain)
and fibromyalgia in hospitalized patients and to study utilization patterns
of health services associated with pain related problems. METHODS: Five
hundred twenty-two patients hospitalized on internal medicine wards were
enrolled. Data were collected with a questionnaire covering demographic
background, information on pain and other symptoms, utilization of health
services, and drug consumption. All subjects were classified into four pain
groups: those with no pain, transient pain, chronic regional pain, and
chronic widespread pain. Tenderness was assessed by thumb palpation, and
patients were diagnosed as having fibromyalgia if they met the 1990 American
College of Rheumatology criteria. RESULTS: Sixty-two percent of the patients
reported pain; 36% reported chronic regional pain, 21% reported chronic
widespread pain, and 5% reported transient pain. Fifteen percent of all
patients had fibromyalgia, most of whom (91%) were women. The prevalence of
chronic widespread pain and of fibromyalgia in women increased with age.
Sleep problems, headache, and fatigue were highly prevalent, especially
among those with chronic widespread pain. Patients with chronic widespread
pain reported more visits to family physicians (6.2 visits per year) and
more frequent use of drugs. They also were more frequently referred to
rheumatologists, and they reported more hospitalizations. CONCLUSIONS: Pain
syndromes and related symptoms are prevalent among hospitalized patients on
the medicine wards. The internist taking care of these patients should be
aware of the presence of these syndromes and realize that some of the
reported symptoms are partly related to these (undiagnosed) pain syndromes
rather than to the cause of hospitalization
(97) Mueller HH,
Donaldson CC, Nelson DV, Layman M. Treatment of fibromyalgia incorporating
EEG-Driven stimulation: a clinical outcomes study. J Clin Psychol 2001;
57(7):933-952.
Abstract: Thirty patients from a private clinical practice who met the 1990
American College of Rheumatology criteria for fibromyalgia syndrome (FS)
were followed prospectively through a brainwave-based intervention known as
electroencephalograph (EEG)-driven stimulation or EDS. Patients were
initially treated with EDS until they reported noticeable improvements in
mental clarity, mood, and sleep. Self-reported pain, then, having changed
from vaguely diffuse to more specifically localized, was treated with very
modest amounts of physically oriented therapies. Pre- to posttreatment and
extended follow-up comparisons of psychological and physical functioning
indices, specific FS symptom ratings, and EEG activity revealed
statistically significant improvements. EDS appeared to be the prime
initiator of therapeutic efficacy. Future research is justified for
controlled clinical trials and to better understand disease mechanisms
(98) Barkhuizen A.
Pharmacologic treatment of fibromyalgia. Curr Pain Headache Rep 2001;
5(4):351-358.
Abstract: Fibromyalgia is a chronic syndrome characterized by widespread
pain, unrefreshed sleep, disturbed mood, and fatigue. Until such time as we
have a clearer understanding of the trigger and/or pathophysiologic
mechanisms producing these symptoms, pharmacologic treatment should be aimed
at individual symptoms. Such treatment should ideally be offered as part of
a multidisciplinary treatment program using both pharmacologic and
nonpharmacologic treatment modalities. Critical components of any successful
fibromyalgia treatment program include addressing physical fitness, work and
other functional activities, and mental health, in addition to
symptom-specific therapies. The main symptoms that should be addressed
include pain, sleep disturbances including restless leg syndrome, mood
disturbances, and fatigue. Pharmacologic therapy should also be considered
for syndromes commonly associated with fibromyalgia including irritable
bowel syndrome, interstitial cystitis, migraine headaches, temporomandibular
joint dysfunction, dysequilibrium including neurally mediated hypotension,
sicca syndrome, and growth hormone deficiency. This article provides general
guidelines in initiating a successful pharmacologic treatment program for
fibromyalgia
(99) Martinez-Lavin
M. Overlap of fibromyalgia with other medical conditions. Curr Pain Headache
Rep 2001; 5(4):347-350.
Abstract: Fibromyalgia is a multisystem illness. One of its defining
features, generalized pain, may also be present in other rheumatic entities.
The diagnosis of fibromyalgia is not easy by any means, it requires a
profound knowledge of internal medicine. This article discusses the
different rheumatic and nonrheumatic diseases that overlap or are prone to
be confused with fibromyalgia. It emphasizes the key points in the
differential diagnosis
(100) Larson AA,
Kovacs KJ. Nociceptive aspects of fibromyalgia. Curr Pain Headache Rep 2001;
5( 4):338-346.
Abstract: Although characterized by a variety of symptoms, chronic
widespread pain is the primary complaint bringing most patients with
fibromyalgia syndrome (FMS) into the clinic. The etiology of this painful
condition is unknown, and any possible relationship between pain and the
many other symptoms of FMS is unclear. This article focuses on the unique
characteristics of nociception in patients with FMS. The intent is to
present criteria that should be considered in the search for biological
events that contribute to FMS pain. Based on this approach, examples are
proposed of factors that fulfill some criteria and may, therefore, deserve
further study for their possible role in pain associated with FMS
(101) Nielson WR,
Merskey H. Psychosocial aspects of fibromyalgia. Curr Pain Headache Rep
2001; 5( 4):330-337.
Abstract: The view that fibromyalgia syndrome (FMS) is a psychiatric
disorder or can be caused by stress or abuse is unproven. The construct of
posttraumatic FMS has not been adequately validated. Similarly, there is no
evidence that communicating the diagnosis to patients causes iatrogenic
consequences. Research suggesting a higher rate of posttraumatic stress
disorder among those with FMS is weak. More research examining specific
psychological processes in FMS is desirable. Because of the potential for
harm to patients, clinicians should be cognizant of possible undue
influences on medical opinion by agencies providing health care and research
funding
(102) White KP,
Harth M. Classification, epidemiology, and natural history of fibromyalgia.
Curr Pain Headache Rep 2001; 5(4):320-329.
Abstract: Fibromyalgia (FM), also known as fibromyalgia syndrome (FMS) and
fibrositis, is a common form of nonarticular rheumatism that is associated
with chronic generalized musculoskeletal pain, fatigue, and a long list of
other complaints. Some have criticized the classification of FM as a
distinct medical entity, but existing data suggest that individuals meeting
the case definition for FM are clinically somewhat distinct from those with
chronic widespread pain who do not meet the full FM definition. Clinic
studies have found FM to be common in countries worldwide; these include
studies in specialty and general clinics. The same is true of general
population studies, which show the prevalence of FM to be between 0.5% and
5%. Knowledge about risk factors for FM is limited. Females are at greater
risk, and risk appears to increase through middle age, then decline.
Although some authors claim that an epidemic of FM has been fueled by an
over- generous Western compensation system, there are no data that
demonstrate an increasing incidence or prevalence of FM; moreover, existing
data refute any association between FM prevalence and compensation. Claims
that the FM label itself causes illness behavior and increased dependence on
the medical system also are not supported by existing research. This article
reviews the classification, epidemiology, and natural history of FM
(103) Wallace DJ,
Hallegua DS. Quality-of-life, legal-financial, and disability issues in
fibromyalgia. Curr Pain Headache Rep 2001; 5(4):313-319.
Abstract: Patients with fibromyalgia have an altered quality of life that is
hard to quantitate using existing indices. The principal legal issues
associated with the syndrome are: Does fibromyalgia exist? Can it be caused
by or flared by stress or trauma? Does disability apply to fibromyalgia and
if so, how? These issues are critically reviewed
(104) Goulding C,
O'Connell P, Murray FE. Prevalence of fibromyalgia, anxiety and depression
in chronic hepatitis C virus infection: relationship to RT-PCR status and
mode of acquisition. Eur J Gastroenterol Hepatol 2001; 13(5):507-511.
Abstract: BACKGROUND: Musculoskeletal complaints, dry eyes, fatigue and
anxiety are common symptoms in patients with hepatitis C virus (HCV)
infection, but there are few controlled data evaluating this. AIM: To assess
the prevalence of rheumatological disease, fatigue and anxiety in different
groups of patients with chronic HCV infection. PATIENTS AND METHODS:
Seventy-seven patients with HCV were evaluated. Of these, 49 (64%) had been
infected via contaminated anti-D immunoglobulin, 25 (33%) were intravenous
drug users (IVDUs), and three were transfusion related; 78% were female.
Twenty-five age- and sex-matched controls were also evaluated. Assessment
was performed by history, physical examination, the Fibromyalgia Impact
Questionnaire (FIQ) and the Hospital Anxiety and Depression Score (HADS).
RESULTS: Four (5%) patients fulfilled the criteria for fibromyalgia. All
were infected via anti-D immunoglobulin, and three were PCR positive. The
mean number of tender points in anti-D patients was 5.0 (+/- 4.07) compared
with 2.8 (+/- 2.7) in controls (P= 0.028) and 2.5 (+/- 2.2) in IVDUs (P<
0.004). There was no significant difference in the number of tender points
between PCR-positive and PCR- negative patients (P= 0.23). Anxiety and
depression scores were significantly higher in anti-D patients (P= 0.0001)
and IVDUs (P= 0.005) compared with controls. Forty per cent of the HCV
patients had a positive Schirmer test. Forty-two per cent of PCR-positive
patients had a positive rheumatoid factor (RF, > 1/80). CONCLUSION: This
study reveals a moderate increase in prevalence of fibromyalgia in HCV
patients. The number of tender points was related to mode of acquisition but
not to PCR status. Anxiety and depression levels are also increased in HCV
patients compared with controls. Prevalence of RF was higher in PCR-positive
patients compared with controls and those who had cleared the virus
(105) Brecher LS,
Cymet TC. A practical approach to fibromyalgia. J Am Osteopath Assoc 2001;
101( 4 Suppl Pt 2):S12-S17.
Abstract: The term fibromyalgia refers to a collection of symptoms with no
clear physiologic cause, but the symptoms together constitute a clearly
recognizable and distinct pathologic entity. The diagnosis is made through
the examiner's clinical observations. The differential diagnosis must
include other somatic syndromes as well as disease entities, including
hepatitis, hypothyroidism, diabetes mellitus, electrolyte imbalance,
multiple sclerosis, and cancer. Diagnostic criteria serve as guidelines for
diagnosis, not as absolute requirements. Treatment of fibromyalgia, which is
an ongoing process, remains individualized, relying on a good
physician-patient relationship. It is goal-oriented, directed at helping
patients get restorative sleep, alleviating the somatic pains, keeping
patients productive, and regulating schedules. It can be achieved through a
goal- oriented agreement between patient and provider. Because fibromyalgia
is chronic and may affect all areas of an individual's functioning, the
physician needs to also evaluate the social support systems of patients with
fibromyalgia. The approach to treatment should integrate patient education
as well as non-pharmacologic and pharmacologic modalities. To keep patients
well educated and involved in their healthcare, physicians should provide
patients with adequate sources for reliable information
(106) Pongratz D,
Spath M. [Fibromyalgia]. Fortschr Neurol Psychiatr 2001; 69(4):189-193.
Abstract: The classification of fibromyalgia is based on the criteria of the
American College of Rheumatology. For diagnostic reasons autonomic
disturbances and mental features have to be considered. The distinction
between fibromyalgia (tender points) and myofascial pain syndrome (trigger
points) is essential. Internal and neurological disorders as a primary cause
of fibromyalgia have to be excluded. The aetiology and pathogenesis of
fibromyalgia still remain uncertain. The myopathological patterns in
fibromyalgia are non-specific: type-II- fiber-atrophy, a slight increase in
lipid droplets, a proliferation of mitochondria and a slightly elevated
incidence of ragged red fibers. Biochemically alterations of the serotonin
system and high levels of substance P in the cerebrospinal fluid of
fibromyalgia patients are important. Animal experiments showed that the
central stimulation by nociceptor input from muscles is exaggerated in
skeletal muscle pain conditions, suggesting central hyperexcitability. The
diagnosis of fibromyalgia requires a thorough exclusion of other
rheumatologic and neurologic disorders. The differential diagnosis is
complicated by an overlap to other chronic somatoform pain disorders
(107) Peters M,
Vlaeyen J. Comment on 'Differences in somatic perception in female patients
with irritable bowel syndrome with and without fibromyalgia' l. Chang et al,
PAIN 84 (2000) 297--307. Pain 2001; 91(3):402-405.
(108) Marques AP,
Rhoden L, de Oliveira SJ, Joao SM. Pain evaluation of patients with
fibromyalgia, osteoarthritis, and low back pain. Rev Hosp Clin Fac Med Sao
Paulo 2001; 56(1):5-10.
Abstract: The purpose of this study was to evaluate and compare pain as
reported by outpatients with fibromyalgia, osteoarthritis, and low back
pain, in view of designing more adequate physical therapy treatment.
PATIENTS AND METHODS: A Portuguese version of the McGill Pain Questionnaire
- where subjects are asked to choose, from lists of pre-categorized words,
one or none that best describes what they feel - was used to assess pain
intensity and quality of 64 patients, of which 24 had fibromyalgia, 22 had
osteoarthritis, and 18 had low back pain. The pre- categorized words were
organized into 4 major classes - sensory, affective, evaluative, and
miscellaneous. RESULTS: Patients with fibromyalgia reported, comparatively,
more intense pain through their choice of pain descriptors, both sensory and
affective; they also chose a higher number of words from these classes than
patients in the other groups and were the only ones to choose specific
affective descriptors such as "vicious", "wretched", "exhausting",
"blinding". CONCLUSION: Assuming that each disease presents unique qualities
of pain experience, and that these can be pointed out by means of this
questionnaire by patients' choice of specific groups of words, the findings
suggest that fibromyalgia include not only a physical component, but also a
psycho-emotional component, indicating that they require both
emotional/affective and physical care
(109) Littlejohn G.
Fibromyalgia. What is it and how do we treat it? Aust Fam Physician 2001;
30(4):327-333.
Abstract: BACKGROUND: Fibromyalgia is a chronic musculoskeletal disorder
that is characterised by widespread pain, tenderness at multiple anatomical
sites and other clinical manifestations such as fatigue and sleep
disturbance. It occurs predominantly in women and affects approximately 2-4%
of people in industrialised societies. OBJECTIVE: To discuss the syndrome of
fibromyalgia and effective management strategies. DISCUSSION: Fibromyalgia
is a disorder of pain amplification due to increased sensitivity of the pain
system. Management of simple fibromyalgia involves education regarding the
nature of the problem, an exercise program and advice on stress management.
However, management needs to be flexible and holistic and may involve
relaxation programs, physical therapies, cognitive behavioural therapy and
analgesic medication
(110) Buskila D,
Abu-Shakra M, Neumann L, Odes L, Shneider E, Flusser D et al. Balneotherapy
for fibromyalgia at the Dead Sea. Rheumatol Int 2001; 20(3):105-108.
Abstract: The aim of this study was to evaluate the effectiveness of
balneotherapy on patients with fibromyalgia (FM) at the Dead Sea. Forty-
eight patients with FM were randomly assigned to a treatment group receiving
sulfur baths and a control group. All participants stayed for 10 days at a
Dead Sea spa. Physical functioning, FM-related symptoms, and tenderness
measurements (point count and dolorimetry) were assessed at four time
points: prior to arrival at the Dead Sea, after 10 days of treatment, and 1
and 3 months after leaving the spa. Physical functioning and tenderness
moderately improved in both groups. With the exception of tenderness
threshold, the improvement was especially notable in the treatment group and
it persisted even after 3 months. Relief in the severity of FM-related
symptoms (pain, fatigue, stiffness, and anxiety) and reduced frequency of
symptoms (headache, sleep problems, and subjective joint swelling) were
reported in both groups but lasted longer in the treatment group. In
conclusion, treatment of FM at the Dead Sea is effective and safe and may
become an additional therapeutic modality in FM. Future studies should
address the outcome and possible mechanisms of this treatment in FM patients
(111) Ebell MH, Beck
E. How effective are complementary/alternative medicine (CAM) therapies for
fibromyalgia? J Fam Pract 2001; 50(5):400-401.
(112) Merchant RE,
Andre CA. A review of recent clinical trials of the nutritional supplement
Chlorella pyrenoidosa in the treatment of fibromyalgia, hypertension, and
ulcerative colitis. Altern Ther Health Med 2001; 7(3):79-91.
Abstract: CONTEXT: It has been suggested that the consumption of natural
"whole foods" rich in macronutrients has many healthful benefits for those
who otherwise ingest a normal, nonvegetarian diet. One example is dietary
supplements derived from Chlorella pyrenoidosa, a unicellular fresh water
green alga rich in proteins, vitamins, and minerals. OBJECTIVE: To find
evidence of the potential of chlorella dietary supplements to relieve signs
and symptoms, improve quality of life, and normalize body functions in
people with chronic illnesses, specifically fibromyalgia, hypertension, and
ulcerative colitis. DESIGN: Double-blind, placebo- controlled, randomized
clinical trials. SETTING: Virginia Commonwealth University's Medical College
of Virginia. PATIENTS: Fifty-five subjects with fibromyalgia, 33 with
hypertension, and 9 with ulcerative colitis. INTERVENTION: Subjects consumed
10 g of pure chlorella in tablet form and 100 mL of a liquid containing an
extract of chlorella each day for 2 or 3 months. MAIN OUTCOME MEASURES: For
fibromyalgia patients, assessments of pain and overall quality of life. For
hypertensive patients, measurements of sitting diastolic blood pressure and
serum lipid levels. For patients with ulcerative colitis, determination of
state of disease using the Disease Activity Index. RESULTS: Daily dietary
supplementation with chlorella may reduce high blood pressure, lower serum
cholesterol levels, accelerate wound healing, and enhance immune functions.
CONCLUSIONS: The potential of chlorella to relieve symptoms, improve quality
of life, and normalize body functions in patients with fibromyalgia,
hypertension, or ulcerative colitis suggests that larger, more comprehensive
clinical trials of chlorella are warranted
(113) Toussirot E,
Wendling D. Fibromyalgia developed after administration of gonadotrophin-releasing
hormone analogue. Clin Rheumatol 2001; 20(2):150-152.
Abstract: We report the case of a woman treated with a gonadotrophin-releasing
hormone analogue for endometriosis who developed typical clinical features
of fibromyalgia, with widespread musculoskeletal pain, sleep difficulties,
neuropsychological complaints and tender points on clininal examination. The
gonadotrophin-releasing hormone analogue treatment probably induced
disturbances in the neuroendocrine system and the secretion of
neurotransmitters, and may be suspected to be the cause of this case of
fibromyalgia
(114) Rosner I,
Rozenbaum M, Naschitz JE, Sabo E, Yeshurun D. Dysautonomia in chronic
fatigue syndrome vs. fibromyalgia. Isr Med Assoc J 2000; 2 Suppl:23-24.
(115) Sukenik S,
Baradin R, Codish S, Neumann L, Flusser D, Abu-Shakra M et al. Balneotherapy
at the Dead Sea area for patients with psoriatic arthritis and concomitant
fibromyalgia. Isr Med Assoc J 2001; 3(2):147-150.
Abstract: BACKGROUND: Balneotherapy has been successfully used to treat
various rheumatic diseases, but has only recently been evaluated for the
treatment of fibromyalgia. Since no effective treatment exists for this
common rheumatic disease, complementary methods of treatment have been
attempted. OBJECTIVES: To assess the effectiveness of balneotherapy at the
Dead Sea area in the treatment of patients suffering from both fibromyalgia
and psoriatic arthritis. METHODS: Twenty-eight patients with psoriatic
arthritis and fibromyalgia were treated with various modalities of
balneotherapy at the Dead Sea area. Clinical indices assessed were duration
of morning stiffness, number of active joints, a point count of 18
fibrositic tender points, and determination of the threshold of tenderness
in nine fibrositic and in four control points using a dolorimeter. RESULTS:
The number of active joints was reduced from 18.4 +/- 10.9 to 9 +/- 8.2 (P <
0.001). The number of tender points was reduced from 12.6 +/- 2 to 7.1 +/- 5
in men (P < 0.003) and from 13.1 +/- 2 to 7.5 +/- 3.7 in women (P < 0.001).
A significant improvement was found in dolorimetric threshold readings after
the treatment period in women (P < 0.001). No correlation was observed
between the reduction in the number of active joints and the reduction in
the number of tender points in the same patients (r = 0.2). CONCLUSIONS:
Balneotherapy at the Dead Sea area appears to produce a statistically
significant substantial improvement in the number of active joints and
tender points in both male and female patients with fibromyalgia and
psoriatic arthritis. Further research is needed to elucidate the distinction
between the benefits of staying at the Dead Sea area without balneotherapy
and the effects of balneotherapy in the study population
(116) Bell IR,
Baldwin CM, Stoltz E, Walsh BT, Schwartz GE. EEG beta 1 oscillation and
sucrose sensitization in fibromyalgia with chemical intolerance. Int J
Neurosci 2001; 108(1-2):31-42.
Abstract: Patients with fibromyalgia (FM) have diffuse musculoskeletal pain;
half report concomitant intolerance for low levels of environmental
chemicals (CI). Previous investigators have hypothesized that the chronic
pain and chemical intolerance reflect sensitization of different central
nervous system limbic and/or mesolimbic reward pathways. We evaluated
electroencephalographic (EEG) beta activity and blood glucose responses of
FM patients with and without CI and normals during three repeated sucrose
ingestion sessions and during a final, water-only session (testing for
conditioning). The FM with CI exhibited oscillation (reversal in direction
of change from session to session) at rest and then sensitization
(progressive amplification) of EEG beta 1 over time across the 3 sucrose
sessions versus controls. FM with CI showed sensitization of blood glucose
over the 3 sucrose sessions, which, like the EEG findings, reverted toward
baseline in the final water-only session. The data suggest that the subset
of FM patients with CI have increased susceptibility to oscillation and
physiological sensitization without conditioning, perhaps contributing to
fluctuations in their chronic course
(117) Asbring P.
Chronic illness -- a disruption in life: identity-transformation among women
with chronic fatigue syndrome and fibromyalgia. J Adv Nurs 2001;
34(3):312-319.
Abstract: BACKGROUND: People with chronic illnesses often suffer from
identity- loss. Empirical research concerning patients with chronic fatigue
syndrome (CFS) or fibromyalgia has not, however, adequately addressed the
consequences of these illnesses for identity. AIM: The aim of this article
is to describe how women with CFS and fibromyalgia create new concepts of
identity after the onset of illness, and how they come to terms with their
newly arisen identities. I aim to illuminate the biographical work done by
these individuals, which includes a re- evaluation of their former identity
and life. This process is illustrated by the following themes: An earlier
identity partly lost and Coming to terms with a new identity. METHOD: The
study is based on interviews with 25 women in Sweden, 12 with the diagnosis
of CFS and 13 diagnosed with fibromyalgia. A grounded theory orientated
approach was used when collecting and analysing the data. FINDINGS: The main
findings are that: (1) the illnesses can involve a radical disruption in the
women's biography that has profound consequences for their identity,
particularly in relation to work and social life, (2) biographical
disruptions are partial rather than total, calling for different degrees of
identity transformation, (3) many of the women also experience illness gains
in relation to the new identity. CONCLUSIONS: Thus, the biographical
disruption and illness experience comprised both losses and illness gains
that had consequences for identity
(118) Goldman JA.
Fibromyalgia and hypermobility. J Rheumatol 2001; 28(4):920-921.
(119) Wilke WS. Can
fibromyalgia and chronic fatigue syndrome be cured by surgery? Cleve Clin J
Med 2001; 68(4):277-279.
(120) Alnigenis MN,
Barland P. Fibromyalgia syndrome and serotonin. Clin Exp Rheumatol 2001;
19(2):205-210.
Abstract: Although disturbances in the musculoskeletal system, in the
neuroendocrine system and in the central nervous system (CNS) have been
implicated in the pathophysiology of fibromyalgia syndrome (FMS), the
primary mechanisms underlying the etiopathogenesis of FMS remain elusive. It
has been postulated that disturbances in serotonin metabolism and
transmission, along with disturbances in several other chemical pain
mediators, are present in patients with FMS. In this article we review
published studies on the pathophysiological role of serotonin in FMS.
Although studies that indirectly measured the function of serotonin in the
CNS in FMS revealed some abnormalities in the metabolism and transmission of
serotonin, the role of serotonin in the pathophysiology of syndrome remains
inconclusive and warrants more studies
(121) Bansevicius D,
Westgaard RH, Stiles T. EMG activity and pain development in fibromyalgia
patients exposed to mental stress of long duration. Scand J Rheumatol 2001;
30(2):92-98.
Abstract: OBJECTIVE: To examine the distribution of stress-induced
upper-body pain in fibromyalgia patients, and the possible association of
pain with electromyographic activity in muscles near the sites of pain
development. METHODS: Fifteen fibromyalgia patients and 15 pain-free
subjects were exposed to low-level mental strain over a one-hour period. EMG
was recorded from frontalis, temporalis, trapezius, and splenius capitis.
Pain in the corresponding locations was recorded before the test, every 10
minutes during the test, and the 30-minute posttest period. RESULTS: The
fibromyalgia patients developed pain during the test in all the above body
locations. Pain development in all locations associated with trapezius EMG
activity, but not with EMG activity in underlying muscles for forehead,
temples, and neck. CONCLUSION: Stress-induced pain in fibromyalgia patients
is not generally caused by muscle activity. The trapezius EMG response may
be part of a general stress response that cause pain independently of motor
activity in muscles
(122) Worrel LM,
Krahn LE, Sletten CD, Pond GR. Treating fibromyalgia with a brief
interdisciplinary program: initial outcomes and predictors of response. Mayo
Clin Proc 2001; 76(4):384-390.
Abstract: OBJECTIVES: To evaluate the efficacy of a brief, intense treatment
program for fibromyalgia and to determine which patient characteristics are
associated with a better treatment response. PATIENTS AND METHODS: Two
self-report measures, the Fibromyalgia Impact Questionnaire (FIQ) and the
Multidimensional Pain Inventory (MPI), were administered before patients
completed treatment and 1 month after participating in the program. The main
outcome measure was the difference in FIQ score and MPI scale before and
after program participation. RESULTS: Of 139 patients who met the American
College of Rheumatology criteria for fibromyalgia, 100 chose to participate
in the 1 1/2-day Fibromyalgia Treatment Program at the Mayo Clinic,
Rochester, Minn. Of these 100 patients, 74 completed the follow-up surveys.
Patients were less affected by fibromyalgia after participation in the
treatment program. This was demonstrated by a posttreatment improvement in
the total FIQ score (P<.001), the MPI pain severity score (P<.001), and the
MPI interference score (P=.01). The 1 patient characteristic found to be
significantly associated (P<.001) with a better response to treatment was a
high pretreatment level of impairment from fibromyalgia, as measured by the
pretreatment FIQ score. CONCLUSIONS: A brief interdisciplinary program for
treating fibromyalgia reduced some associated symptoms. Patients more
severely affected by fibromyalgia may benefit most from this approach.
Clinicians may apply these findings to develop beneficial and convenient
treatment programs for patients with fibromyalgia
(123) Olin R.
[Fibromyalgia--reality or fantasy?]. Lakartidningen 2001; 98(12):1437, 1439.
(124) Winfield JB.
Does pain in fibromyalgia reflect somatization? Arthritis Rheum 2001;
44(4):751-753.
(125) Jentoft ES,
Kvalvik AG, Mengshoel AM. Effects of pool-based and land-based aerobic
exercise on women with fibromyalgia/chronic widespread muscle pain.
Arthritis Rheum 2001; 45(1):42-47.
Abstract: OBJECTIVE: To examine the effects of pool-based (PE) and
land-based (LE) exercise programs on patients with fibromyalgia. METHODS:
The outcomes were assessed by the Fibromyalgia Impact Questionnaire, the
Arthritis Self-Efficacy Scale, and tests of physical capacity. RESULTS:
Eighteen subjects in the PE group and 16 in the LE group performed a
structured exercise program. After 20 weeks, greater improvement in grip
strength was seen in the LE group compared with the PE group (P < 0.05).
Statistically significant improvements were seen in both groups in
cardiovascular capacity, walking time, and daytime fatigue. In the PE group
improvements were also found in number of days of feeling good,
self-reported physical impairment, pain, anxiety, and depression. The
results were mainly unchanged at 6 months followup. CONCLUSION: Physical
capacity can be increased by exercise, even when the exercise is performed
in a warm-water pool. PE programs may have some additional effects on
symptoms
(126) Landis CA,
Lentz MJ, Rothermel J, Riffle SC, Chapman D, Buchwald D et al. Decreased
nocturnal levels of prolactin and growth hormone in women with fibromyalgia.
J Clin Endocrinol Metab 2001; 86(4):1672-1678.
Abstract: Fibromyalgia (FM) is a complex syndrome, primarily of women,
characterized by chronic pain, fatigue, and sleep disturbance. Altered
function of the somatotropic axis has been documented in patients with FM,
but little is known about nocturnal levels of PRL. As part of a laboratory
study of sleep patterns in FM, we measured the serum concentrations of GH
and PRL hourly from 2000--0700 h in a sample of 25 women with FM (mean, 46.9
+/- 7.6 yr) and in 21 control women (mean, 42.6 +/- 8.1 yr). The mean (+/-SEM
) serum concentrations (micrograms per L) of GH and of PRL during the early
sleep period were higher in control women than in patients with FM [GH, 1.6
+/- 0.4 vs. 0.6 +/- 0.2 (P < 0.05); PRL, 23.2 +/- 2.2 vs. 16.9 +/- 2.0 (P <
0.025)]. The mean serum concentrations of GH and PRL increased more after
sleep onset in control women than in patients with FM [GH, 1.3 +/- 0.4 vs.
0.3 +/- 0.2 (P < 0.05); PRL, 16.2 +/- 2.4 vs. 9.7 +/- 1.5 (P < 0.025)].
Sleep efficiency and amounts of sleep or wake stages on the blood draw night
were not different between groups. There was a modest inverse relationship
between sleep latency and PRL and a direct relationship between sleep
efficiency and PRL in FM. There was an inverse relationship between age and
GH most evident in control women. Insulin- like growth factor I levels were
not different between the groups. These data demonstrate altered functioning
of both the somatotropic and lactotropic axes during sleep in FM and support
the hypothesis that dysregulated neuroendocrine systems during sleep may
play a role in the pathophysiology of FM
(127) Pellegrino MJ.
Fibromyalgia and the law. J Rheumatol 2001; 28(3):676-677.
(128) Ferrari R,
Russell A. Fibromyalgia and the law. J Rheumatol 2001; 28(3):675-678.
(129) Romano TJ.
Fibromyalgia and the law. J Rheumatol 2001; 28(3):674-678.
(130) Wittrup IH,
Jensen B, Bliddal H, Danneskiold-Samsoe B, Wiik A. Comparison of viral
antibodies in 2 groups of patients with fibromyalgia. J Rheumatol 2001;
28(3):601-603.
Abstract: OBJECTIVE: The etiologies of fibromyalgia (FM) are unknown. In
some cases an acute onset following a flu-like episode is described; in
other cases patients report slowly developing disease. We previously found
increased prevalence of enterovirus IgM antibodies in patients with acute
onset of FM compared to healthy controls. We looked for differences in
antimicrobial IgM antibodies in acute versus nonacute onset FM. METHODS: Two
well defined, comparable groups of patients with FM (acute 19, nonacute 20)
were studied for antibodies in serum to an array of viruses including IgM
antibodies. RESULTS: In most viruses no IgM antibodies were found. However,
about 50% of the patients with acute FM onset had IgM antibodies against
enterovirus compared to only 15% of the slow onset patients. CONCLUSION: The
higher prevalence of IgM antibodies against enterovirus in patients with
acute onset of FM may indicate a difference in the etiology or the immune
response in these patients
(131) Werle E,
Fischer HP, Muller A, Fiehn W, Eich W. Antibodies against serotonin have no
diagnostic relevance in patients with fibromyalgia syndrome. J Rheumatol
2001; 28(3):595-600.
Abstract: OBJECTIVE: To determine the prevalence and potential diagnostic
relevance of autoantibodies against serotonin, thromboplastin, and
ganglioside Gm1 in patients with fibromyalgia syndrome (FM). METHODS: Sera
from 203 patients with FM and 64 pain-free control subjects were analyzed
with enzyme immunoassays. Clinical and psychometric data of the patients
were analyzed for the presence or absence of autoantibodies. RESULTS:
Compared with control subjects patients with FM had a significantly higher
prevalence of autoantibodies against serotonin (20% vs 5%; p = 0.003) and
thromboplastin (43% vs 9%; p < 0.001), but not against ganglioside Gm1 (15%
vs 9%; p = 0.301). Differences in autoantibody prevalence between controls
and FM patients were not related to age or sex. No association was found
between autoantibody pattern and clinical or psychometric data, e.g., pain,
depression, pain related anxiety, and activities of daily living.
