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Fibromyalgia Community Newsletter #16
Monday, April 8, 2002
Subscription update: 1500 members and 20 new members.
Welcome!
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Featured link: Acupuncture Explained In spite of a great deal of excellent
research designed to explain how acupuncture works, as yet there are no simple
answers available. However,in "How Does Acupuncture Work?" George T. Lewith
M.A., M.R.C.G.P., M.R.C.P. offers a variety of theories that attempt to explain
the mechanism of acupuncture. He goes on to present clinical applications of
these theories.
Check it out:
http://healthy.net/asp/templates/article.asp?id=1817
AOL users: <a href="http://www.healthy.net/asp/templates/article.asp?id=1817">Read
it here</a>
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Co-Cure Announcement
Story of Recovery What does "recovery" mean? For CFS patient JoWynn Johns, it
meant regaining a high quality of life through creating a different kind of life
than the one she had before becoming ill. Her story of restoring control over
her life is this week's feature article at the CFIDS/Fibromyalgia Self-Help
website: http://CFIDSselfhelp.org. The article is another in our series "Success
Stories," personal accounts of coping and recovery.
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This week's news:
1) Abstract - Opioids in non-cancer pain: a life-time sentence?
2) Abstract - Otologic manifestations of Chiari I malformation
3) Abstract - Benefits of Tegaserod for IBS
4) FMS Family Study in California Needs Participants
5) Weather and the pain in fibromyalgia: are they related?
6) Abstract - Treatment of low back pain with a herbal or synthetic
anti-rheumatic
7) Abstract - Serotonergic agents in the treatment of fibromyalgia syndrome
8) Abstract - Sulfur in human nutrition and applications in medicine
9) Abstract - Exercise program effects on women with fibromyalgia syndrome
10) Abstract - Trigger Points: Diagnosis and Management
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1) Abstract - Opioids in non-cancer pain: a life-time sentence?
Dellemijn, P. L. (2001).
European Journal of Pain:Ejp 5(3): 333-9.
There is continuing reluctance to prescribe strong opioids for the management of
chronic non-cancer pain due to concerns about side-effects, physical tolerance,
withdrawal and addiction. Randomized controlled trials have now provided
evidence for the efficacy of opioids against both nociceptive and neuropathic
pain. However, there is considerable variability in response rates, possibly
depending on the type of pain, the type of opioid and its route of
administration, the time to follow-up, compliance and the development of
tolerance.
Five patients were selected with nociceptive or neuropathic pain in whom other
pharmacological or physical therapies had failed to provide satisfactory pain
relief. They received transdermal fentanyl (starting dose 25 microg/h) for at
least 6 weeks.
Transdermal fentanyl dosage was titrated upwards as required. Transdermal
fentanyl provided adequate pain relief in patients with nociceptive pain
(diabetic ulcer, osteoporotic vertebral fracture, ankylosing spondylitis) or
neuropathic pain with a nociceptive component (radicular pain due to disc
protrusion, herpetic neuralgia). The duration of treatment ranged from 6 weeks
to 6 months for four cases. In the case of ankylosing spondylitis, treatment was
carried out for 2 years, stopped and then restarted successfully. There were no
withdrawal effects or addictive behaviour on treatment cessation, regardless of
duration of the treatment. In conclusion, strong opioids may provide prolonged
effective pain relief in selected patients with nociceptive and neuropathic
non-cancer pain. Transdermal fentanyl treatment can often be temporary and can
easily be stopped following adequate pain relief without withdrawal effects or
any evidence of addictive behaviour.
Copyright 2001 European Federation of Chapters of the International Association
for the Study of Pain
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2) Abstract - Otologic manifestations of Chiari I malformation
Sperling, N. M., R. A. Franco, Jr., et al. (2001).
Otology & Neurotology 22(5): 678-81.
OBJECTIVE: To assess the prevalence of otologic symptoms in patients undergoing
surgical decompression for symptomatic Chiari I malformation.
STUDY DESIGN: Cross-sectional, prospective, nonrandomized.
SETTING: Urban tertiary referral center.
PATIENTS: Patients with Chiari I malformation before surgical intervention.
INTERVENTIONS: None.
MAIN OUTCOME MEASURE: Results of completed questionnaire.
RESULTS: Sixteen consecutive patients with Chiari I malformation completed the
self-administered questionnaire.
Eighty-one percent of patients reported episodic aural fullness, 81% reported
tinnitus, 69% reported vertigo, and 56% reported fluctuating hearing loss.
Headaches were reported as frequently as aural fullness and tinnitus.
CONCLUSIONS: Most patients with Chiari I malformation have symptoms that mimic
primary otologic pathologic changes. The existence of common pathophysiologic
mechanisms is proposed.
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3) Abstract - Benefits of Tegaserod for IBS
Tegaserod: A New 5-HT4 Agonist Brian E. Lacy, Ph.D. , M.D. ; Shaoyong Yu, M.D.
From the Marvin M. Schuster Center for Digestive and Motility Disorders, Johns
Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Journal of Clinical Gastroenterology 2002;34:27-33
Tegaserod is a medication that has been shown to be of benefit in women with
irritable bowel syndrome (IBS) associated with abdominal pain, bloating, and
constipation. Tegaserod is a selective serotonin receptor subtype 4 partial
agonist designed to interact with the network of cells and nerves throughout the
gastrointestinal tract that use serotonin. Tegaserod has been shown to modulate
both gastrointestinal motility and visceral sensitivity.
