THE FAILURE OF FIBROMYALGIA TREATMENTS:
WHERE ARE THE REAL CURES?
Over the last 20 years I have watched as FM and Chronic fatigue syndrome have gained acceptance. But what has that meant in terms of cure and full recovery to patients? All I currently see are Band-Aid treatments which help take the edge off some aspect of the patientŐs suffering and watch folks over sell their treatments and protocols to the point of being sad. Cure seems unreal. Medicines seem to help 5-20% at best. And do not help at all in some cases.
One has the strong sense that the leaders in this research are looking under the wrong rocks and not being very effective.
On my web sites I talk about many causes of fatigue. There are approximately 1100 causes of fatigue, but most causes of fatigue that are not addressed by sincere FM physicians or the ones treating chronic fatigue are discussed on this web site or my other web sites or in my books.
- 1: Clin Exp Rheumatol. 2008 Jul-Aug;26(4):663-6.
Sexual dysfunction in fibromyalgia patients.
Orellana C, Casado E, Masip M, Galisteo C, Gratacs J, Larrosa M.
Rheumatology Unit, Hospital de Sabadell, Barcelona, Spain; *ICS, ABS Manso, Spain.
OBJECTIVE:To investigate the prevalence of sexual dysfunction in female patients with fibromyalgia (FM), the impact of FM on sexual activity and the factors associated with sexual dysfunction in these patients.METHODS:Thirty-one consecutive women with FM were enrolled; two groups of 20 aged-matched healthy women and 26 patients with rheumatoid arth-ritis (RA) were used as controls. Demographic features were recorded in all patients. A cross-sectional analysis of pain (100-mm VAS scale), anxiety and depression (as determined by the STAI and Beck Depression Inventory scales, respectively) was performed. Sexual function was assessed by the Changes in Sexual Functioning Questionnaire (CSFQ).RESULTS:FM and RA patients showed a significantly higher rate of sexual dysfunction compared to healthy controls. Sexual dysfunction was more frequent among FM patients (97%) than in RA patients (84%) but without statistical differences. A univariate analysis showed that age (p=0.0002), marital (p=0.036) and work status (p=0.048), pain intensity (p=0.007), level of anxiety (p=0.002), level of depression (p=0.0005), were significantly associated with sexual dysfunction in FM. However, only the intensity of depression was associated with the sexual dysfunction in patients with FM in the multivariate analysis (p=0.012).CONCLUSIONS:Sexual function was very frequently and severely affected in patients with FM and this impairment appeared to be particularly associated with the degree of depression. The recognition of this dysfunction and its inclusion for the multidisciplanary management of FM may contribute to improve quality of life of these patients.
PMID: 18799102 [PubMed - in process]
- 2: Clin Exp Rheumatol. 2008 Jul-Aug;26(4):519-26.
Prevalence and impact of fibromyalgia on function and quality of life in individuals from the general population: results from a nationwide study in Spain.
Mas AJ, Carmona L, Valverde M, Ribas B.
Rheumatology Department, Hospital "Son Lltzer", Palma de Mallorca, Spain.
OBJECTIVE:To estimate the prevalence of fibromyalgia (FM) and to compare some descriptive epidemiological and quality of life data between persons with and without FM criteria in a representative sample of the general Spanish population.METHODS:Cross sectional study of 2,192 Spaniards aged 20 or above, selected by cluster sampling. Subjects were invited to a structured interview carried out by trained rheumatologists to ascertain various musculoskeletal disorders. The visit included screening and examination, validated instruments for measuring function (HAQ) and quality of life (SF-12) and questions about socio-demographic characteristics and musculoskeletal, mental, and other general symptoms. FM was suspected in subjects with widespread pain for more than three months. FM was defined by theAmerican College of Rheumatology classification criteria. All estimates are adjusted to sampling scheme.RESULTS:The prevalence of FM in Spain is 2.4% (95% CI: 1.5-3.2). FM is significantly more frequent in women (4.2%) than in men (0.2%), with an OR for women of 22.5 (95%CI: 7.2- 69.9), mainly in the 40-49 years age interval. It is more frequent in rural (4.1%) than in urban settings (1.7%), with an OR for rural settings of 2.5 (95%CI: 1.03-5.9). FM is associated with a low educational level, to a low social class, and to self-reported depression. The scores in the HAQ and in the SF-12 were significantly lower in FM subjects, despite adjustment by covariates.CONCLUSION:FM has a high prevalence in the general population. FM is associated to female gender, comorbidities, age between 40 and 59 years, and a rural setting. Persons fulfilling FM criteria show impaired functioning and quality of life.
PMID: 18799079 [PubMed - in process]
- 3: Curr Pain Headache Rep. 2008 Jun;12(3):175-81.
Status of immune mediators in fibromyalgia.
Gur A, Oktayoglu P.
Department of Physical Medicine and Rehabilitation, Medical Faculty, Dicle University, Diyarbakir, Turkey. alig@dicle.edu.tr
Fibromyalgia (FM) is a form of nonarticular rheumatism characterized by long-term (> 3 months) and widespread musculoskeletal pain. However, the biophysiology of FM has remained elusive, and the treatment remains mainly empirical. There are numerous hypotheses about the pathophysiology of chronic widespread pain and FM; one includes a possible role of cytokines. Cytokines play a role in diverse clinical processes and phenomena such as fatigue, fever, sleep, pain, stress, and aching. Cytokines related to acute or repetitive tissue injuries may be responsible for long-term activation of spinal cord glia and dorsal horn neurons, thus resulting in central sensitization. Pain, stiffness, and depression in FM could be associated with some signs of inflammatory response system activation. Illumination of the pathophysiologic secrets of FM will result in more effective treatment regimens. We review the role of immune mediators in the pathophysiology of FM.
PMID: 18796266 [PubMed - in process]
- 4: J Rheumatol. 2008 Sep 15. [Epub ahead of print]
Systematic Review of Discriminating Power of Outcome Measures Used in Clinical Trials of Fibromyalgia.