CONCLUSION: There is an elevated prevalence of antibodies against serotonin
and thromboplastin in patients with FM. The pathophysiological significance
of this finding is unknown. Calculation of positive predictive values of
antiserotonin antibodies shows that measurement of these antibodies has no
diagnostic relevance
(132) Palm O, Moum
B, Jahnsen J, Gran JT. Fibromyalgia and chronic widespread pain in patients
with inflammatory bowel disease: a cross sectional population survey. J
Rheumatol 2001; 28(3):590-594.
Abstract: OBJECTIVE: To assess the prevalence of fibromyalgia (FM) and
chronic widespread pain (CWP) in a population based cohort of patients with
inflammatory bowel disease (IBD). METHODS: Patients in a prospective survey
on newly diagnosed IBD were, 5 years after study entry, invited to a
clinical examination including the investigation of musculoskeletal
manifestations. A total of 521 patients were examined, corresponding to 80%
of surviving cases with definite diagnoses of ulcerative colitis (UC) and
Crohn's disease (CD). The diagnoses of FM and CWP strictly followed the
American College of Rheumatology classification criteria of 1990. RESULTS:
At clinical examination, FM was diagnosed in 18 patients (3.5%), 3.7% with
UC and 3.0% with CD. The prevalence was 6.4% in females and 0.4% in males.
Thirty-eight patients (7.3%) had CWP (8.5% with UC; 4.8% with CD). The
female:male ratio was 27:3 in the UC group and 8:0 in CD. In 19 patients
(50%), CWP occurred after onset of IBD. No correlation with the extent of
intestinal inflammation and the occurrence of FM and CWP was found.
CONCLUSION: The prevalences of FM and CWP in patients with IBD were similar
to those of the general population. There were no differences in prevalence
of FM and CWP between UC and CD. Chronic idiopathic inflammation of the
intestine does not appear to predispose to chronic widespread pain
(133) Cohen H,
Neumann L, Alhosshle A, Kotler M, Abu-Shakra M, Buskila D. Abnormal
sympathovagal balance in men with fibromyalgia. J Rheumatol 2001;
28(3):581-589.
Abstract: OBJECTIVE: It is possible that there are differences in clinical
manifestations between men and women with fibromyalgia syndrome (FM),
especially in autonomic dysfunction; we assessed the interaction between the
sympathetic and parasympathetic systems in postural change in men with FM
using power spectral analysis (PSA) of heart rate variability (HRV), and
investigated the pathogenesis of the orthostatic intolerance. METHODS: We
studied 19 men with FM and 19 controls matched for age and sex. A high
resolution electrocardiogram was obtained in supine and standing postures
during complete rest. Spectral analysis of R-R intervals was done by the
fast Fourier transform algorithm. RESULTS: PSA of HRV revealed that men with
FM at rest are characterized by sympathetic hyperactivity and concomitantly
reduced parasympathetic activity. During postural changes, male patients
demonstrated an abnormal sympathovagal response. These results provide the
physiological basis for the orthostatic intolerance in men with FM.
CONCLUSION: This report of autonomic dysfunction in men with FM revealed an
abnormal autonomic response to orthostatic stress. This abnormality may have
implications regarding the symptoms of FM
(134) Anthony KK,
Schanberg LE. Juvenile primary fibromyalgia syndrome. Curr Rheumatol Rep
2001; 3(2):165-171.
Abstract: Juvenile primary fibromyalgia syndrome (JPFS) is a common
musculoskeletal pain syndrome of unknown etiology characterized by
widespread persistent pain, sleep disturbance, fatigue, and the presence of
multiple discrete tender points on physical examination. Other associated
symptoms include chronic anxiety or tension, chronic headaches, subjective
soft tissue swelling, and pain modulated by physical activity, weather, and
anxiety or stress. Research and clinical observations suggest that JPFS may
have a chronic course that impacts the functional status and psychosocial
development of children and adolescents. In addition, several factors have
been implicated in the etiology and maintenance of JPFS including genetic
and anatomic factors, disordered sleep, psychological distress, and familial
and environmental influences. A multidisciplinary approach to treatment of
JPFS is advocated, including pharmacologic and nonpharmacologic
interventions (eg, psychotherapy, aerobic exercise, sleep hygiene)
(135) McBeth J,
Silman AJ. The role of psychiatric disorders in fibromyalgia. Curr Rheumatol
Rep 2001; 3(2):157-164.
Abstract: The cardinal features of fibromyalgia are chronic widespread pain
in the presence of widespread tenderness as measured by multiple tender
points. Despite extensive investigations, the etiology of this syndrome
remains unclear. Increased rates of psychiatric disorders, particularly
depressive, anxiety, and somatoform disorders, are apparent in clinic
populations. Epidemiologic evidence suggests that this is also true for
community subjects. Depression, generalized psychological distress, and
other psychological factors have been shown to be associated with the onset
and persistence of fibromyalgia symptoms. However, the bodily processes
through which such factors may lead to the onset of fibromyalgia are
unclear. Recent investigations have demonstrated altered stress system
responsiveness, most notably the hypothalamic- pituitary-adrenal stress
axis, in patients with fibromyalgia. These findings, and one promising
avenue for investigating the interaction between psychological and
biological factors in the onset of chronic pain syndromes including
fibromyalgia, are discussed
(136) Crofford LJ,
Appleton BE. Complementary and alternative therapies for fibromyalgia. Curr
Rheumatol Rep 2001; 3(2):147-156.
Abstract: Fibromyalgia (FM) is a syndrome of chronic widespread
musculoskeletal pain that is accompanied by sleep disturbance and fatigue.
Clinical treatment usually includes lifestyle modifications and
pharmacologic interventions meant to relieve pain, improve sleep quality,
and treat mood disorders. These therapies are often ineffective or have been
shown in clinical studies to have only short-term effectiveness.
Pharmacologic treatments have considerable side effects. Patients may have
difficulty complying with exercise-based treatments. Thus, patients seek
alternative therapeutic approaches and physicians are routinely asked for
advice about these treatments. This article reviews nontraditional treatment
alternatives, from use of nutritional and herbal supplements to acupuncture
and mind-body therapy. Little is known about efficacy and tolerance of
complementary and alternative therapies in FM and other chronic
musculoskeletal pain syndromes. Most studies on these treatments have been
performed for osteoarthritis, rheumatoid arthritis, or focal musculoskeletal
conditions. Clinical trials are scarce; the quality of these trials is often
criticized because of small study population size, lack of appropriate
control interventions, poor compliance, or short duration of follow-up.
However, because of widespread and growing use of alternative medicine,
especially by persons with chronic illnesses, it is essential to review
efficacy and adverse effects of complementary and alternative therapies
(137) Clark SR,
Jones KD, Burckhardt CS, Bennett R. Exercise for patients with fibromyalgia:
risks versus benefits. Curr Rheumatol Rep 2001; 3(2):135-146.
Abstract: Although exercise in the form of stretching, strength maintenance,
and aerobic conditioning is generally considered beneficial to patients with
fibromyalgia (FM), there is no reliable evidence to explain why exercise
should help alleviate the primary symptom of FM, namely pain. Study results
are varied and do not provide a uniform consensus that exercise is
beneficial or what type, intensity, or duration of exercise is best.
Patients who suffer from exercise-induced pain often do not follow through
with recommendations. Evidence-based prescriptions are usually inadequate
because most are based on methods designed for persons without FM and,
therefore, lack individualization. A mismatch between exercise intensity and
level of conditioning may trigger a classic neuroendocrine stress reaction.
This review considers the adverse and beneficial effects of exercise. It
also provides a patient guide to exercise that takes into account the risks
and benefits of exercise for persons with FM
(138) Yunus MB. The
role of gender in fibromyalgia syndrome. Curr Rheumatol Rep 2001;
3(2):128-134.
Abstract: Fibromyalgia syndrome (FMS), characterized by widespread pain and
tenderness on palpation (tender points), is much more common in women than
in men in a proportion of 9:1. Two recent studies have shown important
gender differences in various clinical characteristics of FMS. In a
community and a clinic sample, women experienced significantly more common
fatigue, morning fatigue, hurt all over, total number of symptoms, and
irritable bowel syndrome. Women had significantly more tender points. Pain
severity, global severity and physical functioning were not significantly
different between the sexes, nor were psychologic factors, eg, anxiety,
stress, and depression. Gender differences have also been observed in other
related syndromes, eg, chronic fatigue syndrome, irritable bowel syndrome,
and headaches. The mechanisms of gender differences in these illnesses are
not fully understood, but are likely to involve an interaction between
biology, psychology, and sociocultural factors
(139) Glass JM, Park
DC. Cognitive dysfunction in fibromyalgia. Curr Rheumatol Rep 2001;
3(2):123-127.
Abstract: Fibromyalgia is a puzzling syndrome of widespread musculoskeletal
pain. In addition to pain, patients with fibromyalgia frequently report that
cognitive function, memory, and mental alertness have declined. A small body
of literature suggests that there is cognitive dysfunction in fibromyalgia.
This article addresses several questions that physicians may have regarding
cognitive function in their patients. These questions concern the types of
cognitive tasks that are problematic for patients with fibromyalgia, the
role of psychological factors such as depression and anxiety, the role of
physical factors such as pain and fatigue, the nature of patients'
perceptions of their cognitive abilities, and whether patients can be tested
for cognitive dysfunction. Critical areas for further investigation are
highlighted
(140) Aaron LA,
Buchwald D. Fibromyalgia and other unexplained clinical conditions. Curr
Rheumatol Rep 2001; 3 (2):116-122.
Abstract: Several unexplained clinical conditions frequently coexist with
fibromyalgia; these include chronic fatigue syndrome, irritable bowel
syndrome, temporomandibular disorder, tension and migraine headaches, and
others. However, only recently have studies directly compared the
physiological parameters of these conditions (eg, fibromyalgia vs irritable
bowel syndrome) to elucidate underlying pathogenic mechanisms. This review
summarizes data from comparative studies and discusses their implications
for future research
(141) Crofford LJ.
Meta-analysis of antidepressants in fibromyalgia. Curr Rheumatol Rep 2001;
3(2):115.
(142) Earnshaw SM,
MacGregor G, Dawson JK. Fibromyalgia-monotheories, monotherapies and
reductionism. Rheumatology (Oxford) 2001; 40(3):348-349.
(143) Wright MG.
Fibromyalgia syndrome. Rheumatology (Oxford) 2001; 40(3):348.
(144) Legangneux E,
Mora JJ, Spreux-Varoquaux O, Thorin I, Herrou M, Alvado G et al.
Cerebrospinal fluid biogenic amine metabolites, plasma-rich platelet
serotonin and [3H]imipramine reuptake in the primary fibromyalgia syndrome.
Rheumatology (Oxford) 2001; 40(3):290-296.
Abstract: BACKGROUND: Primary fibromyalgia syndrome (PFS) is a chronic
disorder commonly seen in rheumatological practice. The pathophysiological
disturbances of this syndrome, which was defined by the American College of
Rheumatology in 1990, are poorly understood. This study evaluated, in 30
patients, the hypothesis that PFS is a pain modulation disorder induced by
deregulation of serotonin metabolism. OBJECTIVES: To compare platelet
[(3)H]imipramine binding sites and serotonin (5-HT) levels in plasma-rich
platelets (PRP) of PFS patients with those of matched healthy controls and
to compare the levels of biogenic amine metabolites in the cerebrospinal
fluid (CSF) of PFS patients with those of matched controls. METHODS:
Platelet [(3)H]imipramine binding sites were defined by two criteria, B(max)
for their density and K(d) for their affinity. PRP 5-HT and CSF metabolites
of 5-HT (5- hydroxyindoleacetic acid, 5-HIAA), norepinephrine (3-methoxy,
4-hydroxy phenylglycol, MHPG) and dopamine (homovanillic acid, HVA) were
assayed by reversed-phase high-performance liquid chromatography with
coulometric detection. RESULTS: [(3)H]Imipramine platelet binding was
similar (P=0.43 for B(max) and P=0.30 for K(d)) in PFS patients (B(max)=901+/-83
fmol/mg protein, K(d)=0.682+/-0.046) and in matched controls (B(max)=1017+/-119
fmol/mg protein, K(d)=0.606+/-0.056). PRP 5- HT was significantly higher
(P=0.0009) in PFS patients (955+/-101 ng/10(9) platelets) than in controls
(633+/-50 ng/10(9) platelets). When adjusted for age, the levels of all CSF
metabolites were lower in PFS patients. The CSF metabolite of norepinephrine
(MHPG) was lower (P:=0.003) in PFS patients (8.33+/-0.33 ng/ml) than in
matched controls (9.89+/-0.31 ng/ml) and 5-HIAA was lower (P=0.042) in PFS
female patients (22.34+/-1.78 ng/ml) than in matched controls (25.75+/-1.75
ng/ml). For HVA in females, the difference between PFS patients
(36.32+/-3.20 ng/ml) and matched controls (38.32+/-2.90 ng/ml) approached
statistical significance (P=0.054). CONCLUSION: Changes in metabolites of
CSF biogenic amines appear to be partially correlated to age but remained
diagnosis-dependent. High levels of PRP 5-HT in PFS patients were associated
with low CSF 5-HIAA levels in female patients but were not accompanied by
any change in serotonergic uptake as assessed by platelet [(3)H]imipramine
binding sites. These findings do not allow us to confirm that serotonin
metabolism is deregulated in PFS patients
(145) Dauvilliers Y,
Touchon J. [Sleep in fibromyalgia: review of clinical and polysomnographic
data]. Neurophysiol Clin 2001; 31(1):18-33.
Abstract: Fibromyalgia syndrome is a common chronic pain syndrome that is
often associated with sleep disturbances characterized by subjective
experience of non-restorative sleep. The complaints of sleep disturbances
are correlated with polysomnographic features showing clear abnormalities in
the continuity of sleep as well as in the sleep architecture.
Sleep-recording abnormalities are characterized by a reduced sleep
efficiency with increased number of awakenings, a reduced amount of slow
wave sleep and an abnormal alpha wave intrusion in non rapid eye movement,
termed alpha-delta sleep. These data were confirmed by spectral analysis of
sleep showing an increased EEG power density in the higher frequency band
and a reduced EEG power density in the lower frequency bands. Moreover,
other microstructural aspects of sleep were modified with high frequency of
arousals and alpha-K complex reported, both indicators of fragmented sleep.
The fibromyalgia symptoms may relate to a non-restorative sleep disorder
associated with the alpha- EEG sleep anomalies. However, alpha-EEG sleep
anomaly is non-specific for fibrositis, also seen in normal controls during
stage 4 sleep deprivation. Moreover, fibromyalgia patients may also
experience primary sleep disorder such as sleep apnea or periodic leg
movements. The etiology of this common condition is incompletely understood
and the existence of a specific entity of fibromyalgia is still a matter of
debate. However, several studies have found abnormal brain metabolism of
substances such as serotonin implicated in sleep arousal and pain mechanisms
and administration of tricyclic antidepressants and selective serotonin
reuptake inhibitors may be useful in fibromyalgia. Pain, poor sleep quality
and anxiety may contribute to the clinical picture. Several factors such as
psychological, environmental, genetic factor, altered serotonin metabolism
and altered sleep physiology are involved in the pathogenesis of
fibromyalgia
(146) Yoshida S.
[Fibromyalgia syndrome]. Ryoikibetsu Shokogun Shirizu 2000;(31):413-416.
(147) Andreu J,
Rourera P. [Do we have to rush to diagnose fibromyalgia?]. Aten Primaria
2001; 27(4):288-289.
(148) Sweetman BJ.
Fibromyalgia... I mistake your shape. Rheumatology (Oxford) 2001; 40(2):239.
(149) Friedberg F,
Jason LA. Chronic fatigue syndrome and fibromyalgia: clinical assessment and
treatment. J Clin Psychol 2001; 57(4):433-455.
Abstract: Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are closely
related illnesses of uncertain etiology. This article reviews the research
literature on these biobehavioral conditions, with an emphasis on
explanatory models, clinical evaluation of comorbid psychiatric disorders,
assessment of stress factors, pharmacologic and alternative therapies, and
cognitive-behavioral treatment studies. Furthermore, clinical protocols
suitable for professional practice are presented based on an integration of
the authors' clinical observations with published data. The article
concludes with the recognition that mental health professionals can offer
substantial help to these patients
(150) Neumann L,
Sukenik S, Bolotin A, Abu-Shakra M, Amir M, Flusser D et al. The effect of
balneotherapy at the Dead Sea on the quality of life of patients with
fibromyalgia syndrome. Clin Rheumatol 2001; 20(1):15-19.
Abstract: Fibromyalgia (FS) is an idiopathic chronic pain syndrome defined
by widespread non-articular musculoskeletal pain and generalised tender
points. As there is no effective treatment, patients with this condition
have impaired quality of life (QoL). The aim of this study was to assess the
possible effect of balneotherapy at the Dead Sea area on the QoL of patients
with FS. Forty-eight subjects participated in the study; half of them
received balneotherapy, and half did not. Their QoL (using SF-36),
psychological well-being and FS-related symptoms were assessed prior to
arrival at the spa hotel in the Dead Sea area, at the end of the 10-day
stay, and 1 and 3 months later. A significant improvement was reported on
most subscales of the SF-36 and on most symptoms. The improvement in
physical aspects of QoL lasted usually 3 months, but on psychological
measures the improvement was shorter. Subjects in the balneotherapy group
reported higher and longer-lasting improvement than subjects in the control
group. In conclusion, staying at the Dead Sea spa, in addition to
balneotherapy, can transiently improve the QoL of patients with FS. Other
studies with longer follow- up are needed to support our findings
(151) Gantz NM,
Coldsmith EE. Chronic fatigue syndrome and fibromyalgia resources on the
world wide web: a descriptive journey. Clin Infect Dis 2001; 32(6):938-948.
Abstract: A wealth of information on chronic fatigue syndrome (CFS) and
fibromyalgia is available on the World Wide Web for health care providers
and patients. These illnesses have overlapping features, and their
etiologies remain unknown. Multiple Web sites were reviewed, and selected
sites providing useful information were identified. Sites were classified
according to their content and target audience and were judged according to
suggested standards of Internet publishing. Fifty- eight sites were
classified into groups as follows: comprehensive and research Web sites for
CFS and fibromyalgia, meetings, clinical trials, literature search services,
bibliographies, journal, and CFS and fibromyalgia Web sites for the patient
(152) Martinez-Lavin
M. Is fibromyalgia a generalized reflex sympathetic dystrophy? Clin Exp
Rheumatol 2001; 19(1):1-3.
Abstract: Fibromyalgia and reflex sympathetic dystrophy share defining
characteristics, namely chronic pain and allodynia, as well as other
important clinical features such as onset after trauma, female predominance,
paresthesias, vasomotor instability, response to sympathetic blockade and
anxiety/depression. Recent research using heart rate variability analysis
demonstrated that patients with fibromyalgia have changes consistent with
relentless circadian sympathetic hyperactivity. I propose that fibromyalgia
is a sympathetically maintained pain syndrome in which ongoing sympathetic
hyperactivity sensitises the primary nociceptors and induces widespread pain
and allodynia
(153) Alfano AP,
Taylor AG, Foresman PA, Dunkl PR, McConnell GG, Conaway MR et al. Static
magnetic fields for treatment of fibromyalgia: a randomized controlled
trial. J Altern Complement Med 2001; 7(1):53-64.
Abstract: OBJECTIVE: To test effectiveness of static magnetic fields of two
different configurations, produced by magnetic sleep pads, as adjunctive
therapies in decreasing patient pain perception and improving functional
status in individuals with fibromyalgia. DESIGN: Randomized,
placebo-controlled, 6-month trial conducted from November 1997 through
December 1998. SETTING AND SUBJECTS: Adults who met the 1990 American
College of Rheumatology criteria for fibromyalgia were recruited through
clinical referral and media announcements and evaluated at a
university-based clinic. INTERVENTIONS: Subjects in Functional Pad A group
used a pad for 6 months that provided whole-body exposure to a low, uniform
static magnetic field of negative polarity. Subjects in the Functional Pad B
group used a pad for 6 months that exposed them to a low static magnetic
field that varied spatially and in polarity. Subjects in two Sham groups
used pads that were identical in appearance and texture to the functional
pads but contained inactive magnets; these groups were combined for
analysis. Subjects in the Usual Care group continued with their established
treatment regimens. OUTCOME MEASURES: Primary outcomes were the change
scores at 6 months in the following measures: functional status
(Fibromyalgia Impact Questionnaire), pain intensity ratings, tender point
count, and a tender point pain intensity score. RESULTS: There was a
significant difference among groups in pain intensity ratings (p = 0.03),
with Functional Pad A group showing the greatest reduction from baseline at
6 months. All four groups showed a decline in number of tender points, but
differences among the groups were not significant (p = 0.72). The functional
pad groups showed the largest decline in total tender point pain intensity,
but overall differences were not significant (p = 0.25). Improvement in
functional status was greatest in the functional pad groups, but differences
among groups were not significant (p = 0.23). CONCLUSIONS: Although the
functional pad groups showed improvements in functional status, pain
intensity level, tender point count, and tender point intensity after 6
months of treatment, with the exception of pain intensity level these
improvements did not differ significantly from changes in the Sham group or
in the Usual Care group
(154) Thune P. The
coexistence of amyopathic dermatomyositis and fibromyalgia. Acta Derm
Venereol 2000; 80(6):453-454.
(155) Staud R,
Vierck CJ, Cannon RL, Mauderli AP, Price DD. Abnormal sensitization and
temporal summation of second pain (wind-up) in patients with fibromyalgia
syndrome. Pain 2001; 91(1-2):165-175.
Abstract: Although individuals with fibromyalgia syndrome (FMS) consistently
report wide-spread pain, clear evidence of structural abnormalities or other
sources of chronic stimulation of pain afferents in the involved body areas
is lacking. Without convincing evidence for peripheral tissue abnormalities
in FMS patients, it seems likely that a central pathophysiological process
is at least partly responsible for FMS, as is the case for many chronic pain
conditions. Therefore, the present study sought to obtain psychophysical
evidence for the possibility that input to central nociceptive pathways is
abnormally processed in individuals with long standing FMS. In particular,
temporal summation of pain (wind-up) was assessed, using series of
repetitive thermal stimulation of the glabrous skin of the hands. Although
wind-up was evoked both in control and FMS subjects, clear differences were
observed. The perceived magnitude of the sensory response to the first
stimulus within a series was greater for FMS subjects compared to controls,
as was the amount of temporal summation within a series. Within series of
stimuli, FMS subjects reported increases in sensory magnitude to painful
levels for interstimulus intervals of 2-5 s, but pain was evoked
infrequently at intervals greater than 2 s for control subjects. Following
the last stimulus in a series, after-sensations were greater in magnitude,
lasted longer and were more frequently painful in FMS subjects. These
results have multiple implications for the general characterization of pain
in FMS and for an understanding of the underlying pathophysiological basis
(156) Klerman EB,
Goldenberg DL, Brown EN, Maliszewski AM, Adler GK. Circadian rhythms of
women with fibromyalgia. J Clin Endocrinol Metab 2001; 86(3):1034-1039.
Abstract: Fibromyalgia syndrome is a chronic and debilitating disorder
characterized by widespread nonarticular musculoskeletal pain whose etiology
is unknown. Many of the symptoms of this syndrome, including difficulty
sleeping, fatigue, malaise, myalgias, gastrointestinal complaints, and
decreased cognitive function, are similar to those observed in individuals
whose circadian pacemaker is abnormally aligned with their sleep-wake
schedule or with local environmental time. Abnormalities in melatonin and
cortisol, two hormones whose secretion is strongly influenced by the
circadian pacemaker, have been reported in women with fibromyalgia. We
studied the circadian rhythms of 10 women with fibromyalgia and 12 control
healthy women. The protocol controlled factors known to affect markers of
the circadian system, including light levels, posture, sleep-wake state,
meals, and activity. The timing of the events in the protocol were
calculated relative to the habitual sleep-wake schedule of each individual
subject. Under these conditions, we found no significant difference between
the women with fibromyalgia and control women in the circadian amplitude or
phase of rhythms of melatonin, cortisol, and core body temperature. The
average circadian phases expressed in hours posthabitual bedtime for women
with and without fibromyalgia were 3:43 +/- 0:19 and 3:46 +/- 0:13,
respectively, for melatonin; 10:13 +/- 0:23 and 10:32 +/- 0:20, respectively
for cortisol; and 5:19 +/- 0:19 and 4:57 +/- 0:33, respectively, for core
body temperature phases. Both groups of women had similar circadian rhythms
in self-reported alertness. Although pain and stiffness were significantly
increased in women with fibromyalgia compared with healthy women, there were
no circadian rhythms in either parameter. We suggest that abnormalities in
circadian rhythmicity are not a primary cause of fibromyalgia or its
symptoms
(157) Gallinaro AL,
Feldman D, Natour J. An evaluation of the association between fibromyalgia
and repetitive strain injuries in metalworkers of an industry in Guarulhos,
Brazil. Joint Bone Spine 2001; 68(1):59-64.
Abstract: Repetitive strain injuries are a common diagnostic label for
musculoskeletal pain occurring at the workplace. Although many individuals
present with diffuse pain, the diagnosis of fibromyalgia in this setting is
rare. Our objective was to establish the point prevalence of the
fibromyalgia syndrome in a population of assembly line workers in Sao Paulo,
Brazil. METHODS: Thirty-four workers with repetitive strain injury diagnoses
were studied and compared with 49 workers, paired by age, sex, and labor
function. All individuals were studied by a comprehensive clinical protocol.
Diagnosis of fibromyalgia syndrome was established when the 1990 American
College of Rheumatology criteria for this syndrome were met. RESULTS: Among
the 34 workers with the diagnosis of repetitive strain injuries, 58.8%
fulfilled the American College of Rheumatology criteria for fibromyalgia
syndrome, while only 10.4% of the controls met the same criteria.
CONCLUSIONS: Fibromyalgia syndrome was largely involved in the symptoms of
patients with repetitive strain injuries, as opposed to coworkers with non-
repetitive strain injuries. So, instead of the repetitive strain injuries
label, many of these cases should be called fibromyalgic patients
(158) Smith IK.
Hurting all over. Patients suffering from fibromyalgia used to be told that
it was all in their head. Not anymore. Time 2001; 157(7):84.
(159) Buskila D.
Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr
Opin Rheumatol 2001; 13(2):117-127.
Abstract: The prevalence of chronic widespread pain in the general
population in Israel was comparable with reports from the USA, UK, and
Canada. Comorbidity with fibromyalgia (FM) resulted in somatic hyperalgesia
in patients with irritable bowel syndrome. One sixth of the subjects with
chronic widespread pain in the general population were also found to have a
mental disorder. Mechanisms involved in referred pain, temporal summation,
muscle hyperalgesia, and muscle pain at rest were attenuated by the
N-methyl-D-aspartate (NMDA) antagonist, ketamine, in FM patients. Delayed
corticotropin release, after interleukin-6 administration, in FM was shown
to be consistent with a defect in hypothalamic corticotropin-releasing
hormone neural function. The basal autonomic state of FM patients was
characterized by increased sympathetic and decreased parasympathetic systems
tones. The severity of functional impairment as assessed by the Medical
Outcome Survey Short Form (SF-36) discriminated between patients with
widespread pain alone and FM patients. Chronic fatigue syndrome (CFS)
occurred in about 0.42% of a random community-based sample of 28,673 adults
in Chicago, Illinois. A significant clinical overlap between CFS and FM was
reported. Cytokine dysregulation was not found to be a singular or dominant
factor in the pathogenesis of CFS. A favorable outcome of CFS in children
was reported; two thirds recovered and resumed normal activities. No major
therapeutic trials in FM and CFS were reported over the past year
(160) Martinez JE,
Barauna F, I, Kubokawa K, Pedreira IS, Machado LA, Cevasco G. Evaluation of
the quality of life in Brazilian women with fibromyalgia, through the
medical outcome survey 36 item short-form study. Disabil Rehabil 2001;
23(2):64-68.
Abstract: PURPOSE: The purpose of this study is to assess the impact of
Fibromyalgia (FM) on the female patient's quality of life who attended the
Rheumatology Outpatient Unit of Sorocaba Hospital Complex and compare it to
the quality of life of healthy control group, through the Medical Outcome
Study Short-form 36 item Survey (SF36). SUBJECTS: 32 women who fitted the
American College of Rheumatology Classification Criteria for Fibromyalgia
and 28 healthy women. MATERIALS AND METHODS: The groups were submitted to
'Medical Outcome Study 36 Item Short-form Survey' (SF36). This questionnaire
is composed of 8 scales about several aspects of the quality of life.
RESULTS: The SF36 scales in the Fibromyalgia group presented the following
results: general health-- 43.3; functional ability--39.4; bodily pain--26.5;
physical functioning- -14.8 (0-75); vitality--38.5 (5-85); emotional
functioning--32.2; mental health--44.2; social functioning--45.1. The SF36
scales in the control group presented the following results: general
health--73.2; functional ability--86.6; bodily pain--68.9; physical
functioning-- 82.4; vitality--59.6; emotional functioning--78.5; mental
health--67.4; social functioning--77.9. Significant statistics variations in
all evaluated scales were presented by the survey group. CONCLUSION:
Fibromyalgia has had a negative impact on the quality of life
(161) Roizenblatt S,
Moldofsky H, Benedito-Silva AA, Tufik S. Alpha sleep characteristics in
fibromyalgia. Arthritis Rheum 2001; 44(1):222-230.
Abstract: OBJECTIVE: To characterize the patterns of alpha
electroencephalographic sleep and their associations with pain and sleep in
patients with fibromyalgia. METHODS: Pain and sleep symptoms of 40 female
patients with fibromyalgia and 43 healthy control subjects were studied
before and after overnight polysomnography. Blinded analyses of alpha
activity in non-rapid eye movement (non-REM) sleep were performed using time
domain, frequency domain, and visual analysis techniques. RESULTS: Three
distinct patterns of alpha sleep activity were detected in fibromyalgia:
phasic alpha (simultaneous with delta activity) in 50% of patients, tonic
alpha (continuous throughout non- REM sleep) in 20% of patients, and low
alpha activity in the remaining 30% of patients. Low alpha activity was
exhibited by 83.7% of control subjects (P < 0.01). All fibromyalgia patients
who displayed phasic alpha sleep, activity reported worsening of pain after
sleep, compared with 58.3% of patients with low alpha activity (P < 0.01)
and 25.0% of patients with tonic alpha activity (P < 0.01). Postsleep
increase in the number of tender points occurred in 90.0% of patients with
phasic alpha activity, 41.7% of patients with low alpha activity, and 25.0%
of patients with tonic alpha activity (P < 0.01). Self ratings of poor sleep
were reported by all patients with phasic alpha activity, 58.3% of patients
with low alpha activity (P < 0.01), and 12.5% of patients with tonic alpha
activity (P < 0.01). Patients with phasic alpha activity reported longer
duration of pain than patients in other subgroups (P < 0.01). Additionally,
patients with phasic alpha sleep activity exhibited less total sleep time
than patients in other subgroups (P < 0.05), as well as lower sleep
efficiency (P < 0.05) and less slow wave sleep (P < 0.05) than patients with
a tonic alpha sleep pattern. CONCLUSION: Alpha intrusion during sleep can be
of different patterns. Phasic alpha sleep activity was the pattern that
correlated better with clinical manifestations of fibromyalgia
(162) Ernberg M,
Voog U, Alstergren P, Lundeberg T, Kopp S. Plasma and serum serotonin levels
and their relationship to orofacial pain and anxiety in fibromyalgia. J
Orofac Pain 2000; 14(1):37-46.
Abstract: AIMS: Serum serotonin levels (S-5-HT) have been reported to be
reduced in patients with fibromyalgia and to show a negative correlation
with pain. We hypothesized that one mechanism behind this could be that
platelets are activated to release 5-HT into the plasma compartment (P-
5-HT), which then binds to nociceptors. The aims of this study were
therefore to investigate the relation between P-5-HT and S-5-HT and their
relationship versus orofacial pain and anxiety in fibromyalgia. METHODS:
Twelve patients with fibromyalgia, 12 patients with rheumatoid arthritis,
and 12 healthy individuals participated in the study. Pain measures used
were pain intensity assessed with a visual analog scale, pain drawings, and
influence of pain on daily living activities (ADL). The Spielberger State
and Trait Anxiety Inventory (STAI) scale was used for self-rating of anxiety
levels. The participants were examined clinically, and the pressure pain
threshold (PPT) over the masseter muscle was assessed. Finally, venous blood
was collected for analysis of P-5-HT and S-5-HT. RESULTS: The ratio between
P-5-HT and S-5-HT was calculated to determine the relative plasma fraction
of serotonin (RPS). Patients with fibromyalgia showed significantly lower
S-5-HT than did patients with rheumatoid arthritis. They also showed
significantly higher STAI scores and tender point index of orofacial muscles
and significantly lower PPT than the healthy individuals. High RPS was
associated with high ADL and STAI scores. CONCLUSION: This study indicates
that a high level of plasma serotonin in relation to serum level is
associated with pain discomfort and increased anxiety in fibromyalgia
(163) The challenge
of fibromyalgia: new approaches. Proceedings from a symposium. Frankfurt,
Neu-Isenburg, Germany. 25-26 November 1999. Scand J Rheumatol Suppl 2000;
113:1-86.
