Fibromyalgia References from 1981 to March 2002
(in order of descending date)
 

     (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