Carville SF, Choy EH.
From the Sir Alfred Baring Garrod Clinical Trials Unit, Department of Academic Rheumatology, King's College London, London, UK.
OBJECTIVE: Fibromyalgia (FM) comprises many symptoms and features. Consequently, studies on the condition have used a wide variety of outcome measures and assessment instruments. We investigated those outcome measures and instruments in association with the OMERACT (Outcome measures in Rheumatoid Arthritis Clinical Trials) FM Workshop initiative to define core outcome measures that should be used to assess FM. METHODS: A systematic literature review up to December 2007 was carried out using the keywords "fibromyalgia," "treatment" or "management," and "trial." Data were extracted on outcome measures and assessment instruments used and the pre and post mean and standard deviation to calculate effect sizes (ES). Further sensitivity analysis was carried out according to treatment type, blinding status, and study outcome. RESULTS: The outcome domains identified fell largely within those defined by OMERACT. Morning stiffness was frequently assessed and therefore has been included here. The number of assessment instruments used was wide-ranging, so sensitivity analysis was only carried out on the top 5 within each domain. ES ranged from 0.54 to 3.77 for the key OMERACT domains. Health-related quality of life (HRQOL) was the only exception that had no instrument with moderate sensitivity. Of the secondary domains, dyscognition was lacking any sensitive instrument, as were fatigue and anxiety in pharmacological trials. CONCLUSION: Each of the key OMERACT domains has an instrument that appears to be sensitive to change, with the exception of HRQOL, which requires further research. Dyscognition, fatigue, and anxiety would all benefit from more research into their assessment instruments.
PMID: 18792996 [PubMed - as supplied by publisher]
- 5: Pain. 2008 Sep 12. [Epub ahead of print]
Response to: Long-term trials of pregabalin and duloxetine for fibromyalgia symptoms: How study designs can affect placebo factors.
Moore RA, Derry S, McQuay HJ.
Nuffield Department of Anaesthetics, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK.
Publication Types:
PMID: 18790568 [PubMed - as supplied by publisher]
- 6: J Womens Health (Larchmt). 2008 Sep 14. [Epub ahead of print]
Fibromyalgia: Diagnosis and Management for the Primary Healthcare Provider.
Huynh CN, Yanni LM, Morgan LA.
Division of General Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.
Abstract Fibromyalgia is a disorder of chronic generalized musculoskeletal pain affecting 2% of the general population, with an increased frequency in women. Clinical diagnosis relies on history and research-supported tender point criteria. As in other chronic pain syndromes, a multidimensional approach optimizes treatment response. Empirical data and consensus support the use of nonpharmacological modalities, such as education, aerobic exercise, and cognitive behavioral therapy, in the management of fibromyalgia. Evidence-supported pharmacological interventions include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, alpha-2-delta ligands, and other serotonergic-noradrenergic analgesic agents, such as tramadol. This paper offers the primary healthcare provider a systematic approach to the diagnosis of fibromyalgia and management strategies based on available evidence, consensus, and empirical data.
PMID: 18788986 [PubMed - as supplied by publisher]
- 7: Pain. 2008 Sep 9. [Epub ahead of print]
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Characteristics of electronic visual analogue and numerical scales for ratings of experimental pain in healthy subjects and fibromyalgia patients.
Price DD, Patel R, Robinson ME, Staud R.
Department of Neuroscience, University of Florida, College of Medicine, Gainesville, FL 32610-0221, USA; Department of Oral Surgery, University of Florida, College of Medicine, Gainesville, FL 32610-0221, USA.
Comparisons of measurement characteristics were made for three types of electronic pain scales: (a) visual analogue scale (VAS), (b) VAS combined with an electronic number box (VAS-N; 0-100), and (c) electronic number box scale (NUM). The three scales were capable of discriminating pain sensations from very small (0.5 degrees C) temperature steps in 13 healthy males, 26 healthy females, and 16 female fibromyalgia (FM) patients. All scales provided monotonic functions when used by subjects to rate pain from 5s nociceptive temperatures (45-49 degrees C), thereby demonstrating the generality of these results across different demographic groups. As expected, FM patients rated heat pain sensations higher on all scales in comparison to healthy females, demonstrating the capacity of these scales to detect well-established group differences in pain sensitivity that exist across these two groups. However, in comparison to male subjects, healthy females gave higher NUM but not VAS or VAS-N ratings to the range of nociceptive presented temperatures. We interpret this difference as a selective scaling bias of female subjects for NUM. Finally, all three groups (total of 55 subjects) found the scales easy to use after brief instructions, though subjects strongly preferred the use of VAS-N or VAS in comparison to NUM scale.
PMID: 18786761 [PubMed - as supplied by publisher]
- 8: Altern Ther Health Med. 2008 Sep-Oct;14(5):24-5.
Influence of comorbidities on improvement of fibromyalgia symptoms when treated with acupuncture: a short report.
Singh BB, Khorsan R, Vinjamury SP.
Medicus Research LLC, Midlothian, Virginia, USA.
BACKGROUND: Fibromyalgia syndrome (FMS) is associated with chronic widespread pain, mood alteration, and disability. A definitive treatment plan has not been identified. The genesis of FMS is unclear and generally occurs in women. PURPOSE: To determine whether patient-identified most disruptive comorbidity (MDC) secondary to FMS may have mediated recovery for individual patients. This is a probative analysis of data from an effectiveness study published in the March 2006 issue of Alternative Therapies in Health and Medicine. (2006;12(2):34-41.) METHODS: The American College ofRheumatology (ACR) criteria for FMS was used in participant selection; 21 participants completed the study. RESULTS: The original outcome study indicated significant changes on standardized measures using specific points and numbers of treatment within an 8-week period. The preliminary data on influence ofMDC on improvement were differential related to self-report MDC by patients. CONCLUSIONS: For all MDCs combined, participants experienced significant improvement at 8 weeks of treatment. Participants with irritable bowel syndrome as their MDC generally had a lower percentage of improvement than other MDC cohort groups. This finding has implications for treatment.