(164) Olson GB,
Savage S, Olson J. The effects of collagen hydrolysat on symptoms of chronic
fibromyalgia and temporomandibular joint pain. Cranio 2000; 18(2):135-141.
Abstract: Twenty (20) people who had medically diagnosed fibromyalgia for
two to 15+ years participated in and completed a 90-day evaluation to
determine effects of collagen hydrolysat on symptoms of chronic
fibromyalgia, with twelve reporting temporomandibular joint pain. Collagen
hydrolysat is a food supplement that is available without prescription, with
no known side effects. Participants were evaluated initially and then at
30-, 60-, and 90-day periods. Final results were obtained and comparisons
made. The average pain complaint levels decreased significantly in an
overall group average, and dramatically with some individuals. It was
concluded that patients with fibromyalgia and concurrent temporomandibular
joint problems may gain symptomatic improvement in their chronic symptoms by
taking collagen hydrolysat
(165) Pay S,
Calguneri M, Caliskaner Z, Dinc A, Apras S, Ertenli I et al. Evaluation of
vascular injury with proinflammatory cytokines, thrombomodulin and
fibronectin in patients with primary fibromyalgia. Nagoya J Med Sci 2000;
63(3-4):115-122.
Abstract: OBJECTIVE: Cold intolerance, cold induced peripheral vasospasm,
Raynaud's phenomenon, livedo reticularis and immunoglobulin deposition in
the skin are often encountered clinical and laboratory findings in patients
with primary fibromyalgia (FM). These findings are suggestive of vascular
injury. METHODS: Eighty patients (4 male, 76 female) with fulfilling primary
FM criteria (FM (+) patient group), 60 patients (3 male, 57 female) with
chronic musculoskeletal complaints but without FM (FM (-) patient control
group) and 40 healthy volunteers (1 male, 39 female) without musculoskeletal
complaints (healthy control group) were enrolled in this cross-sectional
study. The study was carried out in two steps. In the first step, the
clinical findings, routine laboratory tests, autoantibodies and radiological
findings were investigated. The second step were consisted of the laboratory
investigations of thrombomodulin and fibronectin as the mediators indicating
vascular injury and proinflammatory cytokines in FM patients with Raynaud's
phenomenon and/or livedo reticularis and in control groups. RESULTS: There
were no differences between study and control groups with regard to
laboratory, radiological and immunological (ANA, AntidsDNA, ENA,
anticardiolipin IgG and IgM) results. No statistically significant
differences were found in the levels of proinflammatory cytokines between FM
(+) patient group and control groups (p > 0.05). Thrombomodulin was also
shown statistically insignificant difference between FM (+) patient group
and control groups (p > 0.05). However, fibronectin, another mediator of
vascular injury, was higher in FM (+) patient group and the differences
between FM (+) patients and each control groups were statistically
significant (p < 0.0001). CONCLUSION: Our results were suggestive of the
presence of a non-immunological vascular injury in FM patients with
Raynaud's phenomenon and/or livedo reticularis
(166) Anderberg UM,
Uvnas-Moberg K. Plasma oxytocin levels in female fibromyalgia syndrome
patients. Z Rheumatol 2000; 59(6):373-379.
Abstract: OBJECTIVES: Fibromyalgia syndrome (FMS) is a chronic pain
disorder, where 90% of the patients struck by the disorder are women. The
neuropeptide oxytocin is known to have antinociceptive and analgesic, as
well as anxiolytic and antidepressant effects, which makes this neuropeptide
of interest in fibromyalgia research. The aim of this study was to assess
oxytocin concentrations in female FMS patients with different hormonal
status and in depressed and non-depressed patients and relate oxytocin
concentrations to adverse symptoms as pain, stress, depression, anxiety and
to the positive item happiness. METHODS: Thirty- nine patients and 30
controls registered these symptoms daily during 28 days and blood samples
for the assessment of oxytocin were drawn twice in all patients and
controls. Besides the daily ratings, depression was also estimated with the
self-rating instrument Beck Depression Inventory (BDI). RESULTS: Depressed
patients according to the BDI differed significantly with low levels of
oxytocin compared to the non- depressed patients and the controls. Low
levels of oxytocin were also seen in high scoring pain, stress and
depression patients according to the daily ratings; however, these subgroups
were small. A negative correlation was found between the scored symptoms
depression and anxiety and oxytocin concentration, and a positive
correlation between the item happiness and oxytocin. The oxytocin
concentration did not differ between the hormonally different subgroups of
patients or controls. CONCLUSION: The results suggest that the neuropeptide
oxytocin may, together with other neuropeptides and neurotransmitters, play
a role in the integration of the stress axes, monoaminergic systems and the
pain processing peptides in the pathophysiologic mechanisms responsible for
the symptoms in the FMS
(167) Karper WB.
Exercise program effects on one woman with multiple sclerosis, Crohn's
disease, fibromyalgia syndrome, and clinical depression. N C Med J 2001;
62(1):14-16.
(168) Maquet D,
Croisier JL, Crielaard JM. [Fibromyalgia in the year 2000]. Rev Med Liege
2000; 55(11):991-997.
Abstract: Musculoskeletal pain is common in the population. Several
pathologies like fibromyalgia (FM), chronic fatigue syndrome (CFS) or
spasmophilia are associated with functional myalgia. The etiology of FM
remains elusive, but the diagnosis is well established. The criteria for the
classification are widespread pain combined with tenderness at 11 or more of
the 18 specific tender points sites. The prevalence is 2% in the general
population. This article reviews recent data on the pathophysiology and
treatment of FM
(169) Slawson JG,
Meurer LN. Are antidepressants effective in the treatment of fibromyalgia,
and is this effect independent of depression? J Fam Pract 2001; 50(1):14.
(170) Nielson WR,
Jensen MP, Hill ML. An activity pacing scale for the chronic pain coping
inventory: development in a sample of patients with fibromyalgia syndrome.
Pain 2001; 89(2-3):111-115.
Abstract: Patients with fibromyalgia syndrome (FS) experience a decreased
ability to participate in both vocational and avocational activities.
Although many treatment programs advocate activity pacing techniques,
'pacing' is a poorly understood concept for which there are no available
measures. The present study describes a brief six-item pacing scale that can
be administered as part of the Chronic Pain Coping Inventory (CPCI).
Preliminary data indicate that this scale is a valid, reliable index of the
pacing construct that is associated with physical impairment in patients
with FS and is unrelated to simple task persistence
(171) Stevens A,
Batra A, Kotter I, Bartels M, Schwarz J. Both pain and EEG response to cold
pressor stimulation occurs faster in fibromyalgia patients than in control
subjects. Psychiatry Res 2000; 97(2-3):237-247.
Abstract: Pain-evoked brain potentials elicited by laser stimulation have
been repeatedly shown to be abnormal in fibromyalgia syndrome. However, to
our knowledge this is the first study assessing enduring (cold pressor) pain
and correlated EEG changes in fibromyalgia. EEG power and subjective pain
ratings during the cold pressor test were analyzed and contrasted with tasks
not involving sensory stimulation (rest, mental arithmetic and pain imagery)
in 20 patients with fibromyalgia and 21 healthy control subjects.
Fibromyalgia patients both perceived pain and judged pain as intolerable
earlier than control subjects, while pain intensity ratings and EEG power
changes during subjective awareness of pain were similar in both groups. In
patients and control subjects, pain was correlated with a rise in delta,
theta and beta power. EEG power spectra during pain imagery and mental
arithmetic were significantly different from those observed during the cold
pressor test. In conclusion, fibromyalgia patients seem to process painful
stimuli abnormally in a quantitative sense, thus producing both the
sensation of pain, as well as the associated EEG patterns, much earlier than
control subjects. However, the quality of the pain-associated EEG changes
seems similar
(172) Malt EA, Berle
JE, Olafsson S, Lund A, Ursin H. Fibromyalgia is associated with panic
disorder and functional dyspepsia with mood disorders. A study of women with
random sample population controls. J Psychosom Res 2000; 49(5):285-289.
Abstract: BACKGROUND: We compared ICD-10 psychiatric disorders in female
patients with fibromyalgia (n=45) or functional dyspepsia (n=18) with age-
matched random sample controls (n=49). METHOD: Version 2 of The Schedules
for Clinical Assessment in Neuropsychiatry (SCAN) was used for present state
examination and lifetime diagnoses. RESULTS: Current psychiatric disorders
(somatoform pain disorder and specific phobia omitted) were diagnosed in 80%
of fibromyalgia patients (OR=8.3), 83% of functional dyspepsia patients
(OR=10.3) and 33% controls. Among fibromyalgia patients 27% had lifetime
panic disorder. Lifetime mood disorders were found in 83% of functional
dyspepsia patients. First- degree relatives with psychiatric disorder were
found in 16% of the fibromyalgia patients, 50% of functional dyspepsia
patients and 20% of controls. CONCLUSIONS: Fibromyalgia is associated with
panic disorder and functional dyspepsia with mood disorders in substantial
subgroups. Psychiatric symptoms and somatic complaints are closely related
in these disorders
(173) Van Houdenhove
B, Neerinckx E, Lysens R, Vertommen H, Van Houdenhove L, Onghena P et al.
Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care:
a controlled study on prevalence and characteristics. Psychosomatics 2001;
42(1):21-28.
Abstract: The authors studied the prevalence and characteristics of
different forms of victimization in 95 patients suffering from chronic
fatigue syndrome (CFS) or fibromyalgia (FM) compared with a chronic disease
group, including rheumatoid arthritis (RA) and multiple sclerosis (MS)
patients, and a matched healthy control group. The authors assessed
prevalence rates, nature of victimization (emotional, physical, sexual),
life period of occurrence, emotional impact, and relationship with the
perpetrator by a self-report questionnaire on burdening experiences. CFS and
FM patients showed significantly higher prevalences of emotional neglect and
abuse and of physical abuse, with a considerable subgroup experiencing
lifelong victimization. The family of origin and the partner were the most
frequent perpetrators. With the exception of sexual abuse, victimization was
more severely experienced by the CFS/FM group. No differences were found
between healthy control subjects or RA/MS patients, and between CFS and FM
patients. These findings support etiological hypotheses suggesting a pivotal
role for chronic stress in CFS and FM and may have important therapeutic
implications
(174) Clauw DJ,
Russel IJ. Toward optimal health: the experts discuss fibromyalgia. J Womens
Health Gend Based Med 2000; 9(10):1055-1060.
(175) Sarmer S,
Ergin S, Yavuzer G. The validity and reliability of the Turkish version of
the Fibromyalgia Impact Questionnaire. Rheumatol Int 2000; 20(1):9-12.
Abstract: This study was undertaken to translate and adapt the Fibromyalgia
Impact Questionnaire (FIQ) into the Turkish language and investigate its
validity and reliability for Turkish female fibromyalgia (FM) patients.
After translation into Turkish, we administered the FIQ and Health
Assessment Questionnaire (HAQ) to 51 women with fibromyalgia. As well as
sociodemographic characteristics, the severity of relevant clinical
symptoms, e.g., pain intensity, fatigue, and sleep disturbance, were
assessed by visual analog scales. A tender point score (TPS) was calculated
from tender points conducted by thumb palpation. Test-retest reliability,
internal consistency, and concurrent and construct validities of FIQ were
evaluated. Test-retest reliability and internal consistency were good at
0.81 and 0.72, respectively. Correlation between FIQ and HAQ scores was
0.43, which was low but statistically significant. Significant moderate
correlations were obtained between the FIQ items and severity of clinical
symptoms (0.63-0.77), except TPS, 0.31. The FIQ is a reliable and valid
instrument for measuring functional disability in Turkish female FM patients
(176) Kwiatek R,
Barnden L, Tedman R, Jarrett R, Chew J, Rowe C et al. Regional cerebral
blood flow in fibromyalgia: single-photon-emission computed tomography
evidence of reduction in the pontine tegmentum and thalami. Arthritis Rheum
2000; 43(12):2823-2833.
Abstract: OBJECTIVE: To determine whether regional cerebral blood flow (rCBF)
is abnormal in any cerebral structure of women with fibromyalgia (FM),
following a report that rCBF is reduced in the thalami and heads of caudate
nuclei in FM. METHODS: Seventeen women with FM and 22 healthy women had a
resting single-photon-emission computed tomography (SPECT) brain scan to
assess rCBF and a T1-weighted magnetic resonance imaging (MRI) scan to
enable precise anatomic localization. Additionally, all participants
underwent 2 manual tender point examinations and completed a set of
questionnaires evaluating clinical features. SPECT scans were analyzed for
differences in rCBF between groups using statistical parametric mapping (SPM)
and regions of interest (ROIs) manually drawn on coregistered MRI. RESULTS:
Compared with control subjects, the rCBF in FM patients was significantly
reduced in the right thalamus (P = 0.006), but not in the left thalamus or
head of either caudate nucleus. SPM analysis indicated a statistically
significant reduction in rCBF in the inferior pontine tegmentum (corrected P
= 0.006 at the cluster level and corrected P = 0.023 for voxel of maximal
significance), with consistent findings from ROI analysis (P = 0.003). SPM
also detected a reduction in rCBF on the perimeter of the right lentiform
nucleus. No correlations were found with clinical features or indices of
pain threshold. CONCLUSION: Our finding of a reduction in thalamic rCBF is
consistent with findings of functional brain imaging studies of other
chronic clinical pain syndromes, while our finding of reduced pontine
tegmental rCBF is new. The pathophysiologic significance of these changes in
FM remains to be elucidated
(177) Wittrup IH,
Christensen LS, Jensen B, Danneskiold-Samsee B, Bliddal H, Wiik A. Search
for Borna disease virus in Danish fibromyalgia patients. Scand J Rheumatol
2000; 29(6):387-390.
Abstract: OBJECTIVE: The purpose of this study was to look for Borna disease
virus (BDV) in 18 patients with acute onset of fibromyalgia (FMS) following
a "flu-like" episode. BDV is a neurotropic RNA virus affecting horses and
sheep. Infections in animals have been reported to cause immune mediated
disease characterized by abnormalities in behavior. A possible link between
BDV and neuropsychiatric diseases in man has been described, and lately a
connection to chronic fatigue syndrome (CFS) has been suggested. METHODS: A
BDV-specific nested PCR (RT-PCR) was performed on serum and spinal fluid.
RESULTS: The BDV genome was not detected in any of the FMS cases.
CONCLUSION: Although BDV was not demonstrated in spinal fluid or serum from
the tested patients with FMS, we believe that it is important to report our
results, since FMS can exhibit many manifestations in common with CFS.
Possible reasons for the discrepant findings are discussed
(178) Hadhazy VA,
Ezzo J, Creamer P, Berman BM. Mind-body therapies for the treatment of
fibromyalgia. A systematic review. J Rheumatol 2000; 27(12):2911-2918.
Abstract: OBJECTIVE: To assess the effectiveness of mind-body therapy (MBT)
for fibromyalgia syndrome (FM) by systematically reviewing randomized/quasirandomized
controlled trials using methods recommended by the Cochrane Collaboration.
METHODS: Nine electronic databases, 69 conference proceedings, and several
citation lists were searched for relevant trials in any language. Eligible
trials were scored for methodological quality using a validated instrument.
Information on major outcomes was extracted. Insufficient data reporting
prevented statistical pooling, therefore a best-evidence synthesis was
performed. RESULTS: Thirteen trials involving 802 subjects were included.
Seven trials received a high methodological score. Compared to waiting
list/treatment as usual, there is strong evidence that MBT is more effective
for self-efficacy, limited evidence for quality of life, inconclusive
evidence for all other outcomes. There is limited evidence that MBT is more
effective than placebo (for pain and global improvement); inconclusive
evidence that MBT is more effective than physiotherapy, psychotherapy, or
education/attention control for all outcomes; strong evidence that
moderate/high intensity exercise is more effective than MBT (for pain and
function). There is moderate evidence that MBT plus exercise (MBT+E) is more
effective than waiting list/treatment as usual (for self-efficacy and
quality of life); limited evidence that MBT+E is more effective than
education/attention control; inconclusive for other outcomes. There is
inconclusive evidence for MBT+E vs other active treatments for all outcomes.
Longterm within-groups results show greatest benefit for MBT+E. CONCLUSION:
MBT is more effective for some clinical outcomes compared to waiting
list/treatment as usual or placebo. Compared to active treatments, results
are largely inconclusive, except for moderate/high intensity exercise, where
results favor the latter. Further research needs to focus on the synergistic
effects of MBT plus exercise and/or plus antidepressants
(179) De Stefano R,
Selvi E, Villanova M, Frati E, Manganelli S, Franceschini E et al. Image
analysis quantification of substance P immunoreactivity in the trapezius
muscle of patients with fibromyalgia and myofascial pain syndrome. J
Rheumatol 2000; 27(12):2906-2910.
Abstract: OBJECTIVE: Substance P (SP), a neurotransmitter stored within the
afferent nociceptive fibers, is likely to be involved in the pathogenesis of
musculoskeletal pain. We investigated SP immunoreactive (SP-ir) nerve fibers
in the upper trapezius of patients with fibromyalgia (FM) and myofascial
pain syndrome (MPS) by immunochemistry. METHODS: Trapezius muscle obtained
from tender points of 9 women with primary FM, from trigger points of 9
women with regional myofascial pain, and from 9 control women were
immunostained with anti-SP sera. Quantitative evaluation was performed by
computerized image analysis. RESULTS: No significant differences in the
number of SP-ir areas were detected between groups (one way ANOVA: p = 0.2);
in contrast, mean optical density (OD) of SP-ir showed a significant
difference comparing the groups (one way ANOVA: p < 0.0001). Mean OD of the
immunostaining for SP was statistically greater in trapezius muscle of
patients with MPS (0.594 +/- 0.096) compared to specimens from patients with
FM (0.436 +/- 0.140) (p < 0.05) and controls (0.314 +/- 0.105) (p < 0.05);
mean OD of immunostaining for SP was greater in FM specimens than in
controls (p < 0.05). CONCLUSION: Our results point to a peripheral
hyperactivity of the peptidergic nervous system in FM as well as in MPS.
These findings support the notion of pathogenetic involvement of the
afferent nervous system in the development and perception of myofascial pain
(180) Bradley LA,
McKendree-Smith NL, Alberts KR, Alarcon GS, Mountz JM, Deutsch G. Use of
neuroimaging to understand abnormal pain sensitivity in fibromyalgia. Curr
Rheumatol Rep 2000; 2(2):141-148.
Abstract: This paper examines the use of neuroimaging to measure change in
regional cerebral blood flow (rCBF) produced by pain in patients with
fibromyalgia and in healthy individuals. Fibromyalgia patients differ from
healthy persons in rCBF distribution in several brain structures involved in
pain processing and pain modulation both at rest and during experimental
pain induction. These abnormalities may contribute to abnormal pain
sensitivity as well as the maladaptive pain behaviors that characterize many
patients with fibromyalgia. We anticipate that future neuroimaging studies
will enhance our understanding of abnormal pain sensitivity and of pain
management interventions aimed at altering central nervous system function
in patients with fibromyalgia
(181) Park JH,
Niermann KJ, Olsen N. Evidence for metabolic abnormalities in the muscles of
patients with fibromyalgia. Curr Rheumatol Rep 2000; 2(2):131-140.
Abstract: Widespread muscle pain, fatigue, and weakness are defining
characteristics of patients with fibromyalgia (FM). The aim of this review
is to summarize recent investigations of muscle abnormalities in FM, which
can be classified as structural, metabolic, or functional in nature.
Histologic muscle abnormalities of membranes, mitochondria, and fiber type
have been well described at both the light microscopic and ultrastructural
levels. These structural abnormalities often correlate with biochemical
abnormalities, defective energy production, and the resultant dysfunction of
FM muscles. The observed abnormalities in FM muscles are consistent with
neurologic findings and disturbances in the hypothalamic-pituitary-adrenal
axis. Functional changes in FM muscles are assessed most directly by
strength and endurance measurements, but pain and psychologic factors may
interfere with accurate assessments. To compensate for diminished effort,
the decreased efficiency of the work performance by patients with FM can be
verified from P-31 magnetic resonance spectroscopy (MRS) data by calculation
of the work/energy- cost ratio for various tasks. In the disease course,
muscle abnormalities may be elicited by intrinsic changes within the muscle
tissue itself and/or extrinsic neurologic and endocrine factors. The
accurate assignment of intrinsic or extrinsic factors has been substantially
clarified by a recent surge of experimental findings. Irrespective of the
multifaceted causes of muscle dysfunction and pain, an in-depth
understanding of the muscle defects may provide ideas for characterization
of the underlying pathogenesis and development of new therapeutic approaches
for fibromyalgia syndrome
(182) Korszun A.
Sleep and circadian rhythm disorders in fibromyalgia. Curr Rheumatol Rep
2000; 2(2):124-130.
Abstract: Fibromyalgia (FM) is a syndrome of generalized muscle pain that is
also associated with equally distressing symptoms of sleep disturbance and
fatigue. FM shows clinical overlap with other stress-associated disorders,
including chronic fatigue syndrome (CFS) and depression. All of these
conditions have the features of disrupted sleep patterns and dysregulated
biologic circadian rhythms, such as stress hormone secretion. This review
focuses on the role of sleep and circadian rhythm disorders in FM and, in
the absence of any specific treatment for FM, presents a pragmatic
therapeutic approach aimed at identifying and treating comorbid sleep and
depressive disorders, optimizing sleep habits, and judicious use of
pharmacologic agents
(183) Petzke F,
Clauw DJ. Sympathetic nervous system function in fibromyalgia. Curr
Rheumatol Rep 2000; 2(2):116-123.
Abstract: This review focuses on studies of the sympathetic nervous system
in fibromyalgia (FM). First, a brief review of the sympathetic system, and
its relationship to the human stress response, is outlined. Then various
studies of functional assessment of sympathetic function in FM are
highlighted. Certain methods of assessment (eg, heart rate variability,
biochemical, and psychophysical responses to various stressors) that we
believe to be of specific importance for future research are discussed in
greater detail. Finally, findings on autonomic function in related
disorders--specifically, chronic fatigue syndrome, irritable bowel syndrome,
and migraine--will be briefly presented
(184) Turk DC,
Okifuji A. Pain in patients with fibromyalgia syndrome. Curr Rheumatol Rep
2000; 2(2):109-115.
Abstract: Chronic diffuse pain and hyperalgesia are two cardinal features of
pain in fibromyalgia syndrome (FMS). Advancement in understanding the
pathophysiology and treatment efficacy often depends on pain that is defined
and measured. Pain is a subjective phenomenon that we can measure only by
indirect methods. In this article, we provide methodological guidelines for
pain assessment and review recent developments in understanding pain
mechanisms and evaluating treatments in FMS. Finally, we demonstrate the
heterogeneity of the FMS population and suggest the need for matching
treatments to patient characteristics in order to improve clinical outcomes
(185) Buskila D,
Neumann L. Musculoskeletal injury as a trigger for
fibromyalgia/posttraumatic fibromyalgia. Curr Rheumatol Rep 2000;
2(2):104-108.
Abstract: The issue of musculoskeletal injury as a trigger for fibromyalgia
(FM) is controversial. The present review critically evaluates the evidence
that trauma can initiate FM, specifically addressing the scope of the
problem, the issue of causality, possible pathophysiologic mechanisms, and
medicolegal aspects. One major problem is the fact that most of the data
come from anecdotal reports and small case series and not from controlled
prospective studies. Overall data from the current literature are
insufficient to indicate whether causal relationships exist between trauma
and FM. However, recent reports suggest that soft tissue trauma to the neck
can result in an increased incidence of FM compared with other injuries.
Future studies should prospectively document the chronology of symptoms from
the onset of trauma and repeatedly evaluate the patients for disability,
quality of life, change in occupation, and litigation status
(186) Crofford LJ,
Appleton BE. The treatment of fibromyalgia: a review of clinical trials.
Curr Rheumatol Rep 2000; 2(2):101-103.
(187) Hakkinen A,
Hakkinen K, Hannonen P, Alen M. Strength training induced adaptations in
neuromuscular function of premenopausal women with fibromyalgia: comparison
with healthy women. Ann Rheum Dis 2001; 60(1):21-26.
Abstract: OBJECTIVE: To investigate the effects of 21 weeks' progressive
strength training on neuromuscular function and subjectively perceived
symptoms in premenopausal women with fibromyalgia (FM). METHODS: Twenty one
women with FM were randomly assigned to experimental (FM(T)) or control (FM(C))
groups. Twelve healthy women served as training controls (H(T)). The FM(T)
and H(T) groups carried out progressive strength training twice a week for
21 weeks. The major outcome measures were muscle strength and
electromyographic (EMG) recordings. Secondary outcome measures were pain,
sleep, fatigue, physical function capacity (Stanford Health Assessment
Questionnaire), and mood (short version of Beck's depression index).
RESULTS: Female FM(T) subjects increased their maximal and explosive
strength and EMG activity to the same extent as the H(T) group. Moreover,
the progressive strength training showed immediate benefits on subjectively
perceived fatigue, depression, and neck pain of training patients with FM.
CONCLUSIONS: The strength training data indicate comparable trainability of
the neuromuscular system of women with FM and healthy women. Progressive
strength training can safely be used in the treatment of FM to decrease the
impact of the syndrome on the neuromuscular system, perceived symptoms, and
functional capacity. These results confirm the opinion that FM syndrome has
a central rather than a peripheral or muscular basis
(188) Soriano SE,
Gelado Ferrero MJ, Girona Bastus MR. [Fibromyalgia: a Cinderella diagnosis].
Aten Primaria 2000; 26(6):415-418.
(189) Maes M,
Verkerk R, Delmeire L, Van Gastel A, van Hunsel F, Scharpe S. Serotonergic
markers and lowered plasma branched-chain-amino acid concentrations in
fibromyalgia. Psychiatry Res 2000; 97(1):11-20.
Abstract: The aims of the present study were to examine serotonergic
markers, i.e. [3H]paroxetine binding characteristics and the availability of
plasma tryptophan, the precursor of serotonin (5-HT), and the plasma
concentrations of the branched chain amino acids (BCAAs), valine, leucine
and isoleucine, in fibromyalgia. The [3H]paroxetine binding characteristics,
B(max) and K(d) values, and tryptophan and the competing amino acids (CAA),
known to compete for the same cerebral uptake mechanism (i.e. valine,
leucine, isoleucine, phenylalanine and tyrosine), were determined in
fibromyalgia patients and normal controls. There were no significant
differences in the [3H]paroxetine binding characteristics (B(max) and K(d))
between fibromyalgia and control subjects. There were no significant
differences in plasma tryptophan or the tryptophan/CAA ratio between
fibromyalgia patients and normal controls. In the fibromyalgia patients,
there were no significant correlations between [3H]paroxetine binding
characteristics or the availability of tryptophan and myalgic or depressive
symptoms. Patients with fibromyalgia had significantly lower plasma
concentrations of the three BCAAs (valine, leucine and isoleucine) and
phenylalanine than normal controls. It is hypothesized that the relative
deficiency in the BCAAs may play a role in the pathophysiology of
fibromyalgia, since the BCAAs supply energy to the muscle and regulate
protein synthesis in the muscles. A supplemental trial with BCAAs in
fibromyalgia appears to be justified
(190) Lindell L,
Bergman S, Petersson IF, Jacobsson LT, Herrstrom P. Prevalence of
fibromyalgia and chronic widespread pain. Scand J Prim Health Care 2000;
18(3):149-153.
Abstract: OBJECTIVE: To explore the prevalence of fibromyalgia and chronic
widespread musculoskeletal pain in a general population using the criteria
of the American College of Rheumatology from 1990. DESIGN: Structured
interview and clinical examination, including tender-point count and pain
threshold measured with a dolorimeter, of subjects with suspected chronic
widespread musculoskeletal pain. SETTING: The general population in
south-west Sweden 1995-1996. SUBJECTS: 303 individuals with suspected
chronic widespread pain were identified in a previously defined cohort
containing 2425 men and women aged 20-74 years. 202 individuals were invited
and 147 agreed to participate. MAIN OUTCOME MEASURES: Tenderpoint count,
pain threshold and prevalence of chronic widespread pain and fibromyalgia.
RESULTS: The prevalence of fibromyalgia was estimated to 1.3% (95% CI
0.8-1.7; n = 2425) and that of all chronic widespread pain to 4.2% (95% CI
3.4-5.0; n = 2425). The mean pain threshold measured with a dolorimeter was
lower in subjects with chronic widespread pain (p < 0.01) and correlated
with the number of tender points (r = -0.59, p < 0.01) but could not be used
to distinguish the subjects with fibromyalgia. CONCLUSION: Compared to other
studies, fibromyalgia and chronic widespread musculoskeletal pain seemed to
be relatively rare conditions in the south-west of Sweden
(191) Catley D,
Kaell AT, Kirschbaum C, Stone AA. A naturalistic evaluation of cortisol
secretion in persons with fibromyalgia and rheumatoid arthritis. Arthritis
Care Res 2000; 13(1):51-61.
Abstract: OBJECTIVE: To compare cortisol levels, diurnal cycles of cortisol,
and reactivity of cortisol to psychological stress in fibromyalgia (FM) and
rheumatoid arthritis (RA) patients in their natural environment, and to
examine the effect on results of accounting for differences among the groups
in psychological stress and other lifestyle and psychosocial variables.
METHODS: Participants were 21 FM patients, 18 RA patients, and 22 healthy
controls. Participants engaged in normal daily activities were signaled with
a preprogrammed wristwatch alarm to complete a diary (assessing
psychosocial- and lifestyle-related variables) or provide a saliva sample
(for cortisol assessment). Participants were signaled to provide 6 diary
reports and 6 saliva samples on each of two days. Reports of sleep quality
and sleep duration were also made upon awakening. RESULTS: FM and RA
patients had higher average cortisol levels than controls; however, there
were no differences between the groups in diurnal cycles of cortisol or
reactivity to psychological stress. While the groups differed on stress
measures, surprisingly, the patient groups reported less stress.
Furthermore, statistically accounting for psychosocial- and lifestyle-
related differences between the groups did not change the cortisol findings.
CONCLUSION: The results provide additional evidence of
hypothalamic-pituitary-adrenal axis disturbance in FM and RA patients. While
such elevations are consistent with other studies of chronically stressed
groups, the elevations in cortisol in this study did not appear to be due to
ongoing daily stress, and there was no evidence of disturbed cortisol
reactivity to acute stressors
(192) Bernard AL,
Prince A, Edsall P. Quality of life issues for fibromyalgia patients.
Arthritis Care Res 2000; 13(1):42-50.
Abstract: OBJECTIVE: To collect information from patients with fibromyalgia
syndrome (FMS) in regard to quality of life, impact of FMS, coping
strategies, and what they want from their health care providers. METHODS:
Two hundred seventy support group members in Washington, Illinois, and
Pennsylvania completed an 85-item questionnaire. RESULTS: On a scale from 1
to 10 (10 being highest positive rating), patients ranked past quality of
life as 8.6, present quality of life as 4.8, and future quality of life
without FMS as 9.2. Respondents indicated that FMS has had a negative impact
on personal relationships, career, and mental health. Many also reported a
lack of social support. Most respondents reported a variety of coping
responses including talking to friends, praying, exercise, hobbies,
relaxation techniques, talking to a professional, and meditation. Patients
reported needing more support, better educated health professionals, for
people to believe that this disease exists, more funding for research, and
better diagnostic tools. CONCLUSIONS: Health care workers need to be
cognizant of the effect FMS has on quality of life. Treatment options should
not be limited to prescription medication therapy. Patients are using a
variety of methods to cope with their FMS symptoms, some positive, but
others that are negative, and health care providers need to be alert to
negative coping strategies such as alcohol and nonprescription medication
abuse
(193) Kaartinen K,
Lammi K, Hypen M, Nenonen M, Hanninen O, Rauma AL. Vegan diet alleviates
fibromyalgia symptoms. Scand J Rheumatol 2000; 29(5):308-313.
