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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 |