PMID: 18780581 [PubMed - in process]
- 9: Patient Educ Couns. 2008 Sep 6. [Epub ahead of print]
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Participation in online patient support groups endorses patients' empowerment.
van Uden-Kraan CF, Drossaert CH, Taal E, Seydel ER, van de Laar MA.
Institute for Behavioural Research, University of Twente, The Netherlands.
OBJECTIVE: Although much has been expected of the empowering effect of taking part in online patient support groups, there is no direct evidence thus far for the effects of participation on patient empowerment. Hence our exploring to what extent patients feel empowered by their participation in online support groups, and which processes that occur in these groups are related to the empowering outcomes. METHODS: An online questionnaire was completed by 528 individuals who were active in online groups for patients with breast cancer, fibromyalgia and arthritis. RESULTS: The respondents felt empowered in several ways by their participation. The empowering outcomes that were experienced to the strongest degree were 'being better informed' and 'enhanced social well-being'. No significant differences in empowering outcomes between diagnostic groups were found. The empowering outcomes could only be predicted in a modest way by the processes that took place in the online support groups. CONCLUSION: This study indicates that participation in online support groups can make a valuable contribution to the empowerment of patients. PRACTICE IMPLICATIONS: Health care providers should acquaint their patients with the existence of online support groups and with the benefits that participation in these groups can offer.
PMID: 18778909 [PubMed - as supplied by publisher]
- 10: J Pain. 2008 Sep 2. [Epub ahead of print]
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Hippocampal Metabolite Abnormalities in Fibromyalgia: Correlation With Clinical Features.
Wood PB, Ledbetter CR, Glabus Deceased MF, Broadwell LK, Patterson JC 2nd.
Departments of Family Medicine, Anesthesiology, and Psychiatry.
Although the pathology of fibromyalgia is poorly understood, a growing body of evidence suggests involvement of the central nervous system. The hippocampus is a brain center that is sensitive to the effects of stress exposure and has been demonstrated to be affected in a variety of disorders whose onset, like fibromyalgia, are associated with stressful experience. We therefore interrogated the bilateral hippocampus of 16 female fibromyalgia patients in comparison to 8 age- and gender-matched healthy control subjects using single voxel proton magnetic resonance spectroscopy. Our results demonstrate a significant reduction in the ratio of N-acetylaspartate to creatine (NAA/Cr) in fibromyalgia patients versus matched control subjects specifically in the right temporal lobe from a voxel centered on the right hippocampus (patient vs control, mean +/- standard deviation: 1.20 +/- 0.13 vs 1.34 +/- 0.10, P = .03). Moreover, correlation analysis demonstrated a significant negative correlation between patient scores on the Fibromyalgia Impact Questionnaire and NAA/Cr ratio within the right hippocampus (Spearman rank correlation, rho = -0.681, P = .018). Our results indicate that fibromyalgia is associated with brain metabolite abnormalities within the right hippocampus that correlate with patient symptoms. PERSPECTIVE: We have demonstrated an abnormality in hippocampal brain metabolites in premenopausal female fibromyalgia patients with no psychiatric comorbidity. A significant negative correlation between patient subjective experience of symptoms and a reduced NAA/Cr ratio suggests a role for hippocampal pathology in fibromyalgia.
PMID: 18771960 [PubMed - as supplied by publisher]
- 11: Arthritis Res Ther. 2008 Aug 8;10(4):211. [Epub ahead of print]
Biology and therapy of fibromyalgia. Evidence-based biomarkers for fibromyalgia syndrome.
Dadabhoy D, Crofford LJ, Spaeth M, Russell IJ, Clauw DJ.
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA. dclauw@med.umich.edu.
ABSTRACT: Researchers studying fibromyalgia strive to identify objective, measurable biomarkers that may identify susceptible individuals, may facilitate diagnosis, or that parallel activity of the disease. Candidate objective measures range from sophisticated functional neuroimaging to office-ready measures of the pressure pain threshold. A systematic literature review was completed to assess highly investigated, objective measures used in fibromyalgia studies. To date, only experimental pain testing has been shown to coincide with improvements in clinical status in a longitudinal study. Concerted efforts to systematically evaluate additional objective measures in research trials will be vital for ongoing progress in outcome research and translation into clinical practice.
PMID: 18768089 [PubMed - as supplied by publisher]
- 12: Curr Pain Headache Rep. 2008 Oct;12(5):338-43.
Central mechanisms in the maintenance of chronic widespread noninflammatory muscle pain.
DeSantana JM, Sluka KA.
Physical Therapy and Rehabilitation Science, 1-242 MEB, University of Iowa, Iowa City, IA 52252, USA.
Chronic widespread pain (CWP) conditions such as fibromyalgia and myofascial syndromes are characterized by generalized pain, tenderness, morning stiffness, disturbed sleep, and pronounced fatigue. However, CWP pathophysiology is still unclear. A number of hypotheses have been proposed as the underlying pathophysiology of CWP: muscular dysfunction/ischemia, central sensitization, and a deficit in endogenous pain-modulating systems. This article reviews the current and emerging literature about the pathophysiology and neurobiology of chronic widespread -musculoskeletal pain. Widespread musculoskeletal pain results in changes in the central nervous system in human subjects and animal models. These changes likely reflect alterations in supraspinal modulation of nociception, and include increases in excitatory and decreases in inhibitory modulation pathways. These alterations in excitation and inhibition likely drive changes observed in the spinal cord to result in central sensitization, and the consequent pain and hyperalgesia.
PMID: 18765138 [PubMed - in process]
- 13: Curr Pain Headache Rep. 2008 Oct;12(5):333-7.
Neuromodulators for the treatment of headache disorders and fibromyalgia.
Krymchantowski AV, Bryson J, Lipton RB, Bigal ME.
Merck Research Laboratories, 1 Merck Drive, Whitehouse Station, NJ 08889, USA.