Abstract: The effect of a strict, low-salt, uncooked vegan diet rich in
lactobacteria on symptoms in 18 fibromyalgia patients during and after a
3-month intervention period in an open, non-randomized controlled study was
evaluated. As control 15 patients continued their omnivorous diet. The
groups did not differ significantly from each other in the beginning of the
study in any other parameters except in pain and urine sodium. The results
revealed significant improvements in Visual analogue scale of pain (VAS)
(p=0.005), joint stiffness (p=0.001), quality of sleep (p=0.0001), Health
assessment questionnaire (HAQ) (p=0.031), General health questionnaire (GHQ)
(p=0.021), and a rheumatologist's own questionnaire (p=0.038). The majority
of patients were overweight to some extent at the beginning of the study and
shifting to a vegan food caused a significant reduction in body mass index
(BMI) (p=0.0001). Total serum cholesterol showed a statistically significant
lowering (p=0.003). Urine sodium dropped to 1/3 of the beginning values
(p=0.0001) indicating good diet compliance. It can be concluded that vegan
diet had beneficial effects on fibromyalgia symptoms at least in the short
run
(194) Dunkl PR,
Taylor AG, McConnell GG, Alfano AP, Conaway MR. Responsiveness of
fibromyalgia clinical trial outcome measures. J Rheumatol 2000;
27(11):2683-2691.
Abstract: OBJECTIVE: To assess the responsiveness of the Fibromyalgia Impact
Questionnaire (FIQ), patient ratings of pain intensity, number of tender
points, and total tender point pain intensity score to perceived changes in
clinical status in patients with fibromyalgia (FM). METHODS: Using data from
a randomized placebo controlled study evaluating efficacy of magnetic
therapy in patients with FM, the ability of primary outcomes to detect
clinically meaningful changes over a 6 month period was assessed by: (1)
degree of association between outcome change scores and patient global
ratings of symptom change (Spearman rank-order correlations); (2) ability of
these scores to discriminate among groups of patients whose perceived health
status had changed to varying degrees (ANOVA); (3) ability of these scores,
individually and jointly, to discriminate between patients who had reported
improvement and those who did not (logistic regression); (4) effect size,
standardized response mean, and Guyatt's statistic were calculated to
quantify responsiveness. RESULTS: Correlations showed the outcome measures
were moderately responsive to perceived symptomatic change. For FIQ, pain
intensity ratings and number of tender points, differences in change scores
between globally improved and unchanged groups and between globally improved
and worsened groups were significant; for total tender point pain intensity,
the globally improved differed from worsened group. FIQ outperformed the
other measures in discriminating between patients who reported improvement
from those who did not. Summary statistics were consistent with
discriminatory analyses, indicating the measures were sensitive to
improvement, but relatively unresponsive to decline. CONCLUSION: The FIQ was
the most responsive measure to perceived clinical improvement and we
recommend its inclusion as a primary endpoint in FM clinical trials
(195) White KP,
Harth M, Speechley M, Ostbye T. A general population study of fibromyalgia
tender points in noninstitutionalized adults with chronic widespread pain. J
Rheumatol 2000; 27(11):2677-2682.
Abstract: OBJECTIVE: To assess the distribution and predictive ability of
fibromyalgia (FM) tender points (TP) in adults with chronic widespread pain.
METHODS: Using published classification criteria, we confirmed 100 FM cases
and 76 controls with widespread pain not meeting the 1990 American College
of Rheumatology (ACR) classification criteria for FM (pain controls) in a
survey of 3,395 adults screened for widespread musculoskeletal pain in a
general population survey. RESULTS: At each of the 18 FM tender points, FM
cases were more likely than pain controls to have tenderness, and the
likelihood ratio (LR) was statistically greater than 1.0 for 13 of 18
points. However, the LR for individual points ranged from 4.0 to as low as
1.2. Females were more likely to have TP, especially at lower body points;
however, lower body points were more discriminatory in males. CONCLUSION: TP
differ in their ability to predict FM among adults in the general population
with chronic widespread pain
(196) Khostanteen I,
Tunks ER, Goldsmith CH, Ennis J. Fibromyalgia: can one distinguish it from
simulation? An observer-blind controlled study. J Rheumatol 2000;
27(11):2671-2676.
Abstract: OBJECTIVE: A randomized controlled trial was conducted to assess
reliability and accuracy in identification of fibromyalgia (FM), motivated
simulation, and normal controls. METHODS: Eight female subjects with chronic
FM were age matched with 19 healthy female volunteers. The volunteers were
randomized to a financially motivated "simulator" group who were paid to
simulate FM, or to a "normal control" group. Examiners under blinded
conditions rated tender and control points, and illness behavior. Intraclass
correlation coefficients and F values showed that counts of tender points
significantly discriminated the 3 groups. Variance was mostly due to
experimental groups and not to observer or error factors. In this study,
simulators could not be discriminated from normals or FM subjects on the
basis of tenderness at "control points." Examiner ratings of illness
behavior (UAB), and subjects' self-ratings for pain showed that FM subjects
had the highest scores, normals the lowest, and simulators had mean scores
midway between the mean FM and simulator. On grip strength, the normals
obtained the highest scores, the simulators the lowest, and the FM subjects
had scores midway between those of the other 2 groups. Diagnostic accuracy
of the blinded examiners in distinguishing FM from simulators and from
normals was 80%, and for correct diagnosis the kappa value was significant
at 0.69. Despite this, simulators were misidentified as FM in 1/3 of
judgments, and FM was misidentified as simulators in 1/5 of judgments.
CONCLUSION: Under randomized blinded conditions, examiners using the
American College of Rheumatology criteria for FM and other bedside
observations are able to distinguish chronic FM, normal individuals, and
motivated simulators with 80% accuracy, with a good level of agreement and
reliability in tender point counts. Our results do not provide a "test for
malingering," and it is likely that an important minority of motivated
simulators and of FM subjects will be misidentified
(197) Pankoff B,
Overend T, Lucy D, White K. Validity and responsiveness of the 6 minute walk
test for people with fibromyalgia. J Rheumatol 2000; 27(11):2666-2670.
Abstract: OBJECTIVE: To determine the concurrent validity and responsiveness
of the 6 minute walk test (6-MWT) as a measure of cardiorespiratory fitness
in people with fibromyalgia. METHODS: Subjects completed the 6- MWT, a
Fibromyalgia Impact Questionnaire (FIQ), and a peak oxygen consumption
(pVO2) exercise test before (n = 28) and after (n = 20) a 12 week exercise
program. RESULTS: The correlations between 6-MWT distance and pVO2 before (r
= 0.328) and after (r = 0.420) the exercise program were not significant.
Significant correlations were obtained between 6-MWT distance and FIQ total
(r = -0.494, p < 0.01) and physical impairment (r = -0.403, p < 0.05)
scores. Fifteen of 28 subjects completed the exercise program, with
significant (p < 0.05) changes in 6-MWT distance (+78 m), pVO2 (+1.8
ml/kg/min), and FIQ total score (-9.9). The change in 6-MWT distance was
correlated significantly (p < 0.05) with change in FIQ total score but no
change in pVO2. CONCLUSION: The 6-MWT was not a valid predictor of
cardiorespiratory fitness. However, it was sensitive to change and was also
significantly related to FIQ total score
(198) Raj SR,
Brouillard D, Simpson CS, Hopman WM, Abdollah H. Dysautonomia among patients
with fibromyalgia: a noninvasive assessment. J Rheumatol 2000;
27(11):2660-2665.
Abstract: OBJECTIVE: Fibromyalgia (FM) is a prevalent and poorly understood
disorder associated with a significant amount of disability. Some clinical
characteristics are common to both FM and vasovagal syncope (which is caused
by dysautonomia). We assessed the response of patients with FM to a head up
tilt table test (HUT). We also examined sympathovagal balance by assessing
heart rate variability (HRV). METHODS: We studied 17 women with FM and 14
female control subjects. After baseline functional assessments, they
underwent a 3 stage HUT (with isoproterenol). HRV was assessed over a 24 h
period and also before and during HUT. Quality of life was assessed using
the Medical Outcomes Study SF-36 Short Form Health Survey. RESULTS: HUT was
positive in 64.7% of the patients with FM compared with 21.3% of controls (p
= 0.016). FM patients had less HRV, as measured by either time domain or
frequency domain analysis. The FM group had a different response to HUT than
controls. Quality of life was significantly lower in patients with FM
compared to controls (p < or = 0.001 in all domains). CONCLUSION: Patients
with FM have abnormal responses to 2 tests of autonomic nervous system
function. Further research is needed to determine if dysautonomia plays a
role in the pathogenesis of FM or is a result of FM
(199) Bliddal H,
Moller HJ, Schaadt M, Danneskiold-Samsoe B. Patients with fibromyalgia have
normal serum levels of hyaluronic acid. J Rheumatol 2000; 27(11):2658-2659.
Abstract: OBJECTIVE: To investigate the levels of hyaluronic acid (HA) in
Danish patients with fibromyalgia (FM). METHODS: Serum levels of HA were
determined in 53 patients with established FM and 55 control samples using a
radiometric assay. Values were correlated to clinical disease severity
variables (duration of disease, tender point scales, visual analog scales).
RESULTS: There were no differences in HA levels between patients and
controls. HA levels of all patients except one were within the reference
ranges. There was no association between HA levels and clinical findings.
CONCLUSION: Patients with FM do not generally have increased serum levels of
HA
(200) Smythe H.
Fibromyalgia: can one distinguish it from malingering? More work needed;
more tools supplied. J Rheumatol 2000; 27(11):2536-2540.
(201) Wolfe F. Sayin'
"stand and deliver, for you are a bold deceiver": faking fibromyalgia. J
Rheumatol 2000; 27(11):2534-2535.
(202) Neeck G,
Crofford LJ. Neuroendocrine perturbations in fibromyalgia and chronic
fatigue syndrome. Rheum Dis Clin North Am 2000; 26(4):989-1002.
Abstract: A large body of data from a number of different laboratories
worldwide has demonstrated a general tendency for reduced adrenocortical
responsiveness in CFS. It is still not clear if this is secondary to CNS
abnormalities leading to decreased activity of CRH- or AVP- producing
hypothalamic neurons. Primary hypofunction of the CRH neurons has been
described on the basis of genetic and environmental influences. Other
pathways could secondarily influence HPA axis activity, however. For
example, serotonergic and noradrenergic input acts to stimulate HPA axis
activity. Deficient serotonergic activity in CFS has been suggested by some
of the studies as reviewed here. In addition, hypofunction of sympathetic
nervous system function has been described and could contribute to
abnormalities of central components of the HPA axis. One could interpret the
clinical trial of glucocorticoid replacement in patients with CFS as
confirmation of adrenal insufficiency if one were convinced of a positive
therapeutic effect. If patient symptoms were related to impaired activation
of central components of the axis, replacing glucocorticoids would merely
exacerbate symptoms caused by enhanced negative feedback. Further study of
specific components of the HPA axis should ultimately clarify the
reproducible abnormalities associated with a clinical picture of CFS. In
contrast to CFS, the results of the different hormonal axes in FMS support
the assumption that the distortion of the hormonal pattern observed can be
attributed to hyperactivity of CRH neurons. This hyperactivity may be driven
and sustained by stress exerted by chronic pain originating in the
musculoskeletal system or by an alteration of the CNS mechanism of
nociception. The elevated activity of CRH neurons also seems to cause
alteration of the set point of other hormonal axes. In addition to its
control of the adrenal hormones, CRH stimulates somatostatin secretion at
the hypothalamic level, which, in turn, causes inhibition of growth hormone
and thyroid-stimulating hormone at the pituitary level. The suppression of
gonadal function may also be attributed to elevated CRH because of its
ability to inhibit hypothalamic luteinizing hormone-releasing hormone
release; however, a remote effect on the ovary by the inhibition of
follicle-stimulating hormone-stimulated estrogen production must also be
considered. Serotonin (5-HT) precursors such as tryptophan (5-HTP), drugs
that release 5-HT, or drugs that act directly on 5-HT receptors stimulate
the HPA axis, indicating a stimulatory effect of serotonergic input on HPA
axis function. Hyperfunction of the HPA axis could also reflect an elevated
serotonergic tonus in the CNS of FMS patients. The authors conclude that the
observed pattern of hormonal deviations in patients with FMS is a CNS
adjustment to chronic pain and stress, constitutes a specific entity of FMS,
and is primarily evoked by activated CRH neurons
(203) Hassett AL,
Cone JD, Patella SJ, Sigal LH. The role of catastrophizing in the pain and
depression of women with fibromyalgia syndrome. Arthritis Rheum 2000;
43(11):2493-2500.
Abstract: OBJECTIVE: Although 2 recent studies have found associations
between catastrophizing and poor medical outcomes in patients with
fibromyalgia syndrome (FMS), neither assessed these findings in comparison
with a similar group of patients with chronic pain. Our study examined the
complex relationships between depression, catastrophizing, and the
multidimensional aspects of pain in women with FMS and compared these
relationships with those in women with rheumatoid arthritis (RA). METHODS:
Sixty-four FMS patients and 30 RA patients completed the Coping Strategies
Questionnaire (CSQ), the Beck Depression Inventory II (BDI-II), and the
McGill Pain Questionnaire. RESULTS: Compared with subjects with RA, FMS
subjects scored significantly higher on the catastrophizing subscale of the
CSQ. FMS patients also earned higher scores on overall depression and on the
cognitive subscale of the BDI- II. Furthermore, the relationship between
catastrophizing and depression was significant in the FMS group only.
Regression analyses revealed that in FMS, catastrophizing as a measure of
coping predicted patients' perception of pain better than demographic
variables such as age, duration of illness, and education. CONCLUSION:
Cognitive factors, such as catastrophizing and depressive self-statements,
have a more pronounced role in the self-reported pain of patients with FMS
than in patients with RA. Clinically, this indicates that treating pain and
depression in FMS by adding cognitive therapy and coping skills components
to a comprehensive treatment program may improve the outcomes obtained with
pharmacologic interventions
(204) Bailey A,
Starr L, Alderson M, Moreland J. A comparative evaluation of a fibromyalgia
rehabilitation program. Arthritis Care Res 1999; 12(5):336-340.
Abstract: OBJECTIVE: To compare an evidence-based clinical fibromyalgia
program, referred to as Fibro-Fit, with results of controlled clinical
trials. METHODS: An interdisciplinary group education and exercise program
with 36 sessions over 12 weeks was used. Demographic, clinical, and outcome
variables were collected on 149 participants, of whom 71% completed the
program. Outcomes included measures of self-efficacy, pain, physical
fitness, function, and coping skills. RESULTS: Results of the prospective
before-after evaluation showed statistically significant (P < 0.005)
improvements in all outcomes except for grip strength. These results were
comparable with controlled clinical trials found in the literature. Data
suggest that smoking, fibromyalgia support groups, and medications may be
important modifiable factors. CONCLUSIONS: Results suggest that Fibro-Fit
was effective in improving physical impairments and function. Further
investigation is required to refine the effective components of these
programs and determine how modifiable factors can be used to improve
outcomes
(205) Ozgocmen S,
Ardicoglu O. Lipid profile in patients with fibromyalgia and myofascial pain
syndromes. Yonsei Med J 2000; 41(5):541-545.
Abstract: In this study serum lipid profile of patients with fibromyalgia
syndrome (FMS) and myofascial pain syndrome (MPS) were investigated and
compared with healthy controls. Thirty women who had FMS and 32 women who
had MPS with the characteristic trigger points (TrP), especially on the
periscapular region were included in this study. Thirty one age matched
healthy women were assigned as a control group. All of the subjects were
sedentary healthy housewives. Total cholesterol, triglyceride and
high-density lipoprotein cholesterol (HDL-c) levels were not significantly
different between the FMS and control groups. On the other hand the MPS
group had total cholesterol (198.7 vs 172.9 mg/dL, p=0.003), triglyceride
(124.7 vs 87.6 mg/dL, p=0.01), low- density lipoprotein cholesterol (LDL-c)
(127.5 vs 108.4 mg/dL, p=0.02) and very low-density lipoprotein cholesterol
(VLDL-c) (24.9 vs 17.3 mg/dL, p=0.008) levels, which were significantly
higher than the controls. There was no significant difference between the
lipid profiles in the FMS and MPS groups. Tissue compliance, which was
measured from trigger points in the MPS group, correlated significantly with
total cholesterol and LDL-c levels. In conclusion, a significant difference
was found between the lipid levels of patients with MPS and the controls.
More extensive investigation of lipid and lipoprotein levels is required to
determine whether high lipid levels are the cause or result of MPS
(206) Leonhardt T.
[Etiology of fibromyalgia still not clarified]. Lakartidningen 2000;
97(38):4181.
(207) Henriksson KG.
[Fibromyalgia--functional disorder of the nociceptive nervous system].
Lakartidningen 2000; 97(38):4118-4119.
(208) Tayag-Kier CE,
Keenan GF, Scalzi LV, Schultz B, Elliott J, Zhao RH et al. Sleep and
periodic limb movement in sleep in juvenile fibromyalgia. Pediatrics 2000;
106(5):E70.
Abstract: OBJECTIVES: Fibromyalgia has been recently recognized in children
and adolescents as juvenile fibromyalgia (JF). In adult fibromyalgia,
subjective complaints of nonrestorative sleep and fatigue are supported by
altered polysomnographic findings including a primary sleep disorder known
as periodic limb movements in sleep (PLMS) in some subjects. Although poor
sleep is a diagnostic criterion for JF, few reports in the literature have
evaluated specific sleep disturbances. Our objectives were to evaluate in a
controlled study the polysomnographic findings of children and adolescents
with JF for alterations in sleep architecture as well as possible PLMS not
previously noted in this age group. METHODS: Sixteen consecutive children
and adolescents (15.0 +/- 2.6 years of age) diagnosed with JF underwent
overnight polysomnography. Polysomnography was also performed on 14 controls
(14.0 +/- 2.2 years of age) with no history of an underlying medical
condition that could impact on sleep architecture. Respiratory variables,
sleep stages, and limb movements were measured during sleep in all subjects.
RESULTS: JF subjects differed significantly from controls in sleep
architecture. JF subjects presented with prolonged sleep latency, shortened
total sleep time, decreased sleep efficiency, and increased wakefulness
during sleep. In addition, JF subjects exhibited excessive movement activity
during sleep. Six of the JF subjects (38%) were noted to have an abnormally
elevated PLMS index (>5/hour), indicating PLMS in these subjects.
CONCLUSION: Our study demonstrated abnormalities in sleep architecture in
children with JF. We also noted PLMS in a significant number of subjects.
This has not been reported previously in children with this disorder. We
recommend that children who are evaluated for JF undergo polysomnography
including PLMS assessment. juvenile fibromyalgia; periodic limb movement in
sleep; restless legs syndrome
(209) Bramwell B,
Ferguson S, Scarlett N, Macintosh A . The use of ascorbigen in the treatment
of fibromyalgia patients: a preliminary trial. Altern Med Rev 2000;
5(5):455-462.
Abstract: Twelve female fibromyalgia syndrome (FMS) patients were given 500
mg per day of a blend containing 100 mg ascorbigen and 400 mg broccoli
powder in a preliminary, one-month, open-label trial. This group of patients
showed a mean 20.1 percent (p=0.044) decrease in their physical impairment
score and a mean 17.8 percent (p=0.016) decrease in their total fibromyalgia
impact scores as measured by the Fibromyalgia Impact Questionnaire. The mean
physical impairment score two weeks post- treatment showed a significant
return to near pre-treatment level (p=0.028). Analysis of ten of the
patients' mean threshold pain levels at the 18 possible tender points
obtained before and at the end of treatment showed a strong trend toward an
increase in the mean threshold pain level (p=0.059). The reduced sensitivity
to pain and improvement in quality of life measured in this study appear to
be clinically relevant and a larger, double-blind study is warranted
(210) Giles I,
Isenberg D. Fatigue in primary Sjogren's syndrome: is there a link with the
fibromyalgia syndrome? Ann Rheum Dis 2000; 59(11):875-878.
Abstract: OBJECTIVE: To determine whether fibromyalgia (FM) is more common
in patients with primary Sjogren's syndrome (pSS) who complain of fatigue.
The association and prevalence of fatigue and FM was recorded in a group of
patients with pSS and a control group of lupus patients, a subset of whom
had secondary Sjogren's syndrome (sSS). METHODS: 74 patients with pSS and
216 patients with lupus were assessed with a questionnaire to identify the
presence of fatigue and generalised pain. From the lupus group, in a subset
of 117 lupus patients (from the Bloomsbury unit) those with sSS were
identified. All patients were studied for the presence of FM. RESULTS: 50 of
74 patients with pSS (68%) reported fatigue-a prevalence significantly
higher than in the lupus group (108/216 (50%); p<0.0087). Fatigue was
present in 7/13 (54%) patients with SLE/sSS. FM was present in 9/74 patients
with pSS (12%), compared with 11/216 lupus patients (5%), and in none of the
patients with SLE/sSS. None of these values corresponds with previously
reported figures of the incidence of FM in pSS. CONCLUSION: The results show
that fatigue in patients with pSS and sSS is not due to the coexistence of
FM in most cases. A lower incidence in the United Kingdom of FM in patients
with pSS was found than has been previously reported
(211) Meyer BB,
Lemley KJ. Utilizing exercise to affect the symptomology of fibromyalgia: a
pilot study. Med Sci Sports Exerc 2000; 32(10):1691-1697.
Abstract: Fibromyalgia (FM), a rheumatological disorder of unknown origin,
is characterized by both physical and psychological symptoms. Although
inconclusive results have been reported for most treatment modalities,
exercise appears to have universal support for decreasing the myriad of
symptoms associated with FM. Weaknesses in the literature, however, prevent
conclusive statements regarding exercise prescription and concomitant impact
on FM symptomology. PURPOSE: The current pilot study attempted to examine
the effect of a 24-wk walking program at predetermined intensities on FM.
METHODS: Initial design was a randomized control trial with high- and
low-intensity exercise groups, and a control group. Subsequent nonrandomized
control trials were based on actual exercise behavior. RESULTS: No
differences between initial groups were identified. By collapsing groups,
heart rate (HR) decreased (P < 0.05) weeks 0-12. Functional impairments were
reduced 54% weeks 0- 24, with exercise having a large impact (omega2 = 0.30)
on this decrease. By reassigning groups, impact of FM on current health
status decreased in the low-intensity group (P < 0.05) and increased in the
high-intensity group (P < 0.02) weeks 0-24. Omega squared indicated strong
influence of exercise on pain (omega2 = 0.51), with greater pain in the
high-intensity group. CONCLUSIONS: A larger number of subjects and direct
supervision of the training program to increase compliance is necessary to
clarify the effects of a walking program on the manifestations of FM.
Results indicate that intensity of the walking program is an important
consideration. Individuals with FM can adhere to low-intensity walking
programs two to three times per week, possibly reducing FM impact on daily
activities
(212) Leonhardt T.
[Reply to a comment: Why did the diagnosis fibromyalgia first appear at the
end of the 20th century?]. Lakartidningen 2000; 97(32-33):3509-3510.
(213) Millea PJ,
Holloway RL. Treating fibromyalgia. Am Fam Physician 2000; 62(7):1575-82,
1587.
Abstract: Fibromyalgia is an extremely common chronic condition that can be
challenging to manage. Although the etiology remains unclear, characteristic
alterations in the pattern of sleep and changes in neuroendocrine
transmitters such as serotonin, substance P, growth hormone and cortisol
suggest that dysregulation of the autonomic and neuroendocrine system
appears to be the basis of the syndrome. The diagnosis is clinical and is
characterized by widespread pain, tender points and, commonly, comorbid
conditions such as chronic fatigue, insomnia and depression. Treatment is
largely empiric, although experience and small clinical studies have proved
the efficacy of low- dose antidepressant therapy and exercise. Other less
well-studied measures, such as acupuncture, also appear to be helpful.
Management relies heavily on the physician's supportive counseling skills
and willingness to try novel strategies in refractory cases
(214) Clauw DJ.
Treating fibromyalgia: science vs. art. Am Fam Physician 2000; 62(7):1492 ,
1494.
(215) Dinser R,
Halama T, Hoffmann A. Stringent endocrinological testing reveals subnormal
growth hormone secretion in some patients with fibromyalgia syndrome but
rarely severe growth hormone deficiency. J Rheumatol 2000; 27(10):2482-2488.
Abstract: OBJECTIVE: Several reports suggest that growth hormone (GH)
deficiency may be a pathogenic factor in fibromyalgia syndrome (FM). This
hypothesis has never been adequately examined. METHODS: We measured serum GH
concentration after insulin induced hypoglycemia in subjects with FM. GH
secretion in subjects with a maximal GH increase < 10 ng/ml after
hypoglycemia was assessed by additional arginine stimulation. RESULTS: In
one of 56 subjects tested, GH remained below 3 ng/ml in both tests,
satisfying the criteria for adult GH deficiency. Thirty-two subjects (67%)
had a maximal GH > 10 ng/ml. We retrospectively found an inverse correlation
between low density lipoprotein levels and maximal GH concentration in a
subgroup of patients. CONCLUSION: Severe GH deficiency is not a significant
pathogenic factor in most patients with FM. We observed an impaired
reactivity of the somatotropic axis in one- third of patients with FM, in
keeping with a functional alteration of the hypothalamus
(216) Mannerkorpi K,
Nyberg B, Ahlmen M, Ekdahl C. Pool exercise combined with an education
program for patients with fibromyalgia syndrome. A prospective, randomized
study. J Rheumatol 2000; 27(10):2473-2481.
Abstract: OBJECTIVE: To evaluate the effects of 6 months of pool exercise
combined with a 6 session education program for patients with fibromyalgia
syndrome (FM). METHODS: The study population comprised 58 patients,
randomized to a treatment or a control group. Patients were instructed to
match the pool exercises to their threshold of pain and fatigue. The
education focused on strategies for coping with symptoms and encouragement
of physical activity. The primary outcome measurements were the total score
of the Fibromyalgia Impact Questionnaire (FIQ) and the 6 min walk test,
recorded at study start and after 6 mo. Several other tests and instruments
assessing functional limitations, severity of symptoms, disabilities, and
quality of life were also applied. RESULTS: Significant differences between
the treatment group and the control group were found for the FIQ total score
(p = 0.017) and the 6 min walk test (p < 0.0001). Significant differences
were also found for physical function, grip strength, pain severity, social
functioning, psychological distress, and quality of life. CONCLUSION: The
results suggest that a 6 month program of exercises in a temperate pool
combined with education will improve the consequences of FM
(217) Akkus S,
Delibas N, Tamer MN. Do sex hormones play a role in fibromyalgia?
Rheumatology (Oxford) 2000; 39(10):1161-1163.
(218) O'Malley PG,
Balden E, Tomkins G, Santoro J, Kroenke K, Jackson JL. Treatment of
fibromyalgia with antidepressants: a meta-analysis. J Gen Intern Med 2000;
15(9):659-666.
Abstract: BACKGROUND: Fibromyalgia is a common, poorly understood
musculoskeletal pain syndrome with limited therapeutic options. OBJECTIVE:
To systematically review the efficacy of antidepressants in the treatment of
fibromyalgia and examine whether this effect was independent of depression.
DESIGN: Meta-analysis of English-language, randomized, placebo-controlled
trials. Studies were obtained from searching MEDLINE, EMBASE, and PSYCLIT
(1966-1999), the Cochrane Library, unpublished literature, and
bibliographies. We performed independent duplicate review of each study for
both inclusion and data extraction. MAIN RESULTS: Sixteen randomized,
placebo-controlled trials were identified, of which 13 were appropriate for
data extraction. There were 3 classes of antidepressants evaluated:
tricyclics (9 trials), selective serotonin reuptake inhibitors (3 trials),
and S- adenosylmethionine (2 trials). Overall, the quality of the studies
was good (mean score 5.6, scale 0-8). The odds ratio for improvement with
therapy was 4.2 (95% confidence interval [95% CI], 2.6 to 6.8). The pooled
risk difference for these studies was 0.25 (95% CI, 0.16 to 0.34), which
calculates to 4 (95% CI, 2.9 to 6.3) individuals needing treatment for 1
patient to experience symptom improvement. When the effect on individual
symptoms was combined, antidepressants improved sleep, fatigue, pain, and
well-being, but not trigger points. In the 5 studies where there was
adequate assessment for an effect independent of depression, only 1 study
found a correlation between symptom improvement and depression scores.
Outcomes were not affected by class of agent or quality score using
meta-regression. CONCLUSION: Antidepressants are efficacious in treating
many of the symptoms of fibromyalgia. Patients were more than 4 times as
likely to report overall improvement, and reported moderate reductions in
individual symptoms, particularly pain. Whether this effect is independent
of depression needs further study
(219) Muller W,
Pongratz D, Barlin E, Eich W, Farber L, Haus U et al. The challenge of
fibromyalgia: new approaches. Scand J Rheumatol Suppl 2000; 113:86.
(220) Offenbacher M,
Stucki G. Physical therapy in the treatment of fibromyalgia. Scand J
Rheumatol Suppl 2000; 113:78-85.
Abstract: Fibromyalgia (FM) is a syndrome of unknown etiology characterized
by chronic wide spread pain, increased tenderness to palpation and
additional symptoms such as disturbed sleep, stiffness, fatigue and
psychological distress. While medication mainly focus on pain reduction,
physical therapy is aimed at disease consequences such as pain, fatigue,
deconditioning, muscle weakness and sleep disturbances and other disease
consequences. We systematically reviewed current treatment options in the
treatment of fibromyalgia. Based on evidence from randomized controlled
trials cardiovascular fitness training importantly improves cardiovascular
fitness, both subjective and objective measures of pain as well as
subjective energy and work capacity and physical and social activities.
Based on anecdotal evidence or small observational studies physiotherapy may
reduce overloading of the muscle system, improve postural fatigue and
positioning, and condition weak muscles. Modalities and whole body
cryotherapy may reduce localized as well as generalized pain in short term.
Trigger point injection may reduce pain originating from concomitant trigger
points in selected FM patient. Massage may reduce muscle tension and may be
prescribed as a adjunct with other therapeutic interventions. Acupuncture
may reduce pain and increase pain threshold. Biofeedback may positively
influence subjective and objective disease measures. TENS may reduce
localized musculoskeletal pain in fibromyalgia. While there seems to be no
single best treatment option, physical therapy seem to reduce disease
consequences. Accordingly a multidisciplinary approach combining these
therapies in a well balanced program may be the most promising strategy and
is currently recommended in the treatment of fibromyalgia
(221) Stratz T,
Muller W. The use of 5-HT3 receptor antagonists in various rheumatic
diseases--a clue to the mechanism of action of these agents in fibromyalgia?
Scand J Rheumatol Suppl 2000; 113:66-71.
Abstract: In a pilot study, the action of the 5-HT3 receptor antagonist,
tropisetron, on different types of local rheumatic pain and inflammatory
effects was studied. With intra-articular injection of tropisetron, an
improvement in inflammation and pain was obtained in inflammatory rheumatic
diseases and activated osteoarthrosis. Also, the majority of patients with
localized soft-tissue rheumatic diseases (periarthritis) demonstrated an
obvious decrease in their pain following local infiltration of tropisetron.
Chronic low back pain and cervical pain responded somewhat to i.v. treatment
with tropisetron. The effect of the 5-HT3 receptor antagonists is probable
primarily to limit the release of substance P, which acts as a pain and
inflammatory mediator, and is itself released by the neurogenic inflammation
that occurs after the binding of serotonin to its corresponding receptor.
These results should be backed up with placebo controlled studies, which if
confirmed, might imply that 5-HT3 receptor antagonists could supplement or
replace the local administration of corticosteroids
(222) Stratz T,
Muller W. Do predictors exist for the therapeutic effect of 5-HT3 receptor
antagonists in fibromyalgia? Scand J Rheumatol Suppl 2000; 113:63-65.
Abstract: From the findings outlined below, there are no reliable predictors
of the therapeutic effect of the 5-HT3-receptor antagonists in fibromyalgia.
Neither clinical change in pain and vegetative symptoms, nor alterations in
biochemical parameters are appropriate predictors of response. The
accompanying psychological changes in the form of depressive disorders
appear to be somewhat predictive of decreased therapeutic effect, if such
definitive statements can be applied to individual cases. If, following new
trials, it becomes possible to judge the response of patients to therapy
after 3-5 days treatment with 2 mg intravenous tropisetron then predictors
will be unnecessary in practice
(223) Muller W,
Stratz T. Results of the intravenous administration of tropisetron in
fibromyalgia patients. Scand J Rheumatol Suppl 2000; 113:59-62.
Abstract: The observed effects on the symptoms of fibromyalgia of daily oral
administration of 5 mg of the 5-HT3 receptor antagonist, tropisetron, for 10
days, could be maintained or exceeded with intravenous administration of
only 2 mg of the formulation. Following a single i.v. injection of 2 mg
tropisetron, a more rapid and profound reduction in pain was achieved than
with 5 mg oral tropisetron per day. In individual cases, patients who had
previously experienced no reduction in pain from 10 days of 5 mg oral
tropisetron daily responded to i.v. therapy. A more favourable and
persistent effect on pain, combined with a simultaneous significant
improvement in various vegetative and functional symptoms was achieved with
five days treatment with 2 mg tropisetron i.v. per day. The results outlined
and the possibility for rapid improvements with drug treatment of
fibromyalgia should be confirmed in randomised, placebo controlled trials
(224) Haus U, Varga
B, Stratz T, Spath M, Muller W. Oral treatment of fibromyalgia with
tropisetron given over 28 days: influence on functional and vegetative
symptoms, psychometric parameters and pain. Scand J Rheumatol Suppl 2000;
113:55-58.
Abstract: The 5-HT3 receptor antagonists are a novel therapy for patients
suffering from fibromyalgia, although the optimal duration of treatment is
still unclear. The objective of this phase II study was to evaluate whether
prolonging treatment with tropisetron to 4 weeks is tolerable and correlated
with an improved clinical benefit. Thirty female patients with fibromyalgia
received oral tropisetron (5 mg) daily for 28 days in an open-label fashion.
Treatment resulted in significantly decreased pain as measured by visual
analog scale (VAS), with a mean reduction of 59.7% and an absolute median
change of -25.0 from baseline to day 28 (p<0.0001). A similar, significant
reduction of 55.7% and absolute median change of -31.0 was observed in the
painscore (p<0.0001). The response rate with patients showing a > or = 35%
reduction in individual pain scores was 72.4% at day 28. The pressure
tolerance of tender-points was slightly increased at the end of the
treatment period. In addition, significant improvements were observed in the
State-Trait-Anxiety-Inventory (STAI), scales of von Zerssen (Bf- S) and Beck
Depression Index (BDI). Functional symptoms were compared with the results
from a 10-day, randomized, double-blind phase III study of tropisetron in
418 fibromyalgia patients. In both studies several functional symptoms such
as sleep disturbances and dizziness improved significantly (p<0.05). In the
28 days study, the number and extent of improvement in functional symptoms
was increased compared with the shorter trial. Tolerability and safety of
tropisetron was good, and typically for 5-HT3-receptor antagonists,
gastrointestinal symptoms and headache were the most frequently reported
events. In conclusion, 28 days treatment of fibromyalgia patients with 5 mg
tropisetron resulted in significant pain reduction, which was most
pronounced after 10 days with a further reduction up to day 28. Psychometric
tests showed significant improvements in depression and anxiety state
scores, while functional symptoms improved with extended tropisetron
treatment
(225) Farber L,
Stratz T, Bruckle W, Spath M, Pongratz D, Lautenschlager J et al. Efficacy
and tolerability of tropisetron in primary fibromyalgia--a highly selective
and competitive 5-HT3 receptor antagonist. German Fibromyalgia Study Group.
Scand J Rheumatol Suppl 2000; 113:49-54.
Abstract: OBJECTIVE: Based on a potential role for serotonin receptors in
fibromyalgia, we investigated the efficacy and tolerability of treatment
with tropisetron, a highly selective, competitive inhibitor of the 5-HT3
receptor. METHODS: In this prospective, multicenter, double-blind,
parallel-group, dose-finding study, 418 patients suffering from primary
fibromyalgia (ACR criteria) were randomly assigned to receive either
placebo, 5 mg, 10 mg or 15 mg tropisetron once daily, respectively. The
duration of treatment was 10 days. The clinical response was measured by
changes in pain-score, visual analog scale (VAS), and the number of painful
tender-points. RESULTS: Treatment with 5 mg tropisetron resulted in a
significantly higher response rate (39.2%) when compared with placebo
(26.2%) (p=0.033). The absolute reduction in pain-score was -13.5% for 5 mg
tropisetron, - 13.0% for 10 mg tropisetron, and -6.3% for placebo (p<0.05).
The effects of 15 mg tropisetron were similar to placebo, thus suggesting a
bell-shaped dose-response curve. Compared with placebo, treatment with 5 mg
tropisetron led to a significant improvement (p<0.05) in VAS, while a clear
trend in terms of clinical benefit was seen with 10 mg tropisetron. The
number of painful tender-points was also reduced significantly (p=0.002) in
the 5 mg tropisetron group. Of interest, during the 12-month follow-up
period, pain intensity of responders on 5 mg and 10 mg tropisetron was still
markedly below baseline. The treatment was well tolerated, with
gastro-intestinal complaints being the most frequently reported side
effects, in keeping with the known safety profile for 5-HT3 receptor
antagonists. CONCLUSIONS: This study demonstrates the efficacy of short-term
treatment with 5 mg tropisetron once daily in primary fibromyalgia.
Treatment was well tolerated and prolonged clinical benefits were seen
(226) Hocherl K,
Farber L, Ladenburger S, Vosshage D, Stratz T, Muller W et al. Effect of
tropisetron on circulating catecholamines and other putative biochemical
markers in serum of patients with fibromyalgia. Scand J Rheumatol Suppl
2000; 113:46-48.
Abstract: OBJECTIVE: The aim of the study was to assess the influence of the
5HT3- receptor antagonist tropisetron on circulating catecholamines as
biochemical markers of the activity of the sympathoadrenal system in
fibromyalgia. Moreover, serum concentrations of serotonin, somatomedin C,
oxytocin, calcitonin-gene-related-peptide, calcitonin and cholecystokinin
were assayed as putative markers in pain-related disorders like primary
fibromyalgia. METHODS: In 96 patients, who met the ACR classification
criteria for fibromyalgia, and in 20 sex and age matched controls
concentrations of dopamine, noradrenaline, adrenaline, serotonin and
tropisetron were assayed in serum by HPLC with electrochemical detection.
All other transmitters were determined by ELISA. RESULTS: There was with the
exception of tropisetron, calcitonin and dopamine, no correlation between
doses of tropisetron 5, 10, 15 mg respectively and significant changes in
circulating transmitters or other transmitters as putative biochemicals
markers in primary fibromyalgia. Regarding the prediction of pain reduction
to tropisetron, patients with elevated dopamine and/or reduced plasma 5-HT
concentrations tended to show a higher response rate. CONCLUSION: Despite
these partly disappointing results another prospective pilot study with
selected patients vs. age and sex matched controls, double blind and with
comparison of other 5HT3-receptor antagonists e.g. dolasetron and
granisetron e.g. after i.v. bolus injection is suggested. Still the data
obtained in this preliminary paper provide some evidence regarding the
present discussion on subgroups of patients with primary fibromyalgia
(227) Lautenschlager
J. Present state of medication therapy in fibromyalgia syndrome. Scand J
Rheumatol Suppl 2000; 113:32-36.
Abstract: For the treatment of primary fibromyalgia syndrome (FMS) the low
dose application of tri- and tetracyclic antidepressive drugs was often
studied. Up to now from all those drugs the effects of amitriptyline (AMI)
are best documented. Because of its sedative properties it doesn't only
influence pain but also improves the often disturbed sleep. Its use in
patients with FMS is limited by the occurrence of side effects and the lack
of response in a substantial number of patients. Serotonin reuptake
inhibitors alone seem to be of little value. Nevertheless there is evidence
that they may improve pain in combination with other antidepressive agents.
Regarding pain moclobemide a reversible inhibitor of monoamine oxidase seems
to be inferior to AMI. In controlled studies corticosteroids and non-
steroidal anti-inflammatory drugs (NSAIDs) also failed to improve FMS. The
combination of NSAIDs with benzodiazepines gave inconsistent results.
Although often used, we have only small information about the effectiveness
of opioids. No beneficial effect could be attributed to the muscle relaxant
chlormezanone. In conclusion, although only about 1/3 of the patients
respond, AMI remains the drug of first choice in the conventional medication
treatment of FMS
(228) Eich W,
Hartmann M, Muller A, Fischer H. The role of psychosocial factors in
fibromyalgia syndrome. Scand J Rheumatol Suppl 2000; 113:30-31.
Abstract: OBJECTIVE: The main objective of this review was to evaluate the
role of psychosocial factors in the development of fibromyalgia syndrome.
METHOD: Review of the literature concerning the influence of psychosocial
factors. RESULTS: In fibromyalgia syndrome psychosocial factors are relevant
at different etiological levels. They can be classified into predisposing,
triggering and stabilising/"chronifying" factors. CONCLUSION: Due to the
increasing knowledge about the influence of psychosocial factors for the
development of fibromyalgia, the biomedical model has to be expanded to a
biopsychosocial model. The biopsychosocial concept has an impact on the
therapeutic approach. Strong evidence for the model is provided by the good
results of interdisciplinary treatment studies
(229) Mense S.
Neurobiological concepts of fibromyalgia--the possible role of descending
spinal tracts. Scand J Rheumatol Suppl 2000; 113:24-29.
Abstract: In the spinal cord, long descending pathways are known to exist
which modulate pain sensations by either inhibiting or facilitating the
discharges of spinal nociceptive neurones. In this article, the hypothesis
is discussed that the pain of fibromyalgia may be due to a dysfunction of
these pain-modulating pathways. Theoretically, two kinds of disturbance
could lead to pain, namely reduced activity in the pain- inhibiting
(antinociceptive) system or increased activity in the pain- facilitating (pronociceptive)
pathways. Data from animal experiments show that interruption of the dorsal
descending systems leads to hyperactivity of spinal nociceptive neurones,
namely increase in background activity, lowering in stimulation threshold,
and increase in response magnitude to noxious stimuli. The responses of the
neurones to input from nociceptors in deep tissues were more strongly
inhibited by the descending pathways than were responses to input from
cutaneous nociceptors. Collectively, the findings indicate that the dorsal
descending systems are tonicly active and have a particularly strong
inhibitory action on neurones that mediate pain from deep tissues. If these
systems operate in a similar way also in patients, an impairment of their
function is likely to lead to 1. spontaneous deep pain (because of an
increased background activity in nociceptive neurones supplying deep
tissues), 2. tenderness of deep tissues (because of a lowered mechanical
threshold of the same neurones), and 3. hyperalgesia of deep tissues
(because of increased neuronal responses to noxious stimuli). These changes
will affect large areas of the body because the descending inhibitory
systems have widespread terminations in the spinal cord. Thus, a dysfunction
of the descending inhibitory pathways could mimick to a large extent the
pain of fibromyalgia
(230) Neeck G.
Neuroendocrine and hormonal perturbations and relations to the serotonergic
system in fibromyalgia patients. Scand J Rheumatol Suppl 2000; 113:8-12.
Abstract: The symptomatology of the fibromyalgia syndrome (FMS) often
resembles an alteration in central nervous set points at least in three
systems. The patients suffer under chronic pain in the region of the
locomotor system, presumably reflecting a disturbed central processing of
pain. Anxiety and depression often characterizes the clinical picture.
Almost all of the hormonal feedback mechanisms controlled by the
hypothalamus are altered. Characteristic for FMS patients are the elevated
basal values of ACTH, follicle-stimulating hormone (FSH), and cortisol as
well as lowered basal values of insulin-like growth factor 1 (IGF-1,
somatomedin C), free triiodothyronine (FT3), and oestrogen. In FMS patients,
the systemic administration of the relevant releasing hormones of
corticotropin-releasing hormone (CRH), growth hormone- releasing hormone (GHRH),
thyreotropin-releasing hormone (TRH), and luteinizing hormone-releasing
hormone (LHRH) leads to increased secretion of ACTH and prolactin, whereas
the degree to which TSH can be stimulated is reduced. The stimulation of the
hypophysis with LHRH in female FMS patients during their follicular phase
results in a significantly reduced LH response. All in all, the typical
alterations in set points of hormonal regulation that are typical for FMS
patients can be explained as a primary stress activation of hypothalamic CRH
neurons caused by the chronic pain. In addition to the stimulation of
pituitary ACTH secretion, CRH activates somatostatin on the hypothalamic
level, which in turn inhibits the release of GH and TSH on the hypophyseal
level. The lowered oestrogen levels could be accounted for both via an
inhibitory effect of the CRH on the hypothalamic release of LHRH or via a
direct CRH-mediated inhibition of the FSH- stimulated oestrogen production
in the ovary. Serotonin (5HT), precursors like tryptophan (5HTP), drugs
which release 5HT or act directly on 5HT receptors stimulate HPA axis,
indicating a stimulatory serotonergic influence on HPA axis function.
Therefore activation of the HPA axis may reflect an elevated serotonergic
tonus in the central nervous system of FMS patients
(231) Pongratz DE,
Sievers M. Fibromyalgia-symptom or diagnosis: a definition of the position.
Scand J Rheumatol Suppl 2000; 113:3-7.
Abstract: According to the American College of Rheumatology the diagnosis of
fibromyalgia is based on criteria for the classification of fibromyalgia
consisting entirely of clinical signs and symptoms. For diagnostic reasons
autonomic disturbances and mental features have to be considered. The
distinction between fibromyalgia (tender points) and myofascial pain
syndrome (trigger points) is essential. Internal and neurological disorders
as a primary cause of fibromyalgia have to be excluded. The etiology and
pathogenesis of fibromyalgia still remain uncertain. The myopathological
patterns in fibromyalgia are non- specific: type II fiber atrophy, an
increase of lipid droplets, a slight proliferation of mitochondria, and a
slightly elevated incidence of ragged red fibers. Initial reports on some
allelic abnormalities in the serotonin system seem to highlight the
important role of serotonin already presumed earlier. Significantly high
levels of substance P in the cerebrospinal fluid of FM patients additionally
support the impact of these neurotransmitters on both nociceptive and
antinociceptive mechanisms
(232) Jason LA,
Taylor RR, Kennedy CL. Chronic fatigue syndrome, fibromyalgia, and multiple
chemical sensitivities in a community-based sample of persons with chronic
fatigue syndrome-like symptoms. Psychosom Med 2000; 62(5):655-663.
Abstract: OBJECTIVE: The aim of this study was to determine illness
comorbidity rates for individuals with chronic fatigue syndrome (CFS),
fibromyalgia (FM), and multiple chemical sensitivities (MCS). An additional
objective was to identify characteristics related to the severity of
fatigue, disability, and psychiatric comorbidity in each of these illness
groups. METHODS: A random sample of 18,675 residents in Chicago, Illinois,
was first interviewed by telephone. A control group and a group of
individuals with chronic fatigue accompanied by at least four minor symptoms
associated with CFS received medical and psychiatric examinations. RESULTS:
Of the 32 individuals with CFS, 40.6% met criteria for MCS and 15.6% met
criteria for FM. Individuals with MCS or more than one diagnosis reported
more physical fatigue than those with no diagnosis. Individuals with more
than one diagnosis also reported greater mental fatigue and were less likely
to be working than those with no diagnosis. Individuals with CFS, MCS, FM,
or more than one diagnosis reported greater disability than those with no
diagnosis. CONCLUSIONS: Rates of coexisting disorders were lower than those
reported in prior studies. Discrepancies may be in part attributable to
differences in sampling procedures. People with CFS, MCS, or FM endure
significant disability in terms of physical, occupational, and social
functioning, and those with more than one of these diagnoses also report
greater severity of physical and mental fatigue. The findings illustrate
differences among the illness groups in the range of functional impairment
experienced
(233) Nielens H,
Boisset V, Masquelier E. Fitness and perceived exertion in patients with
fibromyalgia syndrome. Clin J Pain 2000; 16(3):209-213.
Abstract: OBJECTIVE: The aim of this study was to evaluate the
cardiorespiratory fitness and perceived exertion of female patients with
fibromyalgia syndrome (FMS) compared with that of healthy female subjects.
DESIGN AND SUBJECTS: This was designed as a cross-sectional case-control
study, with a consecutive sample of 30 female patients with FMS and an
age-matched control group of 67 healthy female subjects. SETTING: This study
was conducted at the multidisciplinary pain center of a university hospital
in a city of more than 1 million inhabitants. OUTCOME MEASURES: A
cardiorespiratory fitness index (PWC65%/kg) and an original perceived
exertion index (B65%) were obtained from the heart rates and perceived
exertions scored on a 10-point Borg scale during a submaximal cycle
ergometer test. Average indexes for the FMS patients and control subjects
were compared. RESULTS: The mean cardiorespiratory fitness index of the FMS
patients was not significantly different from that of the controls. The mean
perceived exertion index in the FMS patients was significantly greater than
that of the controls, meaning that the FMS patients systematically reported
higher ratings of perceived exertion during exercise. CONCLUSIONS:
Cardiorespiratory fitness, as expressed by a submaximal work capacity index,
seems normal in female patients with FMS compared with age- and sex-matched
healthy individuals. The fact that FMS patients overscore their perception
of exertion may be due to a greater overlap of peripheral pain and perceived
exertion perceptions during exercise. This observation should be noted when
using perceived exertion scores to prescribe and monitor exercise in FMS
patients
(234) Shanklin DR,
Stevens MV, Hall MF, Smalley DL. Environmental immunogens and
T-cell-mediated responses in fibromyalgia: evidence for immune dysregulation
and determinants of granuloma formation. Exp Mol Pathol 2000; 69(2):102-118.
Abstract: Thirty-nine patients with fibromyalgia syndrome (FMS) according to
American College of Rheumatology criteria were studied for cell- mediated
sensitivity to environmental chemicals. Lymphocytes were tested by standard
[(3)H]thymidine incorporation in vitro for T cell memory to 11 chemical
substances. Concanavalin A (Con A) was used to demonstrate T cell
proliferation. Controls were 25 contemporaneous healthy adults and 252 other
concurrent standard controls without any aspect of FMS. Significantly higher
(P < 0.01) stimulation indexes (SI) were found in FMS for aluminum, lead,
and platinum; borderline higher (0.05 > P > 0.02) SI were found for cadmium
and silicon. FMS patients showed sporadic responses to the specific
substances tested, with no high-frequency result (>50%) and no obvious
pattern. Mitogenic responses to Con A indicated some suppression of T cell
functionality in FMS. Possible links between mitogenicity and immunogenic T
cell proliferation, certain electrochemical specifics of granuloma
formation, maintenance of connective tissue, and the fundamental nature of
FMS are considered
(235) Bradley LA,
McKendree-Smith NL, Alarcon GS. Pain complaints in patients with
fibromyalgia versus chronic fatigue syndrome. Curr Rev Pain 2000;
4(2):148-157.
Abstract: Individuals with fibromyalgia (FM) and/or chronic fatigue syndrome
(CFS) report arthralgias and myalgias. However, only persons with FM alone
exhibit abnormal pain responses to mild levels of stimulation, or allodynia.
We identify the abnormalities in the neuroendocrine axes that are common to
FM and CFS as well as the abnormalities in central neuropeptide levels and
functional brain activity that differentiate these disorders. These two sets
of factors, respectively, may account for the similarities and differences
in the pain experiences of persons with FM and CFS
(236) Lai S, Goldman
JA, Child AH, Engel A, Lamm SH. Fibromyalgia, hypermobility, and breast
implants. J Rheumatol 2000; 27(9):2237-2241.
Abstract: OBJECTIVE: To examine possible relationships among fibromyalgia
(FM, American College of Rheumatology 1990 criteria), hypermobility, and
breast implants. METHODS: The medical records of 2,500 female patients (ages
25-65) who had been seen for the first time in a rheumatology practice in
Atlanta, GA, during 1986-92 were abstracted and analyzed. In each analysis,
patients whose records indicated that the patient met the full case criteria
were compared with patients whose records had no indication of the disease.
Patients whose medical records indicated the clinical onset of FM prior to
breast implantation were identified. RESULTS: Univariate and multivariate
regression analyses were performed, adjusting for age, income, and the
presence of connective tissue disease or rheumatoid arthritis. Significant
associations were found between hypermobility and FM (adjusted OR 2.20, 95%
CI 1.73, 2.80) and between hypermobility and breast implantation (adjusted
OR 1.80, 95% CI 1.19, 2.69). No association was found between breast
implantation and subsequent FM (adjusted OR 0.74, 95% CI 0.42, 1.32).
CONCLUSION: Hypermobility was found to be independently associated with both
FM and with breast implantation, but FM and breast implantation were not
found to be independently associated with each other
(237) Klimas N.
Pathogenesis of chronic fatigue syndrome and fibromyalgia. Growth Horm IGF
Res 1998; 8 Suppl B:123-126.
(238) Kuhn P.
[Fibromyalgia at the crossroads of rheumatology, psychology and social
work]. Rev Med Suisse Romande 2000; 120(7):591-592.
(239) Buskila D,
Neumann L, Alhoashle A, Abu-Shakra M . Fibromyalgia syndrome in men. Semin
Arthritis Rheum 2000; 30(1):47-51.
Abstract: OBJECTIVE: Fibromyalgia syndrome (FMS) is uncommon in men and data
on its characteristics and severity are limited. The current study was
undertaken to determine whether the clinical characteristics and the
spectrum of this disorder are similar in men and women. METHODS: Forty men
with FMS were matched with 40 women by age and educational level. All
subjects were asked about the presence and severity (assessed by visual
analog scale) of FMS symptoms; a count of 18 tender points was conducted by
thumb palpation, and tenderness thresholds were measured by dolorimetry.
Psychological status was assessed by the anxiety and depression subscales of
the revised Arthritis Impact Measurement Scales. Quality of life was
evaluated by two scales, QOL-16 and SF-36, and physical function was
measured by the Fibromyalgia Impact Questionnaire. RESULTS: Men with FMS
reported more severe symptoms than women, decreased physical function, and
lower quality of life. Women had lower tender thresholds than men; however
their mean point counts were similar. CONCLUSION: Although FMS is uncommon
in men, its health outcome in our study population was worse than in women.
Further studies in larger samples and in diverse ethnocultural populations
are needed to confirm this observation
(240) Wolfe F,
Hawley DJ, Goldenberg DL, Russell IJ, Buskila D, Neumann L. The assessment
of functional impairment in fibromyalgia (FM): Rasch analyses of 5
functional scales and the development of the FM Health Assessment
Questionnaire. J Rheumatol 2000; 27(8):1989-1999.
Abstract: OBJECTIVE: Functional assessment by self-report questionnaire
plays an important role in most rheumatic conditions, but psychometric
properties of questionnaires have not been studied in fibromyalgia (FM),
particularly by Rasch analysis, which allows for examining adequacy of the
questionnaire scale. To assess currently used instruments, we examined the
Fibromyalgia Impact Scale (FIQ), 4 versions of the Health Assessment
Questionnaire (HAQ), and the Medical Outcome Survey Short Form (SF-36).
METHODS: More than 2,500 patients from 4 sites (3 US, 1 Israel) completed
the FIQ. The HAQ questionnaires were completed by 1438 patients
participating in the US National Data Bank for Rheumatic Diseases. Seven
hundred sixty patients from Wichita, Kansas, completed the SF-36. Rasch
analysis was applied separately to each of these data sets. RESULTS: The FIQ
systematically underestimated functional impairment by its handling of
activities not usually performed. All questionnaires had problems with non-unidimensionality
and ambiguous items when applied to patients with FM. In addition, scales
were found to be non-linear. Because of these findings we used the 20 item
HAQ questionnaire as an item bank to develop a new questionnaire more
suitable for use in FM, the fibromyalgia HAQ (FHAQ). This questionnaire fits
the Rasch model well, is relevant, is linear, and has a long, well spaced
scale. CONCLUSION: No available functional assessment questionnaire works
well in FM. A new questionnaire, the FHAQ, was developed. It has appropriate
metric properties and should function well in this condition. Since the FHAQ
is a subset of the larger HAQ questionnaire, a new questionnaire is not
required; only a different method of scoring is needed. Additional studies
regarding sensitivity to change are required to fully validate the FHAQ
(241) Offenbaecher
M, Waltz M, Schoeps P. Validation of a German version of the Fibromyalgia
Impact Questionnaire (FIQ-G). J Rheumatol 2000; 27(8):1984-1988.
Abstract: OBJECTIVE: To translate the Fibromyalgia Impact Questionnaire
(FIQ) into German and to evaluate its reliability and validity for the use
of German speaking patients with fibromyalgia (FM). METHODS: We administered
the FIQ to 55 patients with FM (15 patients filled out the questionnaire 10
days later) together with German versions of the Stanford Health Assessment
Questionnaire (HAQ), the Medical Outcomes Survey Short Form-36 (SF-36), and
a tender point count (TPC). All patients were asked about the severity of
pain today (10 cm visual analog scale) and the duration of symptoms.
Tenderness thresholds were assessed by dolorimetry at all tender points with
a Fisher dolorimeter and laboratory tests were obtained. Test-retest
reliability was assessed using Spearman correlations. Internal consistency
was evaluated with Cronbach's alpha of reliability. Construct validity of
the FIQ was evaluated by correlating the HAQ and subscales of the SF-36 as
well as the TPC and the tenderness thresholds. RESULTS: Mean age of
participants was 54.3 years and mean duration of symptoms 9.5 years.
Test-retest reliability was between 0.62 and 1 for the physical functioning
as well as for the total FIQ and other components. Internal consistency was
0.92 for the overall FIQ. Significant correlations were obtained between the
FIQ items, the HAQ, and the SF-36. CONCLUSION: The German FIQ is a reliable
and valid instrument for measuring functional disability and health status
in German patients with FM
(242) Anderberg UM,
Marteinsdottir I, Theorell T, von Knorring L. The impact of life events in
female patients with fibromyalgia and in female healthy controls. Eur
Psychiatry 2000; 15(5):295-301.
Abstract: The aim was to investigate if female fibromyalgia patients (FMS)
had experienced more negative life events than healthy women. Furthermore,
the life events experienced in relation to onset of the FMS were evaluated.
Another important area was to investigate the impact of the events
experienced in the patients compared to healthy women. A new inventory was
constructed to assess life events during childhood, adolescence and in
adulthood as well as life events experienced in relation to the onset of the
disorder. Forty female FMS patients and 38 healthy age-matched women
participated in the study. During childhood or adolescence 51% of the
patients had experienced very negative life events as compared to 28% of the
controls. Conflict with parents was the most common life event. Before
onset, 65% of the patients experienced some negative life event. Economic
problems and conflicts with husband/partner were common. During the last
year, 51% of the patients had life events which they experienced as very
negative, compared to 24.5% of the controls (P < 0.01). Stressful life
events in childhood/adolescence and in adulthood seem to be very common in
FMS. Furthermore, the life events were experienced as more negative than the
life events experienced by healthy controls
(243) Gardner GC.
Fibromyalgia following trauma: psychology or biology? Curr Rev Pain 2000;
4(4):295-300.
Abstract: The concept that fibromyalgia may follow trauma is currently an
area of intense debate within the medical field and is driven to a large
extent by social and legal issues. This article questions whether the
current literature supports the notion that trauma may cause fibromyalgia
and explores the relative contribution of biology and psychology in the
development of and sense of disability from fibromyalgia
(244) Rau CL,
Russell IJ. Is fibromyalgia a distinct clinical syndrome? Curr Rev Pain
2000; 4(4):287-294.
Abstract: The validity of the fibromyalgia syndrome (FMS) as a distinct
clinical entity has been challenged for several reasons. Many skeptics
express concern about the subjective nature of chronic pain, the
subjectivity of the tender point (TeP) examination, the lack of a gold
standard laboratory test, and the absence of a clear pathogenic mechanism by
which to define FMS. Another expressed concern has been the relative nature
of the pain-distress relationship in the rheumatology clinic. The apparently
continuous relationship between TePs and somatic distress across a variety
of clinical disorders is said to argue against FMS as a separate clinical
disorder. The most aggressive challenges of the FMS concept have been from
legal defenses of insurance carriers motivated by economic concerns. Other
forms of critique have presented as psychiatric dogma, uninformed posturing,
suspicion of malingering, ignorance of nociceptive physiology, and
occasionally have resulted from honest misunderstanding. It is not likely
that a few paragraphs of data and logic will cause an unbeliever to change
an ingrained opinion. Therefore, this review describes the clinical
manifestations of FMS, responds to some of the theoretic arguments against
it, and discusses some possible pathophysiologic mechanisms by which FMS may
develop and persist as a unique syndrome
(245) Winfield JB.
Psychological determinants of fibromyalgia and related syndromes. Curr Rev
Pain 2000; 4(4):276-286.
Abstract: Fibromyalgia and other chronic pain and fatigue syndromes
constitute an increasingly greater societal burden that currently is not
being approached effectively by traditional Western medicine. Although the
hallmarks of fibromyalgia--chronic widespread pain, fatigue, and multiple
other somatic symptoms--have neurophysiologic and endocrinologic
underpinnings, these biological aspects derive primarily from psychological
variables. Female gender, adverse experiences during childhood,
psychological vulnerability to stress, and a stressful, often frightening
environment and culture are important antecedents of fibromyalgia. To
understand fibromyalgia and related syndromes and to provide optimum care
requires a biopsychosocial, not a biomedical, viewpoint
(246) Jeschonneck M,
Grohmann G, Hein G, Sprott H. Abnormal microcirculation and temperature in
skin above tender points in patients with fibromyalgia. Rheumatology
(Oxford) 2000; 39(8):917-921.
Abstract: OBJECTIVE: Skin temperature and skin blood flow were studied above
different tender points in 20 patients with fibromyalgia (FM) and 20 healthy
controls. METHODS: Blood flow was measured by laser Doppler flowmetry and
skin temperature was measured with an infrared thermometer. RESULTS: In the
skin above the five tender points examined in each subject, we found an
increased concentration of erythrocytes, decreased erythrocyte velocity and
a consequent decrease in the flux of erythrocytes. A decrease in temperature
was recorded above four of the five tender points. CONCLUSION:
Vasoconstriction occurs in the skin above tender points in FM patients,
supporting the hypothesis that FM is related to local hypoxia in the skin
above tender points
(247) Jahn K, Klenke
T. [Web sites on tinnitus, fibromyalgia, chronic fatigue syndrome, etc. Here
your patients seek information]. MMW Fortschr Med 1999; 141(51-52):14.
(248) Sprott H,
Jeschonneck M, Grohmann G, Hein G. [Microcirculatory changes over the tender
points in fibromyalgia patients after acupuncture therapy (measured with
laser-Doppler flowmetry)] . Wien Klin Wochenschr 2000; 112(13):580-586.
Abstract: Apart from widespread pain which is the main symptom of
fibromyalgia, a great variety of functional and vegetative changes occur in
the presence of this disease. Such changes include alterations in
microcirculation, which may cause pain. A preliminary study demonstrated a
reduction in regional blood flow above "tender points" in fibromyalgia
patients compared with healthy controls. A consensus statement of the
National Institutes of Health (NIH) states that acupuncture is a sufficient
adjuvant method to treat patients with fibromyalgia. The aim of the present
study was to determine parameters to measure the effectiveness of a specific
treatment modality (such as acupuncture) in addition to the patient's
subjective assessment of acupuncture treatment. Twenty patients with
fibromyalgia according to the ACR and the Muller/Lautenschlager criteria
were included in the study. Acupuncture was performed and adapted to
individual needs in accordance with a specific protocol. Five representative
"tender points" were examined before and after therapy by laser flowmetry,
and the data were compared with temperature measurement and dolorimetry.
Increased blood flow was registered above all "tender points" after
acupuncture. Skin temperature had increased in 10/12 tender points by a mean
of 0.45 degree C. The number of "tender points" were reduced from 16.1 to
13.8 after therapy. The pain threshold increased in 10/12 "tender points".
These data suggest that acupuncture is a useful method to treat patients
with fibromyalgia. Besides normalisation of clinical parameters, the
improvement in microcirculation above "tender points" may alleviate pain
(249) Cathebras P.
[Should fibromyalgia survive the century?]. Rev Med Interne 2000;
21(7):577-579.
(250) Neumann L,
Press J, Glibitzki M, Bolotin A, Rubinow A, Buskila D. CLINHAQ
scale--validation of a Hebrew version in patients with fibromyalgia.
Clinical Health Assessment Questionnaire. Clin Rheumatol 2000;
19(4):265-269.