Migraine and fibromyalgia are prevalent and disabling disorders with few preventive medications approved by the US Food and Drug Administration (FDA). Neuromodulators (or antiepileptic drugs; AEDs) are often effective in the treatment of these conditions. Divalproex sodium and topiramate are FDA-approved AEDs for migraine. For fibromyalgia, pregabalin has recently been approved in the United States. We review the use of AEDs in the preventive treatment of these highly prevalent disorders.
PMID: 18765137 [PubMed - in process]
- 14: Curr Pain Headache Rep. 2008 Oct;12(5):327-32.
Religiousness and spirituality in fibromyalgia and chronic pain patients.
Moreira-Almeida A, Koenig HG.
Federal University of Juiz de Fora School of Medicine, Rua da Laguna 485/104, Juiz de Fora, MG, 36015-230, Brazil. alex.ma@ufjf.edu.br
The influence of psychosocial factors on pain experience and patient response has received increasing interest and recognition. Patients with chronic pain from several sources (eg, musculoskeletal, cancer, or sickle cell) usually report that religiousness and spirituality are important in their lives. Prayer is the most used complementary therapy; religious coping is among the most common strategies used to deal with pain. Religious variables are not usually associated with pain measures, except in some studies indicating that petitionary prayer is related to higher pain levels, possibly suggesting a turning to religion due to increasing pain. The best available evidence supports a positive association between religiousness and spirituality, with higher well-being and positive affect, and a negative association with depressive and anxiety symptoms. We discuss the importance of addressing spiritual issues in clinical practice, and increasing and improving research on religiousness/spirituality in chronic pain patients.
PMID: 18765136 [PubMed - in process]
- 15: Curr Pain Headache Rep. 2008 Oct;12(5):321-6.
Fibromyalgia: an update and immunological aspects.
Paiva ES, da Costa ED, Scheinberg M.
Hospital Israelita, Albert Einstein and Research Institute, Av. Albert Einstein 627, Sao Paulo, Brazil.
Fibromyalgia syndrome (FMS) is now understood as a chronic pain syndrome, and recent evidence indicates it is not a pure psychosomatic disorder. We review the current knowledge in FMS pain pathways, focusing on the central system sensitization phenomenon and the abnormalities in the inhibitory pain systems. Chronic headache is one of the most common symptoms in FMS, and better knowledge of their common pathophysiologic features can help us understand both conditions better. These features include the nerve growth factor actions and failure of the endocannabinoid system. In addition, we review new immunological aspects of FMS, both in their humoral (autoantibodies, antipolymer antibodies) and cytokine (interleukin-2) aspects.
PMID: 18765135 [PubMed - in process]
- 16: Nat Clin Pract Rheumatol. 2008 Sep 2. [Epub ahead of print]
Is pregabalin a safe and effective treatment for patients with fibromyalgia?
Spaeth M.
M Spaeth is an Internist and Rheumatologist in private practice in Graefelfing, Germany.
The concept of fibromyalgia being one of several 'central sensitivity syndromes' has led to the use of centrally acting drugs in the treatment of this disorder. One such drug, pregabalin, has recently been approved by the US FDA for the treatment of fibromyalgia. In a study by Mease and colleagues, significant relief from symptomatic pain was achieved in patients treated with pregabalin 300 mg/day, 450 mg/day and 600 mg/day compared with placebo. In addition, Patient Global Impression of Change and sleep scale scores were significantly improved in all treatment groups at the 13-week end point. Dizziness and somnolence were the two most common dose-related adverse events, but led to few withdrawals from the study. The results support the use of pregabalin as a mechanism-based treatment for pain and sleep disturbances in patients with fibromyalgia. Further studies with a longer observation period and randomized trials comparing different medications are needed.
PMID: 18762786 [PubMed - as supplied by publisher]
- 17: Soc Sci Med. 2008 Aug 28. [Epub ahead of print]
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Understanding, embracing, rejecting: Women's negotiations of disability constructions and categorizations after becoming chronically ill.
Crooks VA, Chouinard V, Wilton RD.
Department of Geography, Simon Fraser University, RCB 7123, 8888 University Drive, Burnaby, British Columbia, Canada V5A 1S6.
The purpose of this article is to elucidate the various responses women have to being, or not being, categorized as disabled within specific spheres (e.g., medical, state) or places (e.g., doctor's office, work) after developing a contested chronic illness. Drawing on interviews conducted with 55 women living with fibromyalgia syndrome in Ontario, Canada, we examine how they come to understand various constructions of disability and whether or not they reflect their sense of self, and how and why they either embrace or reject external categorizations of themselves as disabled by the state or medical professionals. In doing so we contribute to the limited geographic literature which stresses the importance of spatiality and ways of being in place to ill and impaired persons' negotiations of the self and relationships with others. We find that negotiating disability was, for many, an emotionally charged and complex process, drawing on one or more strategies: reluctantly employing some meanings associated with 'being disabled' to achieve material ends, creating an understanding of disability that is most in keeping with one's sense of self, embracing other meanings to the extent that they offer a legitimate basis for identity, and/or rejecting disability in the interests of sustaining an existing identity. For those women in need of forms of state assistance such as income support and health care, state institutions exert powerful pressures to come to terms with what disability means in one's life - particularly as medical and state authorities classify people as 'disabled enough' or 'not disabled enough' for entitlement to state resources.
PMID: 18760870 [PubMed - as supplied by publisher]
- 18: Expert Rev Neurother. 2008 Sep;8(9):1339-45.
Laser-evoked potentials in primary headaches and cranial neuralgias.
de Tommaso M.