Abstract: Assessment of health status in patients with rheumatic disease,
including fibromyalgia (FM), using structured questionnaires has become an
important approach to evaluate treatment and outcome. The objectives of this
study were to validate a translated version of the Clinical Health
Assessment Questionnaire (CLINHAQ) to be used by Hebrew-speaking
populations, and specifically to evaluate its usefulness in fibromyalgia
syndrome (FM). The CLINHAQ was translated into Hebrew and administered to 90
women with FM along with the Hebrew versions of the Fibromyalgia Impact
Questionnaire (FIQ) and the Quality of Life (QOL) Scale. The CLINHAQ
includes scales of functional disability, helplessness, anxiety and
depression, as well as assessment of current health status and satisfaction
with this. All subjects were asked about the presence and severity (assessed
by visual analogue scale) of current FM symptoms (pain, fatigue, anxiety
etc.); a count of 18 tender points was conducted by thumb palpation, and
tenderness thresholds were measured by dolorimetry. Test-retest reliability
was assessed by Pearson correlation coefficients, and internal consistency
was evaluated with Cronbach's alpha coefficient of reliability. Construct
validity was tested by correlating the CLINHAQ items with measures of
symptom severity, count of tender point, tenderness thresholds, physical
functioning measured by FIQ, and with a score of QOL. Test- retest
reliability coefficients ranged from 0.82 to 0.99, and Cronbach's alpha
coefficients from 0.725 to 0.929. Significant moderate to high correlations
were obtained between most subscales of CLINHAQ and measures of physical
functioning, quality of life and severity of FM symptoms. In conclusion, the
CLINHAQ is a reliable and valid instrument for measuring health status and
physical functioning in Israeli women with FM
(251) Meiworm L,
Jakob E, Walker UA, Peter HH, Keul J. Patients with fibromyalgia benefit
from aerobic endurance exercise. Clin Rheumatol 2000; 19(4):253-257.
Abstract: Fibromyalgia (FM) is a disorder characterised by diffuse
widespread musculoskeletal aching and stiffness and multiple tender points
[1]. Its pathophysiology is poorly understood. The influence of aerobic
endurance exercise on pain in patients with FM was investigated. Twenty-
seven patients (25 female, 2 male) participated in a controlled clinical
study and performed 12 weeks of jogging, walking, cycling or swimming
following a given schedule. Twelve sedentary FM patients (11 female, 1 male)
served as controls. Before and after training both the study and the control
groups were evaluated spiroergometrically. Tender point pain was quantified
by dolorimetry. The painful body surface was estimated by a pain body
diagram, and its intensity by a visual analogue scale and a ranking scale.
Patients trained for an average of 25 min two to three times a week, with an
average intensity of 50% of maximal oxygen uptake (VO2max). Unlike the
control group, the training group exhibited a decrease in heart rate and VO2
and an increase in respiratory quotient during submaximal workload. Maximal
performance capacity and VO2max remained unchanged, whereas the wattpulse
(watt/heart rate) improved at maximal workload. Pain parameters remained
unchanged in the control group, but in the training group the mean number of
positive tender points (15.4/12.7), the mean pain threshold of the gluteal
tender point (2.89 kp/3.50 kp) and the painful body surface (18%/15% body
surface) decreased significantly. Subjective general pain condition
deteriorated in two patients but improved in 17. Our results suggest a
positive effect of aerobic endurance exercise on fitness and well-being in
patients with FM
(252) Schikler KN.
Is it juvenile rheumatoid arthritis or fibromyalgia? Med Clin North Am 2000;
84(4):967-982.
Abstract: For the clinician evaluating adolescents with chronic
musculoskeletal pain and fatigue, the distinctions between JRA and FS are
clear based on physical examination findings. The two conditions can
coexist. For the patient with an initial diagnosis of either JRA or FS whose
clinical response to therapy is not in keeping with expectations or physical
examination findings or whose clinical course worsens without explanation,
reevaluation to determine if FS in the JRA patient has developed or JRA in
the FS patient has emerged is warranted. Until clinicians have a better
understanding of the intricacies of the neurohormonal and immunologic
systems and how they affect somatic symptoms, they can continue to provide
patients with a treatment plan based on current knowledge that should
minimize patients' discomfort and allow them to have appropriately
functional lives
(253) Jay SJ.
Tobacco use and chronic fatigue syndrome, fibromyalgia, and
temporomandibular disorder. Arch Intern Med 2000; 160(15):2398, 2401.
(254) Aaron LA,
Buchwald D. Tobacco use and chronic fatigue syndrome, fibromyalgia, and
temporomandibular disorder. Arch Intern Med 2000; 160(15):2398-2401.
(255) Epifanov VA,
Epifanov AV. [Methods of physical rehabilitation in fibromyalgia]. Vopr
Kurortol Fizioter Lech Fiz Kult 2000;(3):42-45.
(256) Larson AA,
Giovengo SL, Russell IJ, Michalek JE . Changes in the concentrations of
amino acids in the cerebrospinal fluid that correlate with pain in patients
with fibromyalgia: implications for nitric oxide pathways. Pain 2000;
87(2):201-211.
Abstract: Substance P (SP), a putative nociceptive transmitter, is increased
in the CSF of patients with fibromyalgia syndrome (FMS). Because excitatory
amino acids (EAAs) also appear to transmit pain, we hypothesized that CSF
EAAs may be similarly involved in this syndrome. We found that the mean
concentrations of most amino acids in the CSF did not differ amongst groups
of subjects with primary FMS (PFMS), fibromyalgia associated with other
conditions (SFMS), other painful conditions not exhibiting fibromyalgia
(OTHER) or age-matched, healthy normal controls (HNC). However, in SFMS
patients, individual measures of pain intensity, determined using an
examination-based measure of pain intensity, the tender point index (TPI),
covaried with their respective concentrations of glutamine and asparagine,
metabolites of glutamate and aspartate, respectively. This suggests that
re-uptake and biotransformation mask pain-related increases in EAAs.
Individual concentrations of glycine and taurine also correlated with their
respective TPI values in patients with PFMS. While taurine is affected by a
variety of excitatory manipulations, glycine is an inhibitory transmitter as
well as a positive modulator of the N-methyl-D-asparate (NMDA) receptor. In
both PFMS and SFMS patients, TPI covaried with arginine, the precursor to
nitric oxide (NO), whose concentrations, in turn, correlated with those of
citrulline, a byproduct of NO synthesis. These events predict involvement of
NO, a potent signaling molecule thought to be involved in pain processing.
Together these metabolic changes that covary with the intensity of pain in
patients with FMS may reflect increased EAA release and a positive
modulation of NMDA receptors by glycine, perhaps resulting in enhanced
synthesis of NO
(257) Ozgocmen S,
Catal SA, Ardicoglu O, Kamanli A. Effect of omega-3 fatty acids in the
management of fibromyalgia syndrome. Int J Clin Pharmacol Ther 2000;
38(7):362-363.
(258) Neumann L,
Berzak A, Buskila D. Measuring health status in Israeli patients with
fibromyalgia syndrome and widespread pain and healthy individuals: utility
of the short form 36-item health survey (SF-36). Semin Arthritis Rheum 2000;
29(6):400-408.
Abstract: OBJECTIVES: To examine the usefulness of the Medical Outcomes
Study Short Form-36 (MOS SF-36) in measuring health-related quality of life
(QOL) in fibromyalgia syndrome (FMS) patients, and to determine whether
subscale scores of SF-36 could distinguish patients with FMS from patients
with widespread pain alone, and from healthy individuals. METHODS: The study
population included three groups of women: 90 patients with FMS, 96 patients
with widespread pain, and 50 healthy controls. In all subjects,
health-related QOL was assessed by SF-36. The Health Assessment
Questionnaire was used to evaluate functional disability, helplessness and
psychological status. FMS-related symptoms and tenderness also were
assessed. RESULTS: The 8 subscales of SF-36 showed a consistent pattern for
physical function, physical role functioning, body pain, general health,
vitality, and social function, with the lowest scores in patients with FMS,
intermediate scores in patients with widespread pain alone, and the highest
scores in healthy subjects. Emotional role functioning and mental health
scores were significantly higher among healthy controls than among patients.
The SF- 36 subscales of physical functioning, bodily pain, and social
functioning were highly correlated with another measure of functional
disability (from the Health Assessment Questionnaire) in all patient groups.
Most of the subscales were associated with psychological variables
(helplessness, depression, and anxiety). All eight subscales of SF-36 were
strongly correlated with the mean score of another measure of quality of
life, QOL-16. CONCLUSIONS: Most of the SF-36 subscales represent health
dimensions relevant to patients with FMS and widespread pain alone. The
severity of functional impairment as assessed by the SF-36, distinguishes
patients with FMS and widespread pain alone from healthy individuals, and
also discriminates between patients with widespread pain alone and FMS
patients
(259) Dessein PH,
Stanwix AE. Why would fibromyalgia patients have osteoporosis? J Rheumatol
2000; 27(7):1816-1817.
(260) Karaaslan Y,
Haznedaroglu S, Ozturk M. Joint hypermobility and primary fibromyalgia: a
clinical enigma. J Rheumatol 2000; 27(7):1774-1776.
Abstract: OBJECTIVE: To investigate the association of joint hypermobility (JH)
and primary fibromyalgia (FM). METHODS: Eighty-eight patients admitted with
widespread pain and 90 matched healthy controls were blindly evaluated
according to criteria for the presence of JH and FM. RESULTS: Fifty-six
patients initially recognized as having FM met the American College of
Rheumatology (ACR) diagnostic criteria for FM and 6 of 90 healthy controls
had these criteria at the subsequent blinded examination. The frequency of
JH was 8% in patients with FM and 6% in subjects without FM (p > 0.05).
Interestingly, JH was found in 10 of 32 "FM" patients (31%) who had not
exactly met the ACR criteria for FM. The occurrence of JH was more common in
these patients compared to controls (p < 0.001). In total, 16% of patients
evaluated with widespread pain had associated with JH. CONCLUSION: Some
patients who have clinical symptoms of FM but do not exactly meet the ACR
criteria could in fact have JH, and these patients may be misdiagnosed as
having FM. Widespread pain is associated with JH in women under age 50, with
some of them fulfilling ACR tender point criteria for FM
(261) Fitzcharles
MA. Is hypermobility a factor in fibromyalgia? J Rheumatol 2000;
27(7):1587-1589.
(262) Stoll AL.
Fibromyalgia symptoms relieved by flupirtine: an open-label case series.
Psychosomatics 2000; 41(4):371-372.
(263) Hedenberg-Magnusson
B, Ernberg M, Kopp S. Presence of orofacial pain and temporomandibular
disorder in fibromyalgia. A study by questionnaire. Swed Dent J 1999;
23(5-6):185-192.
Abstract: The objective of this study was to evaluate subjective symptoms
from the temporomandibular system in patients with fibromyalgia. Two hundred
and thirty-seven individuals with fibromyalgia affiliated to the Stockholm
Rheumatologic Association were included in the study. A questionnaire about
symptoms of temporomandibular disorders (TMD) was mailed and returned by 191
(81%). The participants reported frequent and severe symptoms of TMD, 94%
reported local pain from the temporomandibular system with a mean duration
of 12 years. The most frequent sites were the temple, temporomandibular
joint and neck regions. General body pain had a significantly longer
duration than TMD, which indicates that fibromyalgia starts in other parts
of the body and later extends to the temporomandibular region. The severity
of general pain scored significantly higher than local pain, but there was a
significant positive correlation between the two conditions. High frequency,
73-78 %, of headache, facial pain and tiredness of the jaws was found and
about fifty percent of the patients also complained about difficulties to
open the mouth and to chew. Fibromyalgia is thus a probable cause of TMD. In
conclusion this study shows that patients with fibromyalgia often suffer
from symptoms of TMD, and that the intensity of the pain is correlated to
general body pain. These findings indicate that fibromyalgia is one of the
causes of TMD
(264) Gedalia A,
Garcia CO, Molina JF, Bradford NJ, Espinoza LR. Fibromyalgia syndrome:
experience in a pediatric rheumatology clinic. Clin Exp Rheumatol 2000;
18(3):415-419.
Abstract: OBJECTIVE: To report our experience of fibromyalgia syndrome (FMS)
in pediatric rheumatology clinic settings. METHODS: Clinical and laboratory
data were reviewed in all patients with FMS between March 1992 and March
1996. Patients with FMS and an underlying rheumatic disease were excluded
from the study. At presentation and follow-up visits, all patients had a
tender points (TP) count that was conducted by thumb palpation. Both the
children and their parents were questioned concerning the presence of
widespread pain or aching. All the patients fulfilled the ACR criteria for
the diagnosis of primary FMS. All children were evaluated by a protocol that
included relevant information on FMS. Telephone survey questionnaires were
used for patients who missed some of their follow-up visits. RESULTS: There
were 59 children (47 F and 12 M) diagnosed with primary FMS. The mean age at
onset was 13.7 years, and the mean age at diagnosis was 15.5 years. The mean
duration of follow-up was 18.3 months. Diffuse aching was reported in 57
patients (97%), headaches in 45 (76%), and sleep disturbances in 41 (69%).
Less common were stiffness in 17 (29%), subjective joint swelling in 14
(24%), fatigue in 12 (20%), abdominal pain in 10 (17%), and joint
hypermobility and depression in 8 (14%) and 4 (7%) patients, respectively.
The mean ESR was 15 mm/h, RF was negative in all patients, and ANA was
positive (mean titer 1:160) in 17 patients. The mean initial TP count was
14.6. Nine patients were not available for follow-up. There were 50 patients
available for follow-up and survey analysis, and of these 30 (60%) had
improved, while 18 (36%) remained unchanged, and 2 (4%) became worse when
compared with initial presentation. At the end of study follow-up, 37
patients (74%) were still taking medication (20 of them daily). Out of 25
patients whose TP counts were available at the end of follow-up, the mean TP
dropped from 14.12 to 12.04 (p = 0.09) for the total group, and 14.05 to
10.84 (p < 0.01) for the patients who had improved. 22 out of 30 patients in
the improved group and 7 out of 20 in the unchanged or worse group had
continued active exercise programs (p < 0.001). CONCLUSION: The clinical
spectrum of FMS in children is similar to that of adults but with better
outcomes. The TP count correlates with clinical status only in patients who
had improved. Active exercise programs seem to correlate with better
outcomes. Prospective and larger patient population studies, and a longer
follow-up of children with FMS are needed to clarify these findings
(265) Taylor J, Skan
J, Erb N, Carruthers D, Bowman S, Gordon C et al. Lupus patients with
fatigue-is there a link with fibromyalgia syndrome? Rheumatology (Oxford)
2000; 39(6):620-623.
Abstract: OBJECTIVE: To determine whether fibromyalgia syndrome (FMS) was
more common in patients with lupus who were complaining of fatigue. METHODS:
We interviewed 216 patients attending two lupus clinics, all of whom
fulfilled the revised American College of Rheumatology (ACR) criteria for
lupus. The patients completed a questionnaire and were examined to determine
the presence of fatigue and whether they fulfilled the ACR criteria for FMS.
Disease activity was measured using the British Isles Lupus Assessment Group
(BILAG) index and the Systemic Lupus International Collaborating Clinics (SLICC)/ACR
damage score. Measurements of erythrocyte sedimentation rate, complement C3,
lymphocyte count and DNA titre were also performed. RESULTS: Fifty per cent
of our patients complained of fatigue, but only 10% of these patients
fulfilled criteria for FMS. FMS did not correlate with any measure of
disease activity although patients with FMS had lower mean DNA antibody
titres and mean SLICC/ACR damage scores. CONCLUSION: A minority of lupus
patients with fatigue fulfil the ACR criteria for FMS. Other possible
factors leading to fatigue should be considered
(266) Wootton JC.
Fibromyalgia. J Womens Health Gend Based Med 2000; 9(5):571-573.
(267) Lindberg NE,
Lindberg E. [Use available knowledge--also when it is not complete. Current
example: chronic fatigue syndrome, fibromyalgia]. Lakartidningen 2000;
97(21):2651-2652.
(268) Anderberg UM.
[Fibromyalgia--probably a result of prolonged stress syndrome].
Lakartidningen 2000; 97(21):2641-2642.
(269) Leonhardt T.
[Fibromyalgia--a new name of an old "malady". Fatigue and pain syndrome with
a historical background]. Lakartidningen 2000; 97(21):2618-4.
Abstract: Fibromyalgia is a good illustration of the fact that a smart new
name of an old malady can spread like wildfire if well matched in time
socioculturally. "Muscular rheumatism" has earlier been looked upon as a
(rheumatic) inflammation of muscle cells or of muscular connective tissue.
During the last decades the interest of leading clinicians and researchers
have been directed against the pain perceiving system, suggesting defect
pain modulating mechanisms peripherally and centrally. Fibromyalgia seems to
supply several medical and social needs in our time and might be called a
"fin-de-siecle" disease
(270) Smith TC, Gray
GC, Knoke JD. Is systemic lupus erythematosus, amyotrophic lateral
sclerosis, or fibromyalgia associated with Persian Gulf War service? An
examination of Department of Defense hospitalization data. Am J Epidemiol
2000; 151(11):1053-1059.
Abstract: Since the Persian Gulf War ended in 1991, veterans have reported
diverse, unexplained symptoms. Some have wondered if their development of
systemic lupus erythematosus, amyotrophic lateral sclerosis, or fibromyalgia
might be related to Gulf War service. The authors used Cox proportional
hazard modeling to determine whether regular, active-duty service personnel
deployed to the Persian Gulf War (n = 551,841) were at increased risk of
postwar hospitalization with the three conditions compared with nondeployed
Gulf War era service personnel (n = 1,478,704). All hospitalizations in
Department of Defense facilities from October 1, 1988, through July 31,
1997, were examined. With removal of personnel diagnosed with any of the
three diseases before August 1, 1991, and adjustment for multiple
covariates, Gulf War veterans were not at increased risk of postwar
hospitalization due to systemic lupus erythematosus (risk ratio (RR) = 0.94,
95% confidence interval (CI): 0.65, 1.35). Because of the small number of
cases and wide confidence limits, the data regarding amyotrophic lateral
sclerosis were inconclusive. Gulf War veterans were slightly at risk of
postwar hospitalization for fibromyalgia (RR = 1.23, 95% Cl: 1.05, 1.43);
however, this risk difference was probably due to the Gulf War veteran
clinical evaluation program beginning in 1994. These data do not support
Gulf War service and disease associations
(271) Fordyce WE.
Fibromyalgia and related matters. Clin J Pain 2000; 16(2):181-182.
(272) Sherman JJ,
Turk DC, Okifuji A. Prevalence and impact of posttraumatic stress
disorder-like symptoms on patients with fibromyalgia syndrome. Clin J Pain
2000; 16(2):127-134.
Abstract: OBJECTIVE: Traumatic events can result in a set of symptoms
including nightmares, recurrent and intrusive recollections, avoidance of
thoughts or activities associated with the traumatic event, and symptoms of
increased arousal such as insomnia and hypervigilance. These posttraumatic
stress disorder (PTSD)-like symptoms are frequently observed in persons with
chronic pain syndromes. Little is known about how these two phenomena
interact with one another. The present study evaluated PTSD-like symptoms in
patients with fibromyalgia syndrome (FMS) and examined the relation between
PTSD-like symptoms and problems associated with FMS. DESIGN: Ninety-three
consecutive patients underwent a comprehensive FMS evaluation and completed
self-report questionnaires measuring PTSD-like symptoms, disability, and
psychosocial responses to their pain condition. Subjects were divided in two
groups based on level of self-reported PTSD-like symptoms. RESULTS:
Approximately 56% of the sample reported clinically significant levels of
PTSD-like symptoms (PTSD+). The PTSD+ patients reported significantly
greater levels of pain (p < 0.01), emotional distress (p < 0.01), life
interference (p < 0.01), and disability (p < 0.01) than did the patients
without clinically significant levels of PTSD-like symptoms (PTSD-). Over
85% of the PTSD+ patients compared with 50% of the
(273) Green S. Sleep
cycles, TMD, fibromyalgia, and their relationship to orofacial myofunctional
disorders. Int J Orofacial Myology 1999; 25:4-14.
Abstract: Poor quality sleep is caused by many factors including orofacial
myology disorders. TMJ and fibromyalgia patients demonstrate a variety of
similar symptoms making diagnosis difficult. A team approach utilizing
appropriate referrals is critical to successful patient treatment
(274) Cohn LJ.
Management of fibromyalgia. Ann Intern Med 2000; 132(12):1005.
(275) Akama H.
Management of fibromyalgia. Ann Intern Med 2000; 132(12):1005.
(276) Muilenburg N.
Management of fibromyalgia. Ann Intern Med 2000; 132(12):1004-1005.
(277) Wolfe F.
Management of fibromyalgia. Ann Intern Med 2000; 132(12):1004.
(278) Huppert A.
Management of fibromyalgia. Ann Intern Med 2000; 132(12):1004.
(279) Dryson E.
Venlafaxine and fibromyalgia. N Z Med J 2000; 113(1105):87.
(280) Ramsay C,
Moreland J, Ho M, Joyce S, Walker S, Pullar T. An observer-blinded
comparison of supervised and unsupervised aerobic exercise regimens in
fibromyalgia. Rheumatology (Oxford) 2000; 39(5):501-505.
Abstract: OBJECTIVE: To compare a supervised 12-week aerobic exercise class
with unsupervised home aerobic exercises in the treatment of patients with
fibromyalgia. METHODS: This was a 48-week randomized single (observer) blind
study in a teaching hospital rheumatology and physiotherapy department. The
subjects were 74 patients who fulfilled the American College of Rheumatology
criteria for fibromyalgia. Results and conclusions. A 12-week exercise class
programme with home exercises demonstrated no benefit over a single
physiotherapy session with home exercises in the treatment of pain in
patients with fibromyalgia. Neither group (nor the groups combined) showed
an improvement in pain compared with baseline. There was some significant
benefit in psychological well-being in the exercise class group and perhaps
a slowing of functional deterioration in this group
(281) Korszun A,
Young EA, Engleberg NC, Masterson L, Dawson EC, Spindler K et al. Follicular
phase hypothalamic-pituitary-gonadal axis function in women with
fibromyalgia and chronic fatigue syndrome. J Rheumatol 2000;
27(6):1526-1530.
Abstract: OBJECTIVE: Fibromyalgia (FM) and chronic fatigue syndrome (CFS)
are clinically overlapping stress associated disorders. Neuroendocrine
perturbations have been noted in both syndromes, and they are more common in
women, suggesting abnormalities of gonadal steroid hormones. We tested the
hypothesis that women with FM and CFS manifest abnormalities of the
hypothalamic-pituitary-gonadal (HPG) hormonal axis. METHODS: We examined the
secretory characteristics of estradiol, progesterone, follicle stimulating
hormone (FSH), and luteinizing hormone (LH), including a detailed analysis
of LH in premenopausal women with FM (n = 9) or CFS (n = 8) during the
follicular phase of the menstrual cycle compared to matched healthy
controls. Blood was collected from an indwelling intravenous catheter every
10 min. over a 12 h period. LH was assayed from every sample; pulses of LH
were identified by a pulse-detection program. FSH and progesterone were
assayed from a pool of hourly samples for the 12 h period and estradiol from
samples pooled over four 3 h time periods. RESULTS: There were no
significant differences in FSH, progesterone, or estradiol levels in
patients versus controls. There were no significant differences in pulsatile
secretion of LH. CONCLUSION: There is no indication of abnormal gonadotropin
secretion or gonadal steroid levels in this small, but systematic, study of
HPG axis function in patients with FM and CFS
(282) Raymond MC,
Brown JB. Experience of fibromyalgia. Qualitative study. Can Fam Physician
2000; 46:1100-1106.
Abstract: OBJECTIVE: To explore illness experiences of patients diagnosed
with fibromyalgia. DESIGN: Qualitative method of in-depth interviews.
SETTING: Midsize city in Ontario. PARTICIPANTS: Seven patients diagnosed
with fibromyalgia. METHOD: Seven in-depth interviews were conducted to
explore the illness experience of patients diagnosed with fibromyalgia. All
interviews were audiotaped and transcribed verbatim. All interview
transcriptions were read independently by the researchers, who then compared
and combined their analysis. Final analysis involved examining all
interviews collectively, thus permitting relationships between and among
central themes to emerge. The analysis strategy used a phenomenologic
approach and occurred concurrently rather than sequentially. MAIN FINDINGS:
Themes that emerged from the interpretive analysis depict patients' journeys
along a continuum from experiencing symptoms, through seeking a diagnosis,
to coping with the illness. Experiencing symptoms was composed of four
subcategories: pain, a precipitating event, associated symptoms, and
modulating factors. Seeking a diagnosis entailed frustration and social
isolation. Confirmation of diagnosis brought relief as well as anxiety about
the future. After diagnosis, several steps led to creation of adaptive
coping strategies, which were influenced by several factors. CONCLUSION:
Findings suggest that the conventional medical model fails to address the
complex experience of fibromyalgia. Adopting a patient- centred approach is
important for helping patients cope with this disease
(283) Lloyd R. How
should we manage fibromyalgia? Ann Rheum Dis 2000; 59(6):490.
(284) Anderberg UM,
Marteinsdottir I, von Knorring L. Citalopram in patients with
fibromyalgia--a randomized, double-blind, placebo-controlled study. Eur J
Pain 2000; 4(1):27-35.
Abstract: The effect of the selective serotonin reuptake inhibitor
citalopram was studied in a randomized, double-blind, placebo-controlled,
4-month trial in patients with the fibromyalgia syndrome (FMS) who all
fulfilled the American College of Rheumatology criteria. The citalopram
doses varied between 20-40 mg daily. Forty female patients, 21 patients in
the citalopram and 19 in the placebo group, participated. Assessment of
pain, depressive symptoms and physical functioning were made using Visual
Analogue Scales (VAS), the Montgomery Asberg Depression Rating Scale (MADRS)
and the Fibrositis Impact Questionnaire (FIQ).In the global judgement of
improvement, no significant changes were found between the citalopram and
placebo groups as concerns pain or well- being, either in the Intention to
Treat (ITT) analysis or in the completer analysis. However, among the
completers, it was a tendency that more patients in the citalopram group
(52.9%) were improved as compared to the placebo group (22.2%) concerning
well-being. Furthermore, the results indicated that treatment with
citalopram had a significant effect on pain on the VAS after 2 months of
treatment compared to baseline. After 4 months, however, the effect had
diminished. Measured with the FIQ, significant differences in the pain
ratings were seen at the end of the trial. Significant effects on the
depressive symptomatology measured by means of the MADRS were seen already
after 1 month of treatment and were increasing further at the end of the
trial, when a significant difference between the groups was also found
(285) Salerno A,
Thomas E, Olive P, Blotman F, Picot MC, Georgesco M. Motor cortical
dysfunction disclosed by single and double magnetic stimulation in patients
with fibromyalgia. Clin Neurophysiol 2000; 111(6):994-1001.
Abstract: OBJECTIVE: To investigate the motor cortex by single and double
magnetic stimulation, in patients with fibromyalgia.Methods: Thirteen
patients with fibromyalgia and 13 age-matched healthy subjects were
examined. We evaluated, in both limbs, motor evoked potential (MEP) latency
and amplitude and the MCA/MPA ratio, i.e. MEP cortical amplitude (MCA)
/maximal peripheral amplitude of the M response (MPA), the central
conduction time (TCC) and the length of the silent period (SP). With double
magnetic stimulation, different time intervals between shocks were used:
with delays between shocks of 4, 25, 55 and 85 ms, the intensities of the
conditioning shock were 80% the relaxed threshold. With delays between
shocks of 55, 85, 100, 155, 200, 255 and 355 ms, the intensities of the
conditioning shocks were set at 150% the relaxed threshold. In all cases,
the intensity of the test shock was 150% the relaxed threshold. The results
were also compared with those obtained in 5 women affected by rheumatoid
arthritis (RA).Results: As compared to control, the cortical relaxed
threshold was enhanced on both sides and limbs (P<0.05). The cortical silent
period recorded with single magnetic stimulation was reduced in the upper
limbs (P = 2.7x10(- 11)) and lower limbs (both sides P = 3.6x10(-5)). The
other parameters investigated were normal. With double magnetic stimulation,
facilitatory phenomena were absent in fibromyalgic patients and the
inhibitory responses recorded with a delay of 155 ms were reduced (P =
0.0052). No significant differences were noted between FM and RA patients.
Conclusion: This study demonstrated motor cortical dysfunction in patients
with fibromyalgia involving excitatory and inhibitory mechanisms. This
indicates motor cortical involvement and supports the hypothesis of aberrant
central pain mechanisms. The absence of differences between FM and RA
suggest that the lesions were not specific and could be related to chronic
pain disorders within the central nervous system
(286) Hains G, Hains
F. A combined ischemic compression and spinal manipulation in the treatment
of fibromyalgia: a preliminary estimate of dose and efficacy. J Manipulative
Physiol Ther 2000; 23(4):225-230.
Abstract: OBJECTIVES: To provide preliminary information on whether a
regimen of 30 chiropractic treatments that combines ischemic compression and
spinal manipulation effectively reduces the intensity of pain, sleep
disturbance, and fatigue associated with fibromyalgia. In addition, to study
the dose-response relation and identify the baseline characteristics that
may serve as predictors of outcome. DESIGN: Subjects were assessed with
self-administered questionnaires taken at baseline, after 15 and 30
treatments, and 1 month after the end of the treatment trial. SETTING:
Private practice. METHODS: Participating subjects were adult members of a
regional Fibromyalgia Association. Participating subjects had fibromyalgia
for more than 3 months. They received 30 treatments including ischemic
compression and spinal manipulation. The 3 outcomes being evaluated were
pain intensity, fatigue level, and sleep quality. A minimum 50 improvement
in pain intensity from baseline to the end of the treatment trial was needed
to include the patient in the respondent category. RESULTS: Fifteen women
(mean age 51.1 years) completed the trial. A total of 9 (60) patients were
classified as respondents. A statistically significant lessening of pain
intensity and corresponding improvement in quality of sleep and fatigue
level were observed after 15 and 30 treatments. After 30 treatments, the
respondents showed an average lessening of 77.2 (standard deviation = 12.3)
in pain intensity and an improvement of 63.5 (standard deviation = 31.6) in
sleep quality and 74.8 (standard deviation = 23. 1) in fatigue level. The
improvement in the 3 outcome measures was maintained after 1 month without
treatment. Subjects with less than 35 improvement after 15 treatments did
not show a satisfactory response after 30 treatments. A trend, determined as
not statistically significant, suggests that older subjects with severe and
more chronic pain and a greater number of tender points respond more poorly
to treatment. CONCLUSION: This study suggests a potential role for
chiropractic care in the management of fibromyalgia. A randomized clinical
trial should be conducted to test this hypothesis
(287) Richards S,
Cleare A. Treating fibromyalgia. Rheumatology (Oxford) 2000; 39(4):343-346.
(288) Merchant RE,
Carmack CA, Wise CM. Nutritional supplementation with Chlorella pyrenoidosa
for patients with fibromyalgia syndrome: a pilot study. Phytother Res 2000;
14(3):167-173.
Abstract: Fibromyalgia syndrome is a common, chronic musculoskeletal
disorder of unknown aetiology. While available therapy is often
disappointing, most patients can be helped with a combination of medication,
exercise and maintenance of a regular sleep schedule. The objective of the
present study was to determine if adding nutritional supplements derived
from the unicellular green alga, Chlorella pyrenoidosa, produced any
improvements in the clinical and functional status in patients with
moderately severe symptoms of fibromyalgia syndrome. Eligible patients had
2+ palpable tenderness at 11 or more of 18 defined tender points and had a
tender point index (TPI) of at least 22. Each day for 2 months, participants
consumed two commercially available Chlorella- based products, 10 g of 'Sun
Chlorella' tablets and 100 mL of liquid 'Wakasa Gold'. Any amelioration of
symptoms was validated and quantified using semi-objective and subjective
outcome measures systematically administered at clinic visits on days 0, 30
and 60 of the diet therapy. Eighteen of the 20 patients enrolled completed
the 2 month trial. The average TPI for the group which at onset was 32,
decreased to a mean of 25 after 2 months. This decrease was statistically
significant (p = 0.01), representing a 22% decrease in pain intensity. Blood
samples taken on each occasion indicated no significant alterations in serum
chemistries, formed elements, and circulating lymphocyte subsets.
Compilations of the results of patient interviews and self-assessment
questionnaires revealed that seven patients felt that the dietary supplement
had improved their fibromyalgia symptoms, while six thought they had
experienced no change, and five believed the symptoms had worsened over the
time of the trial. The results of this pilot study suggest that dietary
Chlorella supplementation may help relieve the symptoms of fibromyalgia in
some patients and that a larger, more comprehensive double-blind,
placebo-controlled clinical trial in these patients is warranted
(289) Hakkinen A,
Hakkinen K, Hannonen P, Alen M. Force production capacity and acute
neuromuscular responses to fatiguing loading in women with fibromyalgia are
not different from those of healthy women. J Rheumatol 2000;
27(5):1277-1282.