Clinica Neurologica, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy. m.detommaso@neurol.uniba.it
Using neurophysiological methods to explore nociceptive pathways may improve knowledge of the functional changes subtending pain processing in the different forms of headache and facial pain. Laser-evoked potentials (LEPs) are a reliable neurophysiological assay for the clinical assessment of pain syndromes. Reduced amplitude of LEPs seems to characterize trigeminal neuralgia and painful temporomandibular disorders, suggesting the neuropathic origin of pain. In tension-type headache, as well as in fibromyalgia, enhanced pericranial LEP amplitude suggests the psychogenic origin of pain. In migraine, a normal amplitude of basal LEPs with reduced habituation and altered attentive modulation seems to express a general dysfunction of cortical pain processing, which may also contribute, other than to predispose, to the persistence of migraine. LEPs may be employed in the clinical evaluation of the neurophysiological and psychophysiological aspects of pain in the different forms of headaches and facial pain to improve the therapeutic approach and provide an objective measure of treatment efficacy.
PMID: 18759546 [PubMed - in process]
- 19: Arthritis Rheum. 2008 Sep 15;59(9):1299-305.
Substitution of specialized rheumatology nurses for rheumatologists in the diagnostic process of fibromyalgia: A randomized controlled trial.
Kroese ME, Schulpen GJ, Bessems MC, Severens JL, Nijhuis FJ, Geusens PP, Landew RB.
University Hospital Maastricht, Maastricht, The Netherlands.
OBJECTIVE: To evaluate the substitution of specialized rheumatology nurses for rheumatologists in diagnosing fibromyalgia (FM). METHODS: Referred patients with FM symptoms (n = 193) were randomized to a study group diagnosed by a specialized rheumatology nurse (SRN group, n = 97) or to a control group diagnosed by a rheumatologist (RMT group, n = 96). SRN patients were seen within 3 weeks by a nurse who took structured history and initiated routine laboratory tests. During a 5-minute supervision session, the rheumatologist was informed by the nurse about medical history, performed a brief physical examination, and confirmed or rejected the nurse's diagnosis. RMT patients were seen by a rheumatologist after a regular waiting period of 3 months. Outcome measures were initial agreement between the nurse and rheumatologist in the SRN group, final diagnosis after 12-24 months of followup, patient satisfaction, and diagnostic costs. RESULTS: The mean waiting time after randomization was 2.8 and 12.1 weeks in the SRN and RMT groups, respectively. Eight RMT patients cancelled their appointments because of the waiting time. Excellent agreement (kappa = 0.91) between rheumatologists and nurses was found. After 12-24 months of followup, none of the initial diagnoses were recalled in either group. SRN patients were significantly more satisfied than RMT patients. Mean diagnostic costs were lower in the SRN group (euro219) than in the RMT group (euro281) (95% uncertainty interval euro-103, euro-20). CONCLUSION: Substituting specialized nurses for rheumatologists in the diagnostic process of FM is a trustworthy and successful approach that saves waiting time, provides greater patient satisfaction, and is cost-effective.
PMID: 18759317 [PubMed - in process]
- 20: Arthritis Rheum. 2008 Sep 15;59(9):1279-98.
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A systematic review on the effectiveness of treatment with antidepressants in fibromyalgia syndrome.
Ueyler N, Huser W, Sommer C.
University of Wrzburg, Wrzburg, Germany.
OBJECTIVE: To systematically review the efficacy of treatment of fibromyalgia syndrome (FMS) with antidepressants. METHODS: We screened Medline, PsychINFO, SCOPUS, and the Cochrane Library databases (through October 2007) and the reference sections of original studies, meta-analyses, and evidence-based guidelines and recommendations on antidepressants in FMS. Randomized controlled trials (RCTs) on the treatment of FMS with antidepressants were analyzed. Inclusion criteria, study characteristics, quality, and all outcome measures were investigated. RESULTS: Twenty-six of 167 studies were included. The main outcome variables reviewed were pain, fatigue, sleep, depressiveness, and quality of life. Amitriptyline, studied in 13 RCTs, was efficient in reducing pain with a moderate magnitude of benefit (pain reduction by a mean of 26%, improvement in quality of life by 30%). Selective serotonin reuptake inhibitors (SSRIs) were studied in 12 RCTs, which also showed positive results, except for 2 studies on citalopram and 1 on paroxetine. Three RCTs on the dual serotonin and noradrenaline reuptake inhibitors (SNRIs) duloxetine and milnacipran and 1 of the 2 RCTs using the monoamine oxidase inhibitor moclobemide reported a positive result. The longest study duration was 12 weeks. CONCLUSION: Amitriptyline 25-50 mg/day reduces pain, fatigue, and depressiveness in patients with FMS and improves sleep and quality of life. Most SSRIs and the SNRIs duloxetine and milnacipran are probably also effective. Short-term treatment of patients with FMS using amitriptyline or another of the antidepressants that were effective in RCTs can be recommended. Data on long-term efficacy are lacking.
PMID: 18759260 [PubMed - in process]
- 21: J Rehabil Med. 2008 Jul;40(7):582-8.
A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia.
Targino RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT, Furlan AD, Imamura ST, Azevedo Neto RS.
Departamento de Patologia, Avenida Doutor Arnaldo 455, Sao Paulo, Brazil. targino@usp.br
OBJECTIVE: To evaluate the effectiveness of acupuncture for fibromyalgia. METHODS: Fifty-eight women with fibromyalgia were allocated randomly to receive either acupuncture together with tricyclic antidepressants and exercise (n=34), or tricyclic antidepressants and exercise only (n=24). Patients rated their pain on a visual analogue scale. A blinded assessor evaluated both the mean pressure pain threshold value over all 18 fibromyalgia points and quality of life using SF-36. RESULTS: At the end of 20 sessions, patients who received acupuncture were significantly better than the control group in all measures of pain and in 5 of the SF-36 subscales. After 6 months, the acupuncture group was significantly better than the control group in numbers of tender points, mean pressure pain threshold at the 18 tender points and 3 subscales of SF-36. After one year, the acupuncture group showed significance in one subscale of the SF-36; at 2 years there were no significant differences in any outcome measures. CONCLUSION: Addition of acupuncture to usual treatments for fibromyalgia may be beneficial for pain and quality of life for 3 months after the end of treatment. Future research is needed to evaluate the specific effects of acupuncture for fibromyalgia.
Publication Types:
PMID: 18758677 [PubMed - indexed for MEDLINE]
- 22: J Chromatogr B Analyt Technol Biomed Life Sci. 2008 Aug 6. [Epub ahead of print]
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Development and validation of a direct enantiomeric separation of pregabalin to support isolated perfused rat kidney studies.
Zhang Y, Holliman C, Tang D, Fast D, Michael S.
Pharmacokinetics, Dynamics & Metabolism, Pfizer Global Research and Development, Pfizer Inc., Ann Arbor, MI 48105, United States.
Pregabalin (Lyricatrade mark) is the first compound approved to treat the neural pain associated with fibromyalgia. Pregabalin is the S-enantiomer of a gamma-amino acid analogue and chiral separation from its R-enantiomer must be achieved to support metabolic studies. The direct chiral separation of pregabalin from its R-enantiomer has been developed and HPLC/MS/MS assays have been validated to support isolated perfused rat kidney studies. The separation was developed through serial coupling of various macrocyclic glycopeptide stationary phases until partial separation of the enantiomers was achieved. Identification of the resolving stationary phase followed by optimization of the mobile phase enabled the baseline resolution of the enantiomers using mass spectrometry compatible solvents and modifiers. Assays were developed and validated for quantitation of the enantiomers from rat urine, isolated rat kidney perfusate, and isolated rat kidney perfusate ultrafiltrate to support pregabalin metabolic studies.
PMID: 18755638 [PubMed - as supplied by publisher]
- 23: Rheumatol Int. 2008 Aug 27. [Epub ahead of print]
The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review.
McVeigh JG, McGaughey H, Hall M, Kane P.
School of Health Sciences, Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, BT37 0QB, Northern Ireland, UK, j.mcveigh@ulster.ac.uk.
Hydrotherapy is often used in the treatment of fibromyalgia syndrome (FMS), however there has been limited evaluation of its effectiveness. The aim of this systematic review was therefore to examine the effectiveness of hydrotherapy in the management of FMS. AMED, BNI, CINAHL, The Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, Science Direct and Web of Science were searched (1990-July 2006). Key words used 'fibromyalgia' and 'hydrotherapy', 'balneotherapy', 'aqua therapy', 'pool therapy', 'water therapy', 'swimming', 'hydrogalvanic', 'spa therapy', 'physiotherapy', 'physical therapy' and 'rehabilitation'. Searches were supplemented with hand searches of selected journals. Randomised controlled trials (RCTs) were assessed for methodological quality using the van Tulder scale. Ten RCTs met the inclusion criteria. Mean methodological quality was 4.5/9 on the van Tulder scale. Positive outcomes were reported for pain, health-status and tender point count. There is strong evidence for the use of hydrotherapy in the management of FMS.
PMID: 18751709 [PubMed - as supplied by publisher]
- 24: Clin Cardiol. 2008 Aug 25. [Epub ahead of print]
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Association Between Fibromyalgia and Coronary Heart Disease and Coronary Catheterization.
Ablin JN, Beilinson N, Aloush V, Elkayam O, Finkelstein A.
Department of Internal Medicine 6.
BACKGROUND: Fibromyalgia (FM) has been associated with physical and emotional trauma including invasive medical procedures. Both FM and ischemic heart disease have been linked with depression. The purpose of this study was to retrospectively investigate the frequency of FM symptoms and physical findings among patients undergoing coronary catheterization. METHODS: Consecutive patients who underwent coronary angiography during the previous 6 mo were recruited. Patients with major depression, bi-polar disorder, schizophrenia, or malignancy were excluded. Patients underwent dolorimetry for tender-point assessment and completed the fibromyalgia impact questionnaire (FIQ). Group A included patients with significant coronary pathology (n = 43), group B included patients with normal coronary arteries (n = 50), and group C included patients with normal controls (n = 51). A cardiological score incorporated the number of coronary arteries with significant pathology and left ventricular function. Chi-square or Fisher's exact test was used for categorical data and a one-way analysis of variance for continuous variables; a multivariate linear regression was performed to compare groups. RESULTS: Significantly increased levels of tenderness were discovered among patients with coronary pathology compared with healthy controls. Significantly increased levels of depression were also found, as well as higher scores on the FIQ scale. On multivariate analysis, a positive correlation was demonstrated between tenderness/FIQ scores and a composite cardiological score. CONCLUSION: Coronary angiography is associated with a significantly increased frequency of pain, tenderness, and depression after 6 mo, apparent in both patients undergoing coronary procedures and patients with normal coronaries. This association may impact the outcome of patients with significant coronary disease. Copyright (c) 2008 Wiley Periodicals, Inc.
PMID: 18727109 [PubMed - as supplied by publisher]
- 25: Autoimmun Rev. 2008 Aug 22. [Epub ahead of print]
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Chronic fatigue syndrome with autoantibodies - The result of an augmented adjuvant effect of hepatitis-B vaccine and silicone implant.
Nancy AL, Yehuda S.
Center for Autoimmune Diseases, Department of Medicine 'B', Sheba Medical Center, Israel.