Abstract: OBJECTIVE: To compare the maximal and explosive strength
characteristics of the leg muscles in premenopausal women with fibromyalgia
(FM) with those of healthy female controls (HC) and to examine acute
neuromuscular fatigue during heavy resistance loading and short term
recovery from fatigue in these 2 groups. METHODS: Subjects were 11 women
with FM, 38.6 (5.8) years old, and 12 healthy female controls, 37.3 (6.1)
years old. The following were recorded before, during, and after a fatiguing
loading session: maximal bilateral concentric and isometric force, isometric
force-time curves and relaxation-time curves with agonist-antagonist neural
activation (by EMG) of the leg muscles, muscle pain, and blood lactate
concentrations. RESULTS: At baseline all the measured muscle strength
characteristics were comparable between the study groups. The heavy
fatiguing loading led to considerable and comparable acute fatigue found in
both muscle strength characteristics and agonist-antagonist electromyography
in both groups. The respective changes in blood lactate concentration and
subjectively perceived muscular pain in the loaded muscles during strenuous
resistance loading and recovery from fatigue were similar in both groups.
CONCLUSION: Premenopausal women with FM do not demonstrate lower dynamic or
isometric muscle strength characteristics compared to matched healthy
controls. Second, the similar neuromuscular responses recorded during and
after the fatiguing loading strongly support the hypothesis of normal muscle
structure and neuromuscular function in patients with FM
(290) Henriksson C,
Liedberg G. Factors of importance for work disability in women with
fibromyalgia. J Rheumatol 2000; 27(5):1271-1276.
Abstract: OBJECTIVE: To identify factors of importance for women with
fibromyalgia (FM) to continue working despite the limitations imposed by the
symptoms. METHODS: A mail questionnaire with questions regarding social
background, symptoms, sickness benefits, work situation, work conditions and
adjustments, opinions regarding own work ability, and satisfaction with the
situation was sent to 218 consecutive women seen at a university pain or
rheumatology clinic. Answers were obtained from 176 women. RESULTS: Pain,
poor quality sleep, abnormal tiredness, muscle stiffness, and increased pain
after muscle exertion were frequently reported symptoms. Fifty percent of
the women were employed, 15% full-time. Twenty-three percent reported FM as
the reason for not working. The work situation had been changed for 58% of
the working women, and 80% counted on being able to continue working.
CONCLUSION: Work disability is a serious concern in FM, and the majority of
women with FM have limitations in their ability to work. Our results
indicate that individual adjustments in the work situation need to be made
and that women who have found a level matching their ability may continue to
work and find it satisfactory. Early intervention in the work situation is
recommended
(291) Wolfe F. For
example is not evidence: fibromyalgia and the law. J Rheumatol 2000;
27(5):1115-1116.
(292) Tabeeva GR,
Korotkova SB, Vein AM. [Fibromyalgia]. Zh Nevrol Psikhiatr Im S S Korsakova
2000; 100(4):69-77.
(293) Ivanichev GA,
Starosel'tseva NG. [Fibromyalgia (generalized tendomyopathy): defect of a
program of movements and their realization]. Zh Nevrol Psikhiatr Im S S
Korsakova 2000; 100(4):54-61.
Abstract: It was established that fulfillment of any motor action implies a
design of the program of action in CNS and its realization by peripheral
elements of locomotor system. A program includes an acceptor of the result
of action and efferent synthesis on a central level (parietal-premotor area,
pallidostriatal system, lymbico-reticular complex, ex cetera). A very motor
act is realized by the activity of a segmental apparatus of the spinal cord
and skeletal muscles. Acceptor of the result of action provides a control of
the coincidence between afferent parameters of the result of an action and
its real characteristics by means of the reverse feed-back (P.K. Anokhin,
1975). Incoordination of its parameters is a condition for the existence of
a physiologic functional system for the construction of the necessary
movement, while a coincidence of their indices resulted in the
disintegration of this system. Appearance of myofascicular hypertonus in
this system distorts a real parameters of the movement because of a deficit
and imbalance of the proprioception in a segmental apparatus and central
formations. A proprioceptive desafferentation promotes disinhibition of the
neurons and formation of the generators of pathologically increased
irritation with positive feed-back on rubro- segmental (A), pallido-thalamic
(B), strio-piramidal (C) and parietal- premotor (D) levels of the
construction of the movement according to N.A. Bernshtein (1966). Its
appearance on the B and C levels prevents destruction of the physiologic
system of organization after realization of its activity and promotes its
reformation into the pathologic one. It manifested clinically in appearance
of a pathologic dynamic stereotype. Additional integration of lymbico-reticular
complex, and high centers of autonomic supplement into this system promotes
a formation of the stable neurotic, depressive reactions and autonomic
disorders. Such reactions are transitory and have adaptive character at
normal program of construction and fulfillment of the motion, while at
pathologic one they have desadaptive character. Clinically they are known as
multiple psychoautonomic syndromes combined with muscular, fascial and
ligamental pains of different location
(294) Peters ML,
Vlaeyen JW, van Drunen C. Do fibromyalgia patients display hypervigilance
for innocuous somatosensory stimuli? Application of a body scanning reaction
time paradigm. Pain 2000; 86(3):283-292.
Abstract: This study tested the hypothesis that fibromyalgia patients
display hypervigilance for somatosensory signals. Hypervigilance was
operationalized as the detection of weak electrocutaneous stimuli. Innocuous
electrical stimuli gradually increasing in strength were administered to one
of four different body locations. A reaction time paradigm was used in which
subjects had to respond as fast as possible to stimulus detection by
pressing a button corresponding to the correct body location. The detection
task was presented first under single task conditions and subsequently under
dual task conditions, in combination with a second (visual) reaction time
task. It was predicted that hypervigilance would be most prominent under
dual task conditions, where subjects can choose to allocate attention
selectively to one of the tasks. Questionnaires on general body vigilance,
pain vigilance, pain related-fear and pain catastrophizing were also
administered. Thirty female fibromyalgia patients were compared to 30
healthy controls matched on age, sex and educational level. No evidence for
hypervigilance for innocuous signals was found: patients did not show
superior detection of electrical stimuli either under single or dual task
conditions. Also, no differences were found between patients and controls on
the body vigilance questionnaire. Detection of electrical stimuli was,
however, predicted by pain-related fear and pain vigilance
(295) Dessein PH,
Shipton EA, Stanwix AE, Joffe BI. Neuroendocrine deficiency-mediated
development and persistence of pain in fibromyalgia: a promising paradigm?
Pain 2000; 86(3):213-215.
(296) Karjalainen K,
Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H et al.
Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain
in working age adults. Cochrane Database Syst Rev 2000;(2):CD001984.
Abstract: BACKGROUND: Non-malignant musculoskeletal pain is an increasing
problem in western countries. Fibromyalgia syndrome is an increasing
recognised chronic musculoskeletal disorder. OBJECTIVES: The objective of
this systematic review was to determine the effectiveness of
multidisciplinary rehabilitation for fibromyalgia and widespread
musculoskeletal pain among working age adults. SEARCH STRATEGY: An
electronic search was conducted and included Medline from 1966, PsycLIT from
1967 and EMBASE from 1980 to April 1998. The Cochrane Musculoskeletal Group
Trials Register was searched as well as, the Cochrane Controlled Trials
Register (CCTR). The references of identified articles and reviews were
checked, studies published in the Finnish medical database Medic from 1978
to 1998 screened and the Science Citation Index searched. Content experts
were also contacted for additional or unpublished studies. SELECTION
CRITERIA: From all references found in our original search, we selected all
randomized controlled trials (RCTs) and clinical controlled trials (CCTs).
Trials had to assess the effectiveness of multidisciplinary rehabilitation
for patients suffering from fibromyalgia and widespread musculoskeletal pain
among working age adults. The rehabilitation program was required to be
multidisciplinary; that is, it had to consist of a physician's consultation,
plus a psychological, social or vocational intervention, or a combination of
both. DATA COLLECTION AND ANALYSIS: Four reviewers independently selected
the RCTs and CCTs that met the specified inclusion criteria. Two experts in
the field of rehabilitation evaluated the relevance and applicability of the
findings of the selected studies to actual clinical use. Two other reviewers
extracted the data and assessed the main results and the methodological
quality of the studies using standardized forms. Finally, a qualitative
analysis was performed to evaluate the level of scientific evidence for the
effectiveness of multidisciplinary rehabilitation. MAIN RESULTS: After
screening 1808 abstracts, and the references of 65 reviews, we found only
seven relevant studies (1050 patients) that met our inclusion criteria. None
of these were considered, methodologically, a high quality randomized
controlled trial. Four of the included RCTs on fibromyalgia were graded low
quality and suggest no quantifiable benefits. The three included RCTs on
widespread musculoskeletal pain showed that based on limited evidence,
overall, no evidence of efficacy was observed. However, behavioral treatment
and stress management appear to be important components. Education combined
with physical training showed some positive effects in long term follow up.
REVIEWER'S CONCLUSIONS: We conclude that there appears to be little
scientific evidence for the effectiveness of multidisciplinary
rehabilitation for these musculoskeletal disorders. However,
multidisciplinary rehabilitation is a commonly used intervention for chronic
musculoskeletal disorders, which cause much personal suffering and
substantial economic loss to the society. There is a need for high quality
trials in this field
(297) Kaden M,
Bubenzer RH. [License fee for fibromyalgia? Illness with trademark
protection]. MMW Fortschr Med 1999; 141(46):60.
(298) Huston GJ. A
fibromyalgia scale in a general rheumatology clinic. Rheumatology (Oxford)
2000; 39(3):336-337.
(299) Nicassio PM,
Weisman MH, Schuman C, Young CW. The role of generalized pain and pain
behavior in tender point scores in fibromyalgia. J Rheumatol 2000;
27(4):1056-1062.
Abstract: OBJECTIVE: To determine and assess the significance of the
independent role of pain, pain behavior, depression, and weekly stress in
tender point scores in objectively diagnosed fibromyalgia (FM) patients.
METHODS: One hundred eleven patients with FM recruited from the community
and private and university based clinics participated in a comprehensive
evaluation of their pain, psychological distress, and pain behavior. Tender
point assessment was carried out across 18 discrete sites according to
American College of Rheumatology criteria. Pain was assessed with a
composite index of 4 pain measures; psychological distress consisted of
measures of stress and depression, and pain behavior was measured by an
objective index derived from a 10 minute videotaped sequence in which 5 pain
behaviors were recorded. RESULTS: Multiple regression analyses revealed that
high pain, high pain behavior, and shorter illness duration were related
independently to tender point scores. Measures of depression and weekly
stress were not independently related to tender point scores. CONCLUSION:
Tender point scores are related to generalized pain and pain behavior
tendencies in patients with FM, and do not independently reflect generalized
psychological distress
(300) Neerinckx E,
Van Houdenhove B, Lysens R, Vertommen H, Onghena P. Attributions in chronic
fatigue syndrome and fibromyalgia syndrome in tertiary care. J Rheumatol
2000; 27(4):1051-1055.
Abstract: OBJECTIVE: To evaluate the attributions of patients with chronic
fatigue syndrome (CFS) and fibromyalgia (FM) consulting at a university
fatigue and pain clinic. METHODS: Consecutive attenders (n = 192) who met
the CFS criteria (n = 95) or FM criteria (n = 56) or who had medically
unexplained chronic pain and/or fatigue without meeting both criteria (CPF)
(n = 41) were evaluated. All subjects completed an extended form of the
Cause of Illness Inventory. Descriptive statistics, frequency analyses,
chi-square tests, one-way analysis of variance, and sequential Fisher least
significant difference tests were performed. RESULTS: In total, 48 patients
reported physical causes only and 10 patients psychosocial causes only; the
majority (70%) mentioned both types of causes. With regard to the contents,
"a chemical imbalance in my body" (61%), "a virus" (51%), "stress" (61%),
and "emotional confusion" (40%) were reported most frequently. The
diagnostic label did not have a significant influence on number and type of
attributions. Small to moderate effect sizes were registered concerning the
association of specific attributions and diagnosis, sex, duration of the
symptoms, contact with a self-help group, and premorbid depression.
CONCLUSION: The majority of patients with CFS, FM, and CPF reported a great
diversity of attributions open to a preferably personalized cognitive
behavioral approach. Special attention should be paid to patients with
symptoms existing for more than one year and those who had previous contacts
with a self-help group. They particularly show external, stable, and global
attributions that may compromise feelings of self-efficacy in dealing with
the illness
(301) Graven-Nielsen
T, Aspegren KS, Henriksson KG, Bengtsson M, Sorensen J, Johnson A et al.
Ketamine reduces muscle pain, temporal summation, and referred pain in
fibromyalgia patients. Pain 2000; 85(3):483-491.
Abstract: Central mechanisms related to referred muscle pain and temporal
summation of muscular nociceptive activity are facilitated in fibromyalgia
syndrome (FMS) patients. The present study assessed the effects of an NMDA-antagonist
(ketamine) on these central mechanisms. FMS patients received either i.v.
placebo or ketamine (0.3 mg/kg, Ketalar((R))50% decrease in pain intensity
at rest by active drug on two consecutive VAS assessments). Fifteen out of
17 ketamine-responders were included in the second part of the study. Before
and after ketamine or placebo, experimental local and referred pain was
induced by intramuscular (i.m.) infusion of hypertonic saline (0.7 ml, 5%)
into the tibialis anterior (TA) muscle. The saline-induced pain intensity
was assessed on an electronic VAS, and the distribution of pain drawn by the
subject. In addition, the pain threshold (PT) to i.m. electrical stimulation
was determined for single stimulus and five repeated (2 Hz, temporal
summation) stimuli. The pressure PT of the TA muscle was determined, and the
pressure PT and pressure pain tolerance threshold were determined at three
bilaterally located tenderpoints (knee, epicondyle, and mid upper trapezius).
VAS scores of pain at rest were progressively reduced during ketamine
infusion compared with placebo infusion. Pain intensity (area under the VAS
curve) to the post-drug infusion of hypertonic saline was reduced by
ketamine (-18. 4+/-0.3% of pre-drug VAS area) compared with placebo
(29.9+/-18.8%, P<0.02). Local and referred pain areas were reduced by
ketamine (-12. 0+/-14.6% of pre- drug pain areas) compared with placebo
(126.3+/-83. 2%, P<0.03). Ketamine had no significant effect on the PT to
single i.m. electrical stimulation. However, the span between the PT to
single and repeated i.m. stimuli was significantly decreased by the ketamine
(-42.3+/-15.0% of pre-drug PT) compared with placebo (50. 5+/-49.2%, P<0.03)
indicating a predominant effect on temporal summation. Mean pressure pain
tolerance from the three paired tenderpoints was increased by ketamine
(16.6+/-6.2% of pre-drug thresholds) compared with placebo (- 2.3+/-4.9%,
P<0.009). The pressure PT at the TA muscle was increased after ketamine
(42.4+/-9. 2% of pre-drug PT) compared with placebo (7.0+/-6.6%, P<0.011).
The present study showed that mechanisms involved in referred pain, temporal
summation, muscular hyperalgesia, and muscle pain at rest were attenuated by
the NMDA-antagonist in FMS patients. It suggested a link between central
hyperexcitability and the mechanisms for facilitated referred pain and
temporal summation in a sub-group of the fibromyalgia syndrome patients.
Whether this is specific for FMS patients or a general phenomena in painful
musculoskeletal disorders is not known
(302) Torpy DJ,
Papanicolaou DA, Lotsikas AJ, Wilder RL, Chrousos GP, Pillemer SR. Responses
of the sympathetic nervous system and the hypothalamic- pituitary-adrenal
axis to interleukin-6: a pilot study in fibromyalgia. Arthritis Rheum 2000;
43(4):872-880.
Abstract: OBJECTIVE: To determine whether deficient activity of the
hypothalamic corticotropin-releasing hormone (CRH) neuron, which stimulates
the hypothalamic-pituitary-adrenal (HPA) axis and the central control nuclei
of the sympathetic nervous system and inhibits ascending pain pathways, may
be pathogenic in patients with fibromyalgia (FM). METHODS: We administered
interleukin-6 (IL-6; 3 microg/kg of body weight subcutaneously), a cytokine
capable of stimulating hypothalamic CRH release, and measured plasma levels
of adrenocorticotropic hormone (ACTH), cortisol, and catecholamines and
their metabolites and precursors. Thirteen female FM patients and 8 age- and
body mass index- matched female controls were studied. The diagnosis of FM
was made according to American College of Rheumatology criteria. Tender
points were quantitated by pressure algometry. All subjects had HPA axis
studies. Seven FM patients and 7 controls also had catecholamine
measurements. RESULTS: After IL-6 injection, delayed ACTH release was
evident in the FM patients, with peak levels at 96.9 +/- 6.0 minutes (mean
+/- SEM; control peak 68.6 +/- 10.3 minutes; P = 0.02). Plasma cortisol
responses to IL-6 did not differ significantly between patients and
controls. Basal norepinephrine (NE) levels were higher in the FM patients
than in the controls. While a small, although not significant, rise in NE
levels occurred after IL-6 injection in the controls, NE levels dramatically
increased over basal levels in the FM patients between 60 and 180 minutes
after IL-6 injection. Both peak NE levels (mean +/- SEM 537.6 +/- 82.3
versus 254.3 +/- 41.6 pg/ml; P = 0.0001) and time-integrated NE responses
(93.2 +/- 16.6 pg/ml x minutes(-3) versus 52.2 +/- 5.7 pg/ml x minutes(-3);
P = 0.038) were greater in FM patients than in controls. Heart rate was
increased by IL- 6 injection in FM patients and controls, but rose to
significantly higher levels in the FM patients from 30 minutes to 180
minutes after IL-6 injection (P < 0.03). CONCLUSION: Exaggerated NE
responses and heart rate increases, as well as delayed ACTH release, were
observed among female FM patients compared with age-matched female controls.
Delayed ACTH release after IL-6 administration in FM is consistent with a
defect in hypothalamic CRH neuronal function. Exaggerated NE release may
reflect abnormal regulation of the sympathetic nervous system, perhaps
secondary to chronically deficient hypothalamic CRH. The excessive heart
rate response after IL-6 injection in FM patients may be unrelated to the
increase in NE, or it may reflect an alteration in the sensitivity of
cardiac beta-adrenoceptors to NE. These responses to a physiologic stressor
support the notion that FM may represent a primary disorder of the stress
system
(303) Sperber AD,
Carmel S, Atzmon Y, Weisberg I, Shalit Y, Neumann L et al. Use of the
Functional Bowel Disorder Severity Index (FBDSI) in a study of patients with
the irritable bowel syndrome and fibromyalgia. Am J Gastroenterol 2000; 95(4
):995-998.
Abstract: OBJECTIVE: The purpose of this study was to evaluate the utility
of the Functional Bowel Disorder Severity Index (FBDSI) as a measure of
severity of disease among patients with the irritable bowel syndrome (IBS)
and matched controls. METHODS: A total of 75 IBS patients and 69 matched
controls completed questionnaires on bowel symptoms, health status, quality
of life, psychological distress, concerns, anxiety, and sense of coherence.
All participants also were tested for fibromyalgia (FS), a functional
disorder of the musculoskeletal system. All participants were administered a
questionnaire that included the FBDSI. On the basis of their responses to
the questionnaire, the controls were subdivided as healthy controls (n = 48)
or IBS nonpatients (n = 21). On the basis of the FS classification, 75 IBS
patients were subdivided as IBS only (n = 50) or IBS and FS combined (n =
25). RESULTS: The mean FBDSI score was higher for the IBS patients than the
controls (100.5+/- 12.7 and 23.5+/-3.9, respectively; p < 0.001). IBS
nonpatients had an intermediate score of 42.3+/-18.0. Patients with both IBS
and fibromyalgia had the highest mean FBDSI score: 138.8+/-31.5. There was
no association between FBDSI and age or gender, but FBDSI was significantly
associated with other measures of health status. CONCLUSIONS: An association
was found between the FBDSI and IBS patient status: IBS nonpatients,
patients with IBS only, and patients with both IBS and fibromyalgia had
increasingly severe scores. The results provide support for the validity of
FBDSI as a measure of illness severity in functional gastrointestinal
disorders
(304) Armstrong R.
Fibromyalgia: is recovery impeded by the internet? Arch Intern Med 2000;
160(7):1039-1040.
(305) Citera G,
Arias MA, Maldonado-Cocco JA, Lazaro MA, Rosemffet MG, Brusco LI et al. The
effect of melatonin in patients with fibromyalgia: a pilot study. Clin
Rheumatol 2000; 19(1):9-13.
Abstract: The aim of the study was to determine the possible effect of
melatonin treatment on disturbed sleep, fatigue and pain symptoms observed
in fibromyalgia (FM) patients. Twenty-one consecutive patients with FM were
included in an open 4-week-duration pilot study. Before and after treatment
with melatonin 3 mg at bedtime, patients were evaluated using tender point
count by palpation of 18 classic anatomical regions, pain score in four
predesignated areas, pain severity on a 10 cm visual analogue scale (VAS),
sleep disturbances, fatigue, depression, anxiety, and patient and physician
global assessments, also by a VAS. Urine 6- sulphatoxymelatonin levels
(aMT-6S) were measured in the patients and 20 age- and sex-matched controls.
Nineteen patients completed the study. One patient withdrew because of
migraine and another was lost to follow-up. At day 30, median values for the
tender point count and severity of pain at selected points, patient and
physician global assessments and VAS for sleep significantly improved with
melatonin treatment. Other variables improved but did not reach statistical
significance. Adverse events were mild and transient. Lower levels of aMT-6S
were found in FM patients compared with normal median controls (+/-SD, 9.16
+/- 7.9 microg/24 h vs 16.8 +/- 12.8 microg/24 h) (p = 0.06). Although this
is an open study, our preliminary results suggest that melatonin can be an
alternative and safe treatment for patients with FM. Double-blind placebo
controlled studies are needed
(306) Papadopoulos
IA, Georgiou PE, Katsimbri PP, Drosos AA. Treatment of fibromyalgia with
tropisetron, a 5HT3 serotonin antagonist: a pilot study. Clin Rheumatol
2000; 19(1):6-8.
Abstract: In this pilot study we investigated 10 women suffering from
primary fibromyalgia. All patients received 5 mg of tropisetron in the
evening, for a period of 4 weeks. Clinical disease variables included the
measurement of a pain score, fatigue, sleep disturbances and measurement of
the number of tender points. Five of our patients (50%) showed a statistical
clinical improvement of all the above parameters starting after the first
week of treatment. Two patients did not respond to the therapy and three
discontinued the study because of side- effects. We conclude that
administration of tropisetron in fibromyalgia patients could be useful in
the management of this difficult and incurable syndrome
(307) Neerinckx E,
Van Houdenhove B, Lysen R, Vertommen H. What happens to the fibromyalgia
concept? Clin Rheumatol 2000; 19(1):1-5.
(308) Buskila D.
Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr
Opin Rheumatol 2000; 12(2):113-123.
Abstract: Fibromyalgia and widespread pain were common in Gulf War veterans
with unexplained illness referred to a rheumatology clinic. Increased
tenderness was demonstrated in the postmenstrual phase of the cycle compared
with the intermenstrual phase in normally cycling women but not in users of
oral contraceptives. Patients with fibromyalgia had high levels of symptoms
that have been used to define silicone implant- associated syndrome. Tender
points were found to be a common transient finding associated with acute
infectious mononucleosis, but fibromyalgia was an unusual long-term outcome.
The common association of fibromyalgia with other rheumatic and systemic
illnesses was further explored. A preliminary study revealed a possible
linkage of fibromyalgia to the HLA region. Patients with fibromyalgia were
found to have an impaired ability to activate the hypothalamic pituitary
portion of the hypothalamic pituitary adrenal axis as well as the
sympathoadrenal system, leading to reduced corticotropin and epinephrine
response to hypoglycemia. Much interest has been expressed in the literature
on the possible role of autonomic dysfunction in the development or
exacerbation of fatigue and other symptoms in chronic fatigue syndrome.
Mycoplasma genus and mycoplasma fermentans were detected by polymerase chain
reaction in patients with chronic fatigue syndrome. It was reported that
myofascial temporomandibular disorder does not run in families. No major
therapeutic trials in fibromyalgia, chronic fatigue syndrome, or myofascial
pain syndrome were reported over the past year. The effectiveness of
cognitive behavioral therapy and behavior therapy for chronic pain in adults
was emphasized. A favorable outcome of fibromyalgia and chronic fatigue
syndrome in children and adolescents was reported
(309) Arnold LM,
Keck PE, Jr., Welge JA. Antidepressant treatment of fibromyalgia. A
meta-analysis and review. Psychosomatics 2000; 41(2):104-113.
Abstract: Fibromyalgia is a common musculoskeletal pain disorder associated
with mood disorders. Antidepressants, particularly tricyclics, are commonly
recommended treatments. Randomized, controlled trials of antidepressants for
treatment of fibromyalgia were reviewed by methodology, results, and
potential predictors of response. Twenty-one controlled trials, 16 involving
tricyclic agents, were identified; 9 of these 16 studies were suitable for
meta-analysis. Effect sizes were calculated for measurements of physician
and patient overall assessment, pain, stiffness, tenderness, fatigue, and
sleep quality. Compared with placebo, tricyclic agents were associated with
effect sizes that were substantially larger than zero for all measurements.
The largest improvement was associated with measures of sleep quality; the
most modest improvement was found in measures of stiffness and tenderness.
Further studies are needed utilizing randomized, double- blind,
placebo-controlled, parallel designs with antidepressants administered at
therapeutic dose ranges, using standardized criteria for fibromyalgia and
systematically assessed for co-occurring psychiatric illness
(310) White KP,
Ostbye T, Harth M, Nielson W, Speechley M, Teasell R et al. Perspectives on
posttraumatic fibromyalgia: a random survey of Canadian general
practitioners, orthopedists, physiatrists, and rheumatologists. J Rheumatol
2000; 27(3):790-796.
Abstract: OBJECTIVE: To determine which factors physicians consider
important in patients with chronic generalized posttraumatic pain. METHODS:
Using physician membership directories, random samples of 287 Canadian
general practitioners, 160 orthopedists, 160 physiatrists, and 160
rheumatologists were surveyed. Each subject was mailed a case scenario
describing a 45-year-old woman who sustained a whiplash injury and
subsequently developed chronic, generalized pain, fatigue, sleep
difficulties, and diffuse muscle tenderness. Respondents were asked whether
they agreed with a diagnosis of fibromyalgia (FM), and what factors they
considered to be important in the development of chronic, generalized
posttraumatic pain. RESULTS: More-recent medical school graduates were more
likely to agree with the FM diagnosis. Orthopedists (28.8%) were least
likely to agree, while rheumatologists (83.0%) were most likely to agree. On
multivariate analysis, 5 factors predicted agreement or disagreement with
the diagnosis of FM: (1) number of FM cases diagnosed by the respondent per
week (p < 0.0001); (2) patient's sex (p < 0.0001); (3) force of initial
impact (p = 0.003); (4) patient's pre-collision psychiatric history (p =
0.03); and (5) severity of initial injuries (p = 0.03). The force of initial
impact and the patient's pre-collision psychiatric history were both
negatively correlated with agreement in diagnosis. Patient related factors
(personality, emotional stress, pre-collision physical, mental health) were
considered more important than trauma related factors in the development of
chronic, widespread pain. CONCLUSION: Future studies of the association
between trauma and FM should identify potential cases outside of specialty
clinics, and baseline assessments should include some measurement of
personality, stress, and pre-collision physical and mental health
(311) Kaplan RM,
Schmidt SM, Cronan TA. Quality of well being in patients with fibromyalgia.
J Rheumatol 2000; 27(3):785-789.
Abstract: OBJECTIVE: The Quality of Well-being Scale (QWB) is a generic
measure of health related quality of life that can be used for population
monitoring, measurement of clinical outcomes, or cost effectiveness
analysis. We report data on the validity of the QWB for patients with
fibromyalgia (FM) and compare the effect of FM to that of other chronic
diseases. METHODS: The participants were 594 people recruited from a private
health maintenance organization with a confirmed diagnosis of FM. The QWB
was administered, along with measures of self-rated health status, physical
functioning, pain, stiffness, anxiety, sleep, and depression. The QWB places
levels of wellness on a continuum ranging from 0.0 (for death or the
equivalent of being dead) to 1.0 (for optimum functioning without symptoms).
RESULTS: Patients with FM had mean QWB scores of 0.559 (SD 0.074), which is
lower than scores reported for patients in most other chronic disease
categories. QWB was significantly correlated with measures of physical
functioning, stiffness, anxiety, depression, pain, and sleep quality.
CONCLUSION: Evidence supports the validity of the QWB for patients with FM.
Patients with FM obtain lower scores on the QWB than patients with diagnoses
of chronic obstructive pulmonary disease, rheumatoid arthritis, atrial
fibrillation, advanced cancer, and several other chronic diseases. Although
FM is generally considered a syndrome rather than a disease, substantial
disability is experienced by people with this diagnosis
(312) Akkasilpa S,
Minor M, Goldman D, Magder LS, Petri M. Association of coping responses with
fibromyalgia tender points in patients with systemic lupus erythematosus. J
Rheumatol 2000; 27(3):671-674.
Abstract: OBJECTIVE: To determine the association between fibromyalgia (FM)
tender points (TP) and psychological constructs in patients with systemic
lupus erythematosus (SLE). METHODS: One hundred seventy-three patients with
SLE were examined for FM TP, and asked to complete 2 questionnaires at the
same visit, the Health-Related Hardiness Scale (HRHS), and the Mishel
Uncertainty in Illness Scale (MUIS). RESULTS: The examination of FM TP
showed that 38.2% had no TP, 44.5% had 1-10 TP, and 17.3% had > or = 11 TP.
The mean +/- SD score of the HRHS was 155.6 +/- 19.7 (range 105.0-198.0;
higher scores indicate greater hardiness), and the MUIS was 85.3 +/- 18.7
(range 41.0-132.0; higher scores indicate uncertainty). There were
significant associations between FM TP and HRHS (no TP 161.2 +/- 20.2, 1-10
TP 152.5 +/- 19.7, > or = 11 TP 151.0 +/- 15.8; p = 0.0108) and between FM
TP and MUIS (no TP 78.2 +/- 20.2, 1-10 TP 86.9 +/- 17.6, > or = 11 TP 95.8
+/- 14.7; p = 0.0001). CONCLUSION: This study shows a strong association
between FM TP and uncertainty or lack of "hardiness." We conclude that SLE
patients with FM TP are less likely to be good "copers." Prospective studies
to determine if "poor coping" predicts FM in SLE are recommended. If the
association between coping and FM is causal, it will justify interventions
to improve coping and similar constructs, such as self-efficacy
(313) Raphael KG,
Marbach JJ. Comorbid fibromyalgia accounts for reduced fecundity in women
with myofascial face pain. Clin J Pain 2000; 16(1):29-36.
Abstract: OBJECTIVE: This study examined factors related to reduced
fecundity among women with myofascial face pain (MFP) arising from
hypotheses concerning the role of neurohormonal factors in MFP and
associated conditions. DESIGN: Fecundity rates among 162 MFP cases and 173
demographically equivalent acquaintance female controls were compared.
OUTCOME MEASURES: Fecundity indicators and factors underlying differential
fecundity rates were investigated. RESULTS: It was determined that female
cases with MFP had significantly fewer children and were more likely to have
never been pregnant. Although women with MFP were more likely than controls
to indicate that volitional factors related to their health discouraged them
from any or additional pregnancies, these factors did not account for lower
rates of fecundity. MFP cases also did not differ from controls on
self-reported indicators of infertility. Moreover, we show that reduced
fecundity was restricted to the subgroup of MFP cases who reported a history
of fibromyalgia. CONCLUSIONS: Reduced fecundity in women with MFP is
restricted to those who self-report a history of fibromyalgia. Possible
mechanisms for reduced fecundity in fibromyalgia are discussed. These
findings highlight the need to screen for widespread pain among women with
regional myofascial pain syndromes
(314) Fibromyalgia.
Health News 2000; 6(2):1-2.
(315) Martinez-Lavin
M, Amigo MC, Coindreau J, Canoso J. Fibromyalgia in Frida Kahlo's life and
art. Arthritis Rheum 2000; 43(3):708-709.
(316) Sartin JS.
Fibromyalgia and pain management. Mayo Clin Proc 2000; 75(3):316-317.
(317) White KP,
Speechley M, Harth M, Ostbye T. Co-existence of chronic fatigue syndrome
with fibromyalgia syndrome in the general population. A controlled study.
Scand J Rheumatol 2000; 29(1):44-51.