BACKGROUND: Chronic fatigue syndrome (CFS) that defines by prolonged fatigue and other manifestations, was recently integrated into a spectrum of central sensitivity syndromes including several diseases as fibromylagia. CFS etiology is multi-factorial commonly triggered by infectious agents. Vaccines, induce an immune response similarly to infections, and may trigger just like infections autoimmune diseases, CFS and fibromyalgia. Furthermore vaccines contain an adjuvant which enhances their immune stimulation. CASE PRESENTATION: A 56-year-old woman was diagnosed with CFS accompanied by fibromyalgia, demyelination and autoantibodies. Her illness begun following the 2nd dose of hepatitis-B vaccine, and was aggravated by the 3rd vaccination. She underwent silicone breast implantation 6 years before vaccination with no adverse events. However, between the 2nd and 3rd vaccination she suffered a breast injury with local inflammation. Upon explanation of her breast implants silicone leak was observed. DISCUSSION: Vaccines have been reported to precede CFS mainly following exposure to multiple vaccinations (e.g. the Gulf war syndrome), or as an adverse response to the vaccine adjuvant (e.g. the macrophagic myofasciitis syndrome). Silicone is considered an adjuvant to the immune system, and may induce "the adjuvant disease". Silicone implant, especially silicone leak relationship with autoimmunity and CFS has been the focus of considerable debates. CONCLUSION: Our patient illness started following hepatitis-B vaccine, suggesting that it was caused or accelerated by vaccination. In parallel to vaccination our patient suffered from breast injury, which might represent the time of silicone leak. The exposure to the adjuvant, silicone, might have augmented her immune response to the vaccine. To the best of our knowledge this is the first case of combined adverse effect to vaccine and silicone. Vaccine safety in individuals with silicone implants requires further studies.
PMID: 18725327 [PubMed - as supplied by publisher]
- 26: Womens Health Issues. 2008 Sep-Oct;18(5):406-12. Epub 2008 Aug 23.
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Self-assessed physical function levels of women with fibromyalgia a national survey.
Jones J, Rutledge DN, Jones KD, Matallana L, Rooks DS.
Health Sciences, California State University, Fullerton, California.
OBJECTIVE: We sought to determine the self-reported physical function level of women with fibromyalgia (FM). METHODS: We performed a secondary analysis using data from an Internet-based survey posted on the National Fibromyalgia Association website. Data used for this study included women (n = 1,735) aged 31-78 years who reported being diagnosed with FM. RESULTS: More than 25% of women reported having difficulty taking care of personal needs and bathing, and >60% reported difficulty doing light household tasks, going up/down 1 flight of stairs, walking (1/2) mile, and lifting or carrying 10 lbs. More than 90% of women reported having difficulty doing heavy household tasks, lifting or carrying 25 lbs, and doing strenuous activities. Women with lower functional ability reported higher levels of fatigue, pain, spasticity, depression, restless legs, balance problems, dizziness, fear of falling, and bladder problems. CONCLUSIONS: The average woman in this sample reported having less functional ability related to activities of daily living and instrumental activities of daily living than the average community-dwelling woman in her 80s. Several symptoms/conditions were found to be associated with functional limitation in women with FM. Targeting these-singly or in clusters-may potentially be important in terms of future interventions.
PMID: 18723374 [PubMed - in process]
- 27: J Psychopharmacol. 2008 Aug 21. [Epub ahead of print]
Efficacy and tolerability of duloxetine in the treatment of patients with borderline personality disorder: a pilot study.
Bellino S, Paradiso E, Bozzatello P, Bogetto F.
Service for Personality Disorders, Unit of Psychiatry, Department of Neurosciences, University of Turin, Turin, Italy.
AbstractGuidelines of the American Psychiatric Association for borderline personality disorder (BPD) indicate selective serotonin reuptake inhibitors and the serotonin and noradrenaline reuptake inhibitor (SNRI) venlafaxine for treating affective dysregulation and impulsive behavioural dyscontrol symptoms. The SNRI duloxetine has been studied in patients with major depression, generalized anxiety disorder and fibromyalgia, showing particular efficacy on somatic complaints. This study investigates duloxetine in the treatment of patients with BPD. Eighteen outpatients with a DSM-IV-TR diagnosis of BPD were treated with open-label duloxetine, 60 mg/day, for 12 weeks. Patients were assessed at baseline, week 4 and 12 with the CGI Severity item, the BPRS, the HAM-D, the HAM-A, the SOFAS, the BPD Severity Index (BPDSI) and the HSCL-90-Somatization Subscale (HSCL-90 SOM). Adverse effects were evaluated using the Dosage Record Treatment Emergent Symptom Scale. Statistics were performed with the analysis of variance. Significant P values were </=0.05. Fourteen patients completed the study. Four patients (22.2%) discontinued treatment in the first 4 weeks because of non-compliance. A significant change was found for: BPRS, HAM-D, SOFAS, BPDSI total score and items 'impulsivity', 'outbursts of anger' and 'affective instability' and HSCL-90 SOM. Adverse effects were mild headache and nausea. Initial results suggest that duloxetine is an effective and well-tolerated treatment for BPD, with positive effects on somatic symptoms.
PMID: 18719047 [PubMed - as supplied by publisher]
- 28: Clin J Pain. 2008 Sep;24(7):620-6.
Anxiety, mood, and behavioral disorders among pediatric patients with juvenile fibromyalgia syndrome.
Kashikar-Zuck S, Parkins IS, Graham TB, Lynch AM, Passo M, Johnston M, Schikler KN, Hashkes PJ, Banez G, Richards MM.
Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA. Susmita.Kashikar-Zuck@cchmc.org
BACKGROUND: Mood and anxiety disorders are common psychiatric conditions among adult patients with fibromyalgia syndrome, but little is known about whether psychiatric disorders are prevalent among pediatric patients with fibromyalgia. OBJECTIVE: The primary objective of this study was to assess the prevalence of mood, anxiety, and behavioral disorders in a clinical sample of children and adolescents with juvenile primary fibromyalgia syndrome (JPFS) and assess the relationship between psychiatric disorders and JPFS symptom severity. METHODS: Standardized psychiatric interviews were conducted with children and their parents/primary caregivers, and measures of symptom severity including pain intensity and physician global ratings were obtained for 76 children and adolescents diagnosed with JPFS (ages 11 to 18 y) in pediatric rheumatology clinics at 4 hospitals in the Midwest. RESULTS: A total of 67.1% of patients had at least 1 current and 71.5% had at least 1 lifetime DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-fourth edition) psychiatric diagnosis. The most frequent psychiatric diagnosis was anxiety disorder (57.5% of JPFS patients). Although mood difficulties were also common, the presence of major depression was lower than has been reported for adults with fibromyalgia syndrome. Physicians' global assessment of functioning was significantly lower for patients with a current anxiety disorder. There were no significant differences in pain severity among patients with and without anxiety, mood, or behavioral disorders. DISCUSSION: There seems to be a high prevalence of anxiety disorders in patients with JPFS, and presence of anxiety disorder is associated with poorer physician-rated functioning. Future research should explore whether early anxiety symptoms are predictive of long-term functioning.
Publication Types:
PMID: 18716501 [PubMed - in process]
- 29: Am Fam Physician. 2008 Aug 1;78(3):365-70.
Choosing a skeletal muscle relaxant.
See S, Ginzburg R.
St. John's University College of Pharmacy and Allied Health Professions, Jamaica, New York 11439, USA. sees@stjohns.edu
Skeletal muscle relaxants are widely used in treating musculoskeletal conditions. However, evidence of their effectiveness consists mainly of studies with poor methodologic design. In addition, these drugs have not been proven to be superior to acetaminophen or nonsteroidal anti-inflammatory drugs for low back pain. Systematic reviews and meta-analyses support using skeletal muscle relaxants for short-term relief of acute low back pain when nonsteroidal anti-inflammatory drugs or acetaminophen are not effective or tolerated. Comparison studies have not shown one skeletal muscle relaxant to be superior to another. Cyclobenzaprine is the most heavily studied and has been shown to be effective for various musculoskeletal conditions. The sedative properties of tizanidine and cyclobenzaprine may benefit patients with insomnia caused by severe muscle spasms. Methocarbamol and metaxalone are less sedating, although effectiveness evidence is limited. Adverse effects, particularly dizziness and drowsiness, are consistently reported with all skeletal muscle relaxants. The potential adverse effects should be communicated clearly to the patient. Because of limited comparable effectiveness data, choice of agent should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions.
Publication Types:
PMID: 18711953 [PubMed - indexed for MEDLINE]
- 30: Autoimmun Rev. 2008 Aug 12. [Epub ahead of print]
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Etiology of fibromyalgia: The possible role of infection and vaccination.
Buskila D, Atzeni F, Sarzi-Puttini P.
Department of Internal Medicine H, Soroka Medical Center, Ben Gurion University, Beer Sheva, Israel.
Fibromyalgia syndrome (FMS), a condition characterized by widespread pain and diffuse tenderness, is considered a multifactorial disorder. FMS is now recognized as one of the "central" pain syndromes. Environmental and genetic factors play a role in the pathogenesis of FMS. Various triggers including trauma and stress as well as infections, may precipitate the development of FMS. Certain infections including hepatitis C virus, HIV and Lyme disease have been temporally associated with the development of FMS. There is some evidence for the possible role of vaccinations in triggering the development of FMS and related syndromes, however this association remains to be established.
PMID: 18706528 [PubMed - as supplied by publisher]
- 31: Clin Auton Res. 2008 Aug 12. [Epub ahead of print]
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POTS versus deconditioning: the same or different?
Joyner MJ, Masuki S.
Dept. of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA, joyner.michael@mayo.edu.
The 2007 Streeten Lecture focused on the idea that physical deconditioning plays a key role in the symptomology and pathophysiology of POTS. Parallels were drawn between the physiological responses to orthostatic stress seen in POTS patients and the physiological responses seen in "normal" humans after prolonged periods of bedrest, deconditioning, or space flight. Additionally, the idea that endurance exercise training might ameliorate some of these symptoms was also advanced. Finally, potential parallels between POTS, chronic fatigue syndrome, and fibromyalgia were also drawn and the potential role of exercise training as a "therapeutic intervention" in all three conditions was raised. The conceptual model for the lecture was that after some "initiating event" chronic deconditioning plays a significant role in the pathophysiology of these conditions, and these physiological changes in conjunction with "somatic hypervigilence" explain many of the complaints that this diverse group of patients have. Additionally, the idea that systematic endurance exercise training might be helpful was advanced, and data supportive of this idea was reviewed. The main conclusion is that the medical community must retain their empathy for patients with unusual conditions but at the same time send a firm but empowering message about physical activity. As always, we must also ask what do the ideas about physical activity and inactivity and the conditions mentioned above not explain?
PMID: 18704621 [PubMed - as supplied by publisher]
- 32: Intern Med. 2008;47(16):1473-6. Epub 2008 Aug 15.
Efficacy of Waon therapy for fibromyalgia.
Matsushita K, Masuda A, Tei C.
The First Department of Internal Medicine, Kagoshima University Hospital.
OBJECTIVE: Fibromyalgia syndrome (FMS) is a chronic syndrome characterized by widespread pain with tenderness in specific areas. We examined the applicability of Waon therapy (soothing warmth therapy) as a new method of pain treatment in patients with FMS. METHODS: Thirteen female FMS patients (mean age, 45.2+/-15.5 years old; range, 25-75) who fulfilled the criteria of the American College of Rheumatology participated in this study. Patients received Waon therapy once per day for 2 or 5 days/week. The patients were placed in the supine or sitting position in a far infrared-ray dry sauna maintained at an even temperature of 60 degrees C for 15 minutes, and then transferred to a room maintained at 26-27 degrees C where they were covered with a blanket from the neck down to keep them warm for 30 minutes. Reductions in subjective pain and symptoms were determined using the pain visual analog scale (VAS) and fibromyalgia impact questionnaire (FIQ). RESULTS: All patients experienced a significant reduction in pain by about half after the first session of Waon therapy (11-70%), and the effect of Waon therapy became stable (20-78%) after 10 treatments. Pain VAS and FIQ symptom scores were significantly (p<0.01) decreased after Waon therapy and remained low throughout the observation period. CONCLUSION: Waon therapy is effective for the treatment of fibromyalgia syndrome.
PMID: 18703857 [PubMed - in process]
- 33: Med Hypotheses. 2008 Aug 12. [Epub ahead of print]
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Iodine deficiency, more than cretinism and goiter.
Verheesen RH,