Abstract: OBJECTIVE: To determine the proportion of adults with fibromyalgia
syndrome (FMS) in the general population who also meet the 1988 Centre for
Disease Control (CDC) criteria for chronic fatigue syndrome (CFS). METHODS:
Seventy-four FMS cases were compared with 32 non-FMS controls with
widespread pain and 23 with localized pain, all recruited in a general
population survey. RESULTS: Among females, 58.0% of fibromyalgia cases met
the full criteria for CFS, compared to 26.1% and 12.5% of controls with
widespread and localized pain, respectively (p=0.0006). Male percentages
were 80.0, 22.2, and zero, respectively (p=0.003). Compared to those with
FMS alone, those meeting the case definitions for both FMS and CFS reported
a worse course, worse overall health, more dissatisfaction with health, more
non-CFS symptoms, and greater disease impact. The number of total symptoms
and non-CFS symptoms were the best predictors of co-morbid CFS. CONCLUSIONS:
There is significant clinical overlap between CFS and FMS
(318) Strombeck B,
Ekdahl C, Manthorpe R, Wikstrom I, Jacobsson L. Health-related quality of
life in primary Sjogren's syndrome, rheumatoid arthritis and fibromyalgia
compared to normal population data using SF-36. Scand J Rheumatol 2000;
29(1):20-28.
Abstract: OBJECTIVE: To investigate the health-related quality of life in
women with primary Sjogren's syndrome (prim SS) and compare with normative
data and the health-related quality of life in women with rheumatoid
arthritis (RA) and women with fibromyalgia. METHODS: A questionnaire
including the MOS Short-Form 36 (SF-36) was completed by 42 prim SS women,
59 RA women, and 44 women with fibromyalgia. RESULTS: All three patient
groups experienced a decreased quality of life level ranging from 5 to 65 %
in all SF-36 scales compared to normative data. Differences between groups
were seen in 7 of the 8 scales (p< or = 0.004). The prim SS patients
experienced a higher quality of life level with regard to physical function
than the women with RA and fibromyalgia, whereas in the psychological
dimensions the quality of life level was comparable to that of the two other
groups. CONCLUSION: The health-related quality of life was significantly
decreased as compared to norms in prim SS women and comparable to the levels
of women with RA and fibromyalgia
(319) Barth H, Berg
PA, Klein R. Is there any relationship between eosinophilia myalgia syndrome
(EMS) and fibromyalgia syndrome (FMS)? An analysis of clinical and
immunological data. Adv Exp Med Biol 1999; 467:487-496.
Abstract: The eosinophilia-myalgia syndrome (EMS) caused by intake of
contaminated L-tryptophan resembles in its clinical presentation the
fibromyalgia syndrome (FMS). We, therefore, analysed clinical and
immunological parameters in 16 patients with chronic EMS and 100 patients
with FMS in order to see whether there may be a relationship between both
disorders. From 12 FMS patients and 12 controls also peripheral blood
mononuclear cells (PBMC) were obtained. Myalgia and arthralgia was observed
in chronic EMS in the same incidence as in patients with FMS (81%). Also
antibodies to serotonin, gangliosides and phospholipids were present in both
groups. In vitro stimulation of PBMC with different L-tryptophan
preparations revealed in six of the 12 FMS patients but only two of the
control individuals a production of type 2 cytokines (IL-5, IL-10). We,
therefore, conclude that EMS may have developed in patients suffering
primarily from FMS as an allergic reaction towards a more immunogenic L-tryptophan
preparation
(320) Lekander M,
Fredrikson M, Wik G. Neuroimmune relations in patients with fibromyalgia: a
positron emission tomography study. Neurosci Lett 2000; 282(3):193-196.
Abstract: To study relations between neural and immune activity in patients
with chronic pain, we correlated regional cerebral blood flow measured with
[(15)O]butanol positron emission tomography to immune function in five
patients with fibromyalgia. Partly replicating previous data in healthy
volunteers, natural killer cell activity correlated negatively with right
hemisphere activity in the secondary somatosensory and motor cortices as
well as the thalamus. Moreover, natural killer cell activity was negatively
and bilaterally related to activity in the posterior cingulate cortex. Thus,
immune parameters were related to activity in brain areas involved in pain
perception, emotion, and attention. Implicated from a small study
population, these strong neuro- immune associations are discussed in view of
recent findings concerning mechanisms and adaptive values in immuno-cortical
communication and regulation
(321) Cohen H,
Neumann L, Shore M, Amir M, Cassuto Y, Buskila D. Autonomic dysfunction in
patients with fibromyalgia: application of power spectral analysis of heart
rate variability. Semin Arthritis Rheum 2000; 29(4):217-227.
Abstract: OBJECTIVES: To assess the interaction between the sympathetic and
parasympathetic systems in patients with fibromyalgia syndrome (FM), using
power spectrum analysis (PSA) of heart rate variability (HRV). In addition,
we explored the association between HRV, measures of tenderness, FM
symptoms, physical function, psychological well being and quality of life.
METHODS: We studied 22 women with FM and 22 age- matched healthy women.
Twenty-minute electrocardiogram recordings were obtained in a supine
position during complete rest. Spectral analysis of R-R intervals was done
by the fast-Fourier transform algorithm. RESULTS: Heart rate was
significantly higher in FM patients compared with controls (P < .006). FM
patients had significantly lower HRV compared with controls (P= .001), and
higher low-frequency (LF) and lower high-frequency (HF) components of PSA
than controls (P < .001). Quality of life, physical function, anxiety,
depression, and perceived stress were moderately to highly correlated with
LF, HF (in normalized units), and LF/HF. No association was observed between
HRV parameters and measures of tenderness and FM symptoms. CONCLUSIONS: The
basal autonomic state of patients with FM is characterized by increased
sympathetic and decreased parasympathetic tones. Autonomic dysregulation may
have implications regarding the symptomatology, physical and psychological
aspects of health status
(322) White KP,
Carette S, Harth M, Teasell RW. Trauma and fibromyalgia: is there an
association and what does it mean? Semin Arthritis Rheum 2000;
29(4):200-216.
Abstract: OBJECTIVES: The primary objective is to review current research
with respect to the role of trauma in fibromyalgia (FM). A secondary
objective is to hypothesize which steps need to be taken, first to determine
whether such an association truly exists, and second to clarify what such an
association might mean. METHODS: An extensive literature review was
undertaken, including Medline from 1979 to the present. RESULTS: The
strongest evidence supporting an association between trauma and FM is a
recently published Israeli study in which adults with neck injuries had
greater than a 10-fold increased risk of developing FM within 1 year of
their injury, compared with adults with lower extremity fractures (P= .001).
Several other studies provide a hypothetical construct for such an
association. These include studies on (1) postinjury sleep abnormalities;
(2) local injury sites as a source of chronic distant regional pain; and (3)
the concept of neuroplasticity. There are, however, several primary
arguments against such an association: (1) FM may not be a distinct clinical
entity; (2) FM may be a psychological, rather than physical, disease; (3)
the evidence supporting any association is limited and not definitive; (4)
the Israeli study, itself, has some methodological limitations; and (5)
other factors may be more important than the injurious event in determining
chronic symptoms after an acute injury. CONCLUSIONS: Although there is some
evidence supporting an association between trauma and FM, the evidence is
not definitive. Further prospective studies are needed to confirm this
association and to identify whether trauma has a causal role
(323) Martinez-Lavin
M, Hermosillo AG. Autonomic nervous system dysfunction may explain the
multisystem features of fibromyalgia. Semin Arthritis Rheum 2000;
29(4):197-199.
(324) de Jesus M.
Fibromyalgia onset. Am J Nurs 2000; 100(1):14.
(325) Brattberg G.
Connective tissue massage in the treatment of fibromyalgia. Eur J Pain 1999;
3(3):235-244.
Abstract: The aim of this study was to investigate the effect of connective
tissue massage in the treatment of individuals with fibromyalgia. The
results of this random study of 48 individuals diagnosed with fibromyalgia
(23 in the treatment group and 25 in the reference group) show that a series
of 15 treatments with connective tissue massage conveys a pain relieving
effect of 37%, reduces depression and the use of analgesics, and positively
effects quality of life. The treatment effects appeared gradually during the
10-week treatment period. Three months after the treatment period about 30%
of the pain relieving effect was gone, and 6 months after the treatment
period pain was back to about 90% of the basic value. As long as there is a
lack of effective medical treatment for individuals with fibromyalgia, they
ought to be offered treatments with connective tissue massage. However,
further studies are needed in the mechanisms behind the treatment effects.
Copyright 1999 European Federation of Chapters of the International
Association for the Study of Pain
(326) Anderberg UM,
Liu Z, Berglund L, Nyberg F. Elevated plasma levels of neuropeptide Y in
female fibromyalgia patients. Eur J Pain 1999; 3(1):19-30.
Abstract: Neuropeptide Y(NPY) co-exists with norepinephrine in the
sympathetic nervous system, and NPY may represent the sympathetic-neuronal
output. Fibromyalgia syndrome (FMS) patients have perturbations in the
hypothalmic-pituitary-adrenal (HPA) axis and in the sympathetic stress axis
as well. As opioid peptides, monoamines and sex steroids are integrated in
the regulation of stress, it is interesting to further explore the role of
NPY in FMS patients, as they show many symptoms that are related to
perturbations of those systems.In this study, plasma NPY levels were
assessed in subgroups of FMS patients: cyclic (regular menstrual cycles),
non-cyclic (post-menopausal), depressed and non-depressed patients. In order
to examine whether pain and other symptoms seen in FMS patients are
correlated to the NPY levels, the patients were also registering 15
different symptoms daily during 28 days. Sex and age-matched healthy
controls were recruited for comparisons. Non-parametric tests were used for
the statistical analyses.The results showed that the NPY levels were
significantly elevated in the patients compared to the controls. In the
luteal phase of the cyclic patients, the levels of the peptide were higher
than in the corresponding controls. For the non-cyclic patients, there was a
positive correlation between physical symptoms and NPY levels, however, pain
per se did not reach the significant level of correlation. The non-
depressed patients had the same levels of NPY as the depressed FMS patients,
who also had a positive correlation between anxiety and NPY levels.These
results suggest that FMS patients have an altered activity in the NPY
system, most likely due to prolonged and/or repeated stress, and that the
hormonal state and time of the menstrual cycle also may be of importance in
the complex pathophysiologic mechanism behind the development of FMS.
Copyright 1999 European Federation of Chapters of the International
Association for the Study of Pain
(327) Wik G, Fischer
H, Bragee B, Finer B, Fredrikson M. Functional anatomy of hypnotic
analgesia: a PET study of patients with fibromyalgia. Eur J Pain 1999;
3(1):7-12.
Abstract: Hypnosis is a powerful tool in pain therapy. Attempting to
elucidate cerebral mechanisms behind hypnotic analgesia, we measured
regional cerebral blood flow with positron emission tomography in patients
with fibromyalgia, during hypnotically-induced analgesia and resting
wakefulness. The patients experienced less pain during hypnosis than at
rest. The cerebral blood-flow was bilaterally increased in the orbitofrontal
and subcallosial cingulate cortices, the right thalamus, and the left
inferior parietal cortex, and was decreased bilaterally in the cingulate
cortex. The observed blood-flow pattern supports notions of a multifactorial
nature of hypnotic analgesia, with an interplay between cortical and
subcortical brain dynamics. Copyright 1999 European Federation of Chapters
of the International Association for the Study of Pain
(328) Hallberg LR,
Carlsson SG. Anxiety and coping in patients with chronic work-related
muscular pain and patients with fibromyalgia. Eur J Pain 1998; 2(4):309-319.
Abstract: The aims of this study were: (1) to compare two groups of patients
with chronic pain conditions (work-related muscular pain, mainly low back
pain, and fibromyalgia) in general coping and pain-specific coping; (2) to
examine the relationship between general and pain-specific coping and, (3)
to examine the influence of state-trait anxiety on general and pain-specific
coping. The sample included 80 individuals (range=19-70 years; mean=47;
SD=9.9), who were patients at two pain management clinics for examination of
their physical and psychosocial health conditions and consideration on
disability pension. The patients were asked to respond to theStrategies to
Handle Stress Questionnaire, theCoping Strategies Questionnaireand theState-Trait
Anxiety Inventory. Patients with fibromyalgia scored significantly higher on
T-anxiety and adopted <<problem-solving>> (p<0.01) and <<catharsis>>
(p<0.05) less often and <<religion>> more often (p<0.01) than patients with
work- related muscular pain in coping with stressful situations in general.
No differences were revealed in pain-related coping between the groups.
T-anxiety was positively correlated to pain-related <<catastrophizing>>
(p<0.001) and negatively to abilities to control and reduce pain (p<0.05
andp<0.01, respectively). The correlation between general and pain-specific
coping was weak to moderate. In conclusion, patients with fibromyalgia
scored significantly higher on trait-anxiety and seem to interpret stressful
situations as more threatening than patients with work-related muscular
pain. Anxiety seems to be of central importance for coping with chronic
pain. Anxiety-prone patients with fibromyalgia might benefit from
psychological support in the process of coping with pain. Copyright 1998 The
British Infection Society. All rights reserved
(329) Andersson M,
Bagby JR, Dyrehag L, Gottfries C. Effects of staphylococcus toxoid vaccine
on pain and fatigue in patients with fibromyalgia/chronic fatigue syndrome.
Eur J Pain 1998; 2(2):133-142.
Abstract: Positive results of pilot studies of the effect of staphylococcus
toxoid vaccine in patients with fibromyalgia and chronic fatigue syndrome
were the incitement to the present, placebo-controlled study. It included 28
patients who fulfilled the criteria for both fibromyalgia and chronic
fatigue syndrome. The effect of vaccination with a staphylococcus toxoid was
compared with the effect of injections of sterile water. Psychometric
assessment was made using 15 items from the comprehensive psychopathological
rating scale (CPRS), Zung's self- rating depression scale and clinical
global impressions (CGI). The visual analogue scale (VAS) was used to
measure pain levels, and a hand- held electronic pressure algometer was used
to measure pressure pain thresholds. Significant improvement was seen in
seven of the 15 CPRS items in the vaccine group when pretreatment values
were compared to post-treatment values. In CPRS <<fatiguability>>, there
were significant intergroup differences, and in CPRS <<pain>> intergroup
differences bordered on significance. There was no significant improvement
in CPRS items in the placebo group. Clinical global impressions showed
significant improvement in the vaccine-treated group, and VAS did so in both
groups. In a follow-up study of 23 patients, the vaccine treatment was
continued for 2-6 years. Fifty percent were rehabilitated successfully and
resumed half-time or full- time work. The results of this study support the
authors>> hypothesis that treatment with staphylococcus toxoid may be a
fruitful strategy in patients with fibromyalgia and chronic fatigue
syndrome. Copyright 1998 European Federation of Chapters of the
International Association for the Study of Pain
(330) Berg D, Berg
LH, Couvaras J, Harrison H. Chronic fatigue syndrome and/or fibromyalgia as
a variation of antiphospholipid antibody syndrome: an explanatory model and
approach to laboratory diagnosis. Blood Coagul Fibrinolysis 1999;
10(7):435-438.
Abstract: Chronic Fatigue and/or Fibromyalgia have long been diseases
without definition. An explanatory model of coagulation activation has been
demonstrated through use of the ISAC panel of five tests, including,
Fibrinogen, Prothrombin Fragment 1+2, Thrombin/ AntiThrombin Complexes,
Soluble Fibrin Monomer, and Platelet Activation by flow cytometry. These
tests show low level coagulation activation from immunoglobulins (Igs) as
demonstrated by Anti-B2GPI antibodies, which allows classification of these
diseases as a type of antiphospholipid antibody syndrome. The ISAC panel
allows testing for diagnosis as well as monitoring for anticoagulation
protocols in these patients
(331) Wolfe F, Zhao
S, Lane N. Preference for nonsteroidal antiinflammatory drugs over
acetaminophen by rheumatic disease patients: a survey of 1,799 patients with
osteoarthritis, rheumatoid arthritis, and fibromyalgia. Arthritis Rheum
2000; 43(2):378-385.
Abstract: OBJECTIVE: Because there is controversy regarding the efficacy of
acetaminophen in rheumatic diseases and because apparently safer
nonsteroidal antiinflammatory drugs (NSAIDs) are being produced, we surveyed
rheumatic disease patients about their preferences for these agents to
determine the degree to which one type of therapeutic agent is preferred
over the other. METHODS: In 1998, we surveyed by mailed questionnaire 1,799
patients with osteoarthritis (OA), rheumatoid arthritis, or fibromyalgia who
were participating in a long-term outcome study. Patients who had taken
acetaminophen rated the effectiveness of acetaminophen, compared its
effectiveness with that of NSAIDs, and then rated their overall satisfaction
with acetaminophen compared with NSAIDs when both effectiveness and side
effects were considered. RESULTS: Two-thirds of study participants had taken
acetaminophen. About 37% of patients who had taken acetaminophen found it to
be moderately or very effective and about 63% indicated that it was not
effective or was only slightly effective. One-fourth of the patients found
acetaminophen and NSAIDs to be equally effective, but >60% found
acetaminophen to be much less effective or somewhat less effective. About
12% preferred acetaminophen to NSAIDs. When both effectiveness and side
effects were considered together, 25% of the patients had no preference, 60%
preferred NSAIDs, and 14% preferred acetaminophen. CONCLUSION: There was a
considerable and statistically significant preference for NSAIDs compared
with acetaminophen among the 3 groups of rheumatic disease patients.
Although this preference decreased slightly with age and was less pronounced
in OA patients, the preference was noted among all categories of patients
and was not altered by disease severity. If safety and cost are not issues,
there would hardly ever be a reason to recommend acetaminophen over NSAIDs,
since patients generally preferred NSAIDs and fewer than 14% preferred
acetaminophen. If safety and costs are issues, then the recommendation of
the American College Rheumatology that acetaminophen be tried first seems
correct, since 38.2% found acetaminophen to be as effective or more
effective than NSAIDs
(332) Ernberg M,
Lundeberg T, Kopp S. Pain and allodynia/hyperalgesia induced by
intramuscular injection of serotonin in patients with fibromyalgia and
healthy individuals. Pain 2000; 85(1-2):31-39.
Abstract: The aim of this study was to investigate the effect of injection
of serotonin (5-HT) into the masseter muscle on pain and
allodynia/hyperalgesia. Twelve female patients with fibromyalgia (FM) and 12
age-matched female healthy individuals (HI) participated in the study. The
current pain intensity (CPI) and the pressure pain threshold (PPT) of the
superficial masseter muscles were assessed bilaterally. 5- HT in one of
three randomized concentrations (10(-3), 10(-5), 10(-7) M) or isotonic
saline was then injected into either of the two masseter muscles in a
double-blind manner. After the injections the CPI and PPT were recorded ten
times during 30 min. The injections were repeated twice with the other
concentrations of 5-HT after 1 and 2 weeks, respectively. In the FM-group
there was a non-significant increase of CPI after injection that lasted
during the entire 30-min period irrespective of whether 5-HT or saline was
injected. Neither did the PPT change significantly. In the HI-group pain
developed significantly after injection irrespective of whether 5-HT or
saline was injected, but significantly more so after 5-HT at 10(-3) M than
saline injection. CPI decreased quickly and then remained on a very low
level for most of the experiment. 5-HT at both 10(-5) M and 10(-3) M caused
a significantly greater decrease of PPT than saline. In conclusion, our
results show that 5-HT injected into the masseter muscle of healthy female
subjects elicits pain and allodynia/hyperalgesia, while no such responses
occur in patients with fibromyalgia
(333) Nasralla M,
Haier J, Nicolson GL. Multiple mycoplasmal infections detected in blood of
patients with chronic fatigue syndrome and/or fibromyalgia syndrome. Eur J
Clin Microbiol Infect Dis 1999; 18(12):859-865.
Abstract: The aim of this study was to investigate the presence of different
mycoplasmal species in blood samples from patients with chronic fatigue
syndrome and/or fibromyalgia syndrome. Previously, more than 60% of patients
with chronic fatigue syndrome/fibromyalgia syndrome were found to have
mycoplasmal blood infections, such as Mycoplasma fermentans infection. In
this study, patients with chronic fatigue syndrome/fibromyalgia syndrome
were examined for multiple mycoplasmal infections in their blood. A total of
91 patients diagnosed with chronic fatigue syndrome/fibromyalgia syndrome
and with a positive test for any mycoplasmal infection were investigated for
the presence of Mycoplasma fermentans, Mycoplasma pneumoniae, Mycoplasma
hominis and Mycoplasma penetrans in blood using forensic polymerase chain
reaction. Among these mycoplasma-positive patients, infections were detected
with Mycoplasma pneumoniae (54/91), Mycoplasma fermentans (44/91),
Mycoplasma hominis (28/91) and Mycoplasma penetrans (18/91). Multiple
mycoplasmal infections were found in 48 of 91 patients, with double
infections being detected in 30.8% and triple infections in 22%, but only
when one of the species was Mycoplasma pneumoniae or Mycoplasma fermentans.
Patients infected with more than one mycoplasmal species generally had a
longer history of illness, suggesting that they may have contracted
additional mycoplasmal infections with time
(334) Robertson TJ.
Misunderstood illnesses: fibromyalgia and chronic fatigue syndrome. Alta RN
1999; 55(3):6-7.
(335) Yunus MB,
Inanici F, Aldag JC, Mangold RF. Fibromyalgia in men: comparison of clinical
features with women. J Rheumatol 2000; 27(2):485-490.
Abstract: OBJECTIVE: To describe possible differences between male and
female patients with fibromyalgia syndrome (FM) in their clinical
manifestations. METHODS: Five hundred thirty-six consecutive patients with
FM (469 women, 67 men) seen in a university rheumatology clinic and 36
healthy men without significant pain seen in the same clinic were included
in the study. Data on demographic and clinical features were gathered by a
standard protocol. Tender point examination was performed by the same
physician. Level of significance was set at p < or = 0.01. RESULTS: Several
features were significantly (p < or = 0.01) milder or less common among men
than women, including number of tender points (TP), TP score, "hurt all
over," fatigue, morning fatigue, and irritable bowel syndrome (IBS). The
total number of symptoms was also fewer among men and approached
significance (p = 0.02) by parametric test, but reached significance (p =
0.001) by nonparametric analysis. All clinical and psychological symptoms as
well as TP were significantly (p < 0.01) more common or greater in male
patients with FM than healthy male controls, with the exception of IBS (p =
0.03). Patient assessed global severity of illness, Health Assessment
Questionnaire disability score, and pain severity were similar in both
sexes. CONCLUSION: Male patients with FM had fever symptoms and fewer TP,
and less common "hurt all over," fatigue, morning fatigue, and IBS, compared
with female patients. Stepwise logistic regression showed significant
differences between men and women in number of TP (p < 0.001)
(336) Da Costa D,
Dobkin PL, Fitzcharles MA, Fortin PR, Beaulieu A, Zummer M et al.
Determinants of health status in fibromyalgia: a comparative study with
systemic lupus erythematosus. J Rheumatol 2000; 27(2):365-372.
Abstract: OBJECTIVE: To compare perceived health status in women with
fibromyalgia (FM) and systemic lupus erythematosus (SLE) using the Medical
Outcomes Study (MOS) Short Form Health Survey (SF-36); and to identify
determinants of physical and mental health in each patient group. METHODS: A
cross sectional study of 46 women with FM (mean age 48.13 yrs, SD 9.40) and
59 women with SLE (mean age 42.36 yrs, SD 11.31). Patients with FM were
recruited from a rheumatology clinic and a rheumatology practice, while
patients with SLE were recruited from 4 rheumatology clinics. Clinical
examination determined disease activity (by Systemic Lupus Activity Measure)
in SLE and a tender point count was used for FM. Patients completed
questionnaires assessing health status (SF-36), stress (Hassles), social
support (Social Support Questionnaire 6), and coping (Coping Inventory for
Stressful Situations). RESULTS: Patients with FM reported more impairment on
the following SF-36 subscales: physical function (p < 0.001), role physical
(p < 0.001), bodily pain (p < 0.001), and vitality (p < 0.001). Physical
component summary scores were also significantly lower (p < 0.001) for the
FM group. Four hierarchical regression analyses were computed to determine
factors related to physical and mental health in each patient group, with
the following variables in the equation: age, income, disease activity (Step
1), hassles (Step 2), emotional and task coping, and social support (Step
3). Better physical health in FM was related to higher income (R2 = 0.17, p
< 0.05). In the SLE group, better physical health was associated with
younger age, less disease activity, and lower hassles (R2 = 0.37, p <
0.0001). Worse mental health among women with FM was associated with more
hassles, more emotional coping, and less satisfaction with social support
(R2 = 0.64, p < 0.0001), while lower income, higher hassles, and more
emotional coping were linked to worse mental health in SLE (R2 = 0.46, p <
0.0001). CONCLUSION: Health related quality of life (HRQL) is impaired among
women with FM and SLE, with FM patients reporting greater impairment along
several dimensions. Enhancing the HRQL of patients with FM and SLE requires
targeting specific modifiable psychosocial factors
(337) Xie X, Yang Q,
Zhang J, Tan Y, Li X, Liu Y. [Relation between fibromyalgia and bacterial
urine]. Hunan Yi Ke Da Xue Xue Bao 1998; 23(2):217.
(338) Chang L, Mayer
EA, Johnson T, FitzGerald LZ, Naliboff B. Differences in somatic perception
in female patients with irritable bowel syndrome with and without
fibromyalgia. Pain 2000; 84(2-3):297-307.
Abstract: BACKGROUND: Irritable bowel syndrome (IBS) and fibromyalgia (FM)
are considered chronic syndromes of altered visceral and somatic perception,
respectively. Because there is a significant overlap of IBS and FM, shared
pathophysiological mechanisms have been suggested. Although visceral
perception has been well studied in IBS, somatic perception has not. AIMS:
To compare hypervigilance and altered sensory perception in response to
somatic stimuli in patients with IBS, IBS+FM, and healthy controls. METHODS:
Eleven IBS females (mean age 40), 11 IBS+FM females (mean age 46), and ten
healthy female controls (mean age 39) rated pain perception in response to
pressure stimuli administered to active somatic tender points, non-tender
control points and the T-12 dermatome, delivered in a predictable ascending
series, and delivered in an unpredictable randomized fashion (fixed
stimulus). RESULTS: Although IBS patients had similar pain thresholds during
the ascending series compared with controls, they were found to have somatic
hypoalgesia with higher pain thresholds and lower pain frequency and
severity during fixed stimulus series compared with IBS+FM patients and
controls (P<0.05). Patients with IBS+FM were more bothered by the somatic
stimuli and had somatic hyperalgesia with lower pain thresholds and higher
pain frequency and severity. CONCLUSIONS: Both hypervigilance and somatic
hypoalgesia contribute to the altered somatic perception in IBS patients.
Co-morbidity with FM results in somatic hyperalgesia in IBS patients
(339) Romano TJ.
Patients with fibromyalgia must be treated fairly. Arch Intern Med 1999;
159(20):2481-2483.
(340) Baschetti R.
Fibromyalgia, chronic fatigue syndrome, and Addison disease. Arch Intern Med
1999; 159(20):2481-2483.
(341) Borman P,
Celiker R, Hascelik Z. Muscle performance in fibromyalgia syndrome.
Rheumatol Int 1999; 19(1-2):27-30.
Abstract: The objective of the study was to examine the muscle performance,
isokinetic muscle strength, muscle endurance ratio, and submaximal aerobic
performance in fibromyalgia syndrome (FMS) patients, to evaluate the
relation between muscle performance, pain severity, clinical findings, and
physical activity level, and to compare the results with healthy control
subjects. Twenty-four FMS patients and 15 control subjects participated in
this study. Data were obtained about the symptoms, location and onset of
pain, treatment, and associated symptoms. Patients and controls underwent an
examination of isokinetic muscle strength of right quadriceps on a Cybex
dynamometer, and submaximal aerobic performance tests (PWC-170) were done
for all subjects. Maximal voluntary muscle strength of the quadriceps was
significantly lower in patients compared with the control group. Endurance
ratios showing the work capacity were not statistically different between
two groups. Submaximal aerobic performance scores were higher in the control
group. There was not a relation between the decreased muscle performance and
clinical findings, including pain severity, number of tender points, and
duration of the symptoms of FMS patients. We found a reduced quadriceps
muscle strength and submaximal aerobic performance in patients with FMS,
indicating that patients have impaired muscle function
(342) Gunaydin I,
Terhorst T, Eckstein A, Daikeler T, Kanz L, Kotter I. Assessment of
keratoconjunctivitis sicca in patients with fibromyalgia: results of a
prospective study. Rheumatol Int 1999; 19(1-2):7-9.
Abstract: Patients with fibromyalgia (FM) often describe the presence of dry
eyes and other ocular symptoms. It has been claimed that a subgroup of
patients with FM might have features suggestive of primary Sjogren syndrome.
In others, such a relationship could not be found. The purpose of the
present study was to investigate the association and prevalence of
keratoconjunctivitis sicca (KCS) in patients with FM. Among 285 patients
with FM, 40 patients reporting sicca symptoms were screened with Schirmer's
I test, break-up time and Rose-Bengal score. KCS was diagnosed when two of
the selected three tests gave pathological results. A detailed
ophthalmological examination was also performed. In 15 patients the
diagnosis of KCS could be confirmed. Eighteen of 40 patients had been taking
low-dose antidepressants and 7 of them had objective signs of KCS. Eight of
40 patients had signs of chronic blepharitis and 4 of them had KCS. Fourteen
patients showed unremarkable test results. Chronic blepharitis and the use
of tricyclic antidepressants may play a role in developing KCS. It seems
that the rate of KCS does not increase in patients with FM and they probably
have objective ocular findings comparable with the normal population
(343) Okifuji A,
Turk DC, Sherman JJ. Evaluation of the relationship between depression and
fibromyalgia syndrome: why aren't all patients depressed? J Rheumatol 2000;
27(1):212-219.
Abstract: OBJECTIVE: To examine the relationship between fibromyalgia
syndrome (FM) and depression by determining the set of factors that
differentiate FM patients with and without depressive disorders. METHODS: A
sample of 69 patients with FM underwent a standardized tender point
examination and a semistructured psychological interview and completed a set
of self-report inventories. RESULTS: Of the sample, 39 met criteria for
depressive disorder and 30 did not. Depressed patients with FM were
significantly more likely to live alone, report elevated functional
limitations, and display maladaptive thoughts than nondepressed patients.
Nondepressed patients were significantly more likely to have received prior
physical therapy than depressed patients. Pain severity, numbers of positive
tender points, and pain intensity of tender points and control points did
not differentiate the depressed and nondepressed patients. Discriminant
analysis revealed that living status, the perception of functional
limitations, maladaptive thoughts, and physical therapy treatment together
identified diagnoses of depressive disorders for 78% of the patients.
CONCLUSION: Concurrent depressive disorders are prevalent in FM and may be
independent of the cardinal features of FM, namely, pain severity and
hypersensitivity to pressure pain, but are related to the cognitive
appraisals of the effects of symptoms on daily life and functional
activities
(344) Aaron LA,
Burke MM, Buchwald D. Overlapping conditions among patients with chronic
fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern
Med 2000; 160(2):221-227.
Abstract: BACKGROUND: Patients with chronic fatigue syndrome (CFS),
fibromyalgia (FM), and temporomandibular disorder (TMD) share many clinical
illness features such as myalgia, fatigue, sleep disturbances, and
impairment in ability to perform activities of daily living as a consequence
of these symptoms. A growing literature suggests that a variety of comorbid
illnesses also may commonly coexist in these patients, including irritable
bowel syndrome, chronic tension-type headache, and interstitial cystitis.
OBJECTIVE: To describe the frequency of 10 clinical conditions among
patients with CFS, FM, and TMD compared with healthy controls with respect
to past diagnoses, degree to which they manifested symptoms for each
condition as determined by expert-based criteria, and published diagnostic
criteria. METHODS: Patients diagnosed as having CFS, FM, and TMD by their
physicians were recruited from hospital-based clinics. Healthy control
subjects from a dermatology clinic were enrolled as a comparison group. All
subjects completed a 138-item symptom checklist and underwent a brief
physical examination performed by the project physicians. RESULTS: With
little exception, patients reported few past diagnoses of the 10 clinical
conditions beyond their referring diagnosis of CFS, FM, or TMD. In contrast,
patients were more likely than controls to meet lifetime symptom and
diagnostic criteria for many of the conditions, including CFS, FM, irritable
bowel syndrome, multiple chemical sensitivities, and headache. Lifetime
rates of irritable bowel syndrome were particularly striking in the patient
groups (CFS, 92%; FM, 77%; TMD, 64%) compared with controls (18%) (P<.001).
Individual symptom analysis revealed that patients with CFS, FM, and TMD
share common symptoms, including generalized pain sensitivity, sleep and
concentration difficulties, bowel complaints, and headache. However, several
symptoms also distinguished the patient groups. CONCLUSIONS: This study
provides preliminary evidence that patients with CFS, FM, and TMD share key
symptoms. It also is apparent that other localized and systemic conditions
may frequently co-occur with CFS, FM, and TMD. Future research that seeks to |