Specifically, it increases the peristaltic reflex and decreases visceral
sensitivity. Clinical studies have shown that tegaserod improves symptoms of
abdominal pain, bloating, and constipation in women with IBS. This article
discusses the role of serotonin in gastrointestinal tract physiology, the
structure and pharmacokinetic profile of tegaserod, and clinical applications of
this new drug.
Key Words: Tegaserod ; Zelnorm ; Irritable bowel syndrome ; Serotonin ;
Constipation
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4) FMS Family Study in California Needs Participants
Under the sponsorship of Arthritis, Musculoskeletal and Skin Diseases (NAIMS),
National Institutes of Health, Bethesda, Maryland 20892-2350 and Case Western
Reserve University, School of Medicine, Department of Epidemiology &
Biostatistics, Fibromyalgia Family Study, R252A, will be holding clinical
trials, during the week of April 15-19th, in Southern California.
Principal investigator: Jane Olson, PhD.: Co-investigators: Irving Kushner, MD,
M Asim Khan, MD - Metro Health Medical Center, Sudha Iyengar, PhD -
Case Western Reserve University, Muhammed Yunus, MD - University of Illinois
Medical School, William Wilke, MD - Cleveland Clinic Foundation,I Jon. Russell,
MD, PhD - University of Texas, San Antonio.
National Fibromyalgia Association in Orange, California, will assist with the
Southern California trial. Other trial sites will be in Cleveland, San Antonio,
& Peoria. For further information about the trial, go to the NFA web site at
http://www.fmaware.org and click on "Clinical trials".
AOL users: <a href="http://www.fmaware.org">Read it here</a>
The benefit of participating in this study, while not immediate, is that it will
contribute to medical research and future cases of individuals and families with
fibromyalgia syndrome. Scientific information suggests that FMS runs in
families. Given this possibility, the study focus will be on families with more
than one living family member who has been diagnosed with FMS.
If you have been diagnosed with fibromyalgia, and have at least one living
family member* who also has been diagnosed, live in, or can travel to, Orange,
California, and think you would like to participate in this study, please
contact Sharon Squires, RN, Director, Patient Services, NFA, at tuck-@msn.com,
or call the NFA office at 714-921-0150, to make arrangements.
*(Note: For purposes of this study, a family member is someone who is a blood
relative, such as a parent, a brother, a sister, or a child)
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5) Abstract - Weather and the pain in fibromyalgia: are they related?
E A Fors1 and H Sexton2
1 Department of Psychiatry and Behavioural Medicine and Multidisciplinary Pain
Centre, University Hospital of Trondheim, Norway
2 Psychiatric Research Centre for Finnmark and Troms, Tromsö, Norway
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.
Correspondence to:
Dr E A Fors, Department of Psychiatry and Behavioural Medicine, NTNU, PO Box
3008 Lade, NO-7441 Trondheim, Norway; eaf-@online.no
Source:
http://ard.bmjjournals.com/cgi/content/abstract/61/3/247
AOL users: <a href="http://ard.bmjjournals.com/cgi/content/abstract/61/3/247">Read
it here</a>
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6) Abstract - Treatment of low back pain with a herbal or synthetic
anti-rheumatic: a randomized controlled study. Willow bark extract for low back
pain
Chrubasik, S., O. Kunzel, et al. (2001).
Rheumatology 40(12): 1388-93.
OBJECTIVES: To compare the effects of a proprietary extract of willow bark (Assalix)
and a selective inhibitor (rofecoxib) of the enzyme cyclo-oxygenase-2 (COX-2).
METHODS: An open, randomized, post-marketing study was carried out in an
out-patients clinic on two groups of patients aged 18 to 80 yr presenting over a
6-month period with acute exacerbations of low back pain. Using
computer-generated random list, 114 patients were allocated to receive a daily
dose of herbal extract containing 240 mg of salicin [PAID (phyto-anti-inflammatory
drug) group] and 114 were allocated to receive 12.5 mg of the synthetic COX-2
inhibitor rofecoxib [NSAID (non-steroidal anti-inflammatory drug) group]. The
doses were chosen according to existing recommendations. All patients were free
to use whatever additional conventional treatments were thought necessary. The
outcome measures were a modified Arhus index, its pain component and the Total
Pain Index.
RESULTS: Groups were well matched. After 4 weeks of treatment, the Arhus index
had improved by about 20%, its pain component by about 30% and the Total Pain
Index by about 35%. The number of pain-free patients (visual analogue scale
score <2) was about 20 in each group. About
60% of the patients in each group responded well to the treatment (as judged by
an improvement of >/=30% in the Total Pain Index relative to its baseline). The
improvement was also reflected reasonably well in the physicians' and patients'
judgements of the effectiveness of treatment, which were largely concordant. Few
patients of either group resorted to the additional conventional treatment
options. The incidence of adverse events was similar in the two groups.
Treatment with rofecoxib was about 40% more expensive than that with Assalix.
CONCLUSION: There was no significant difference in effectiveness between the two
treatments at the doses chosen.
Treatment with Assalix was less expensive.
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7) Abstract - Serotonergic agents in the treatment of fibromyalgia syndrome
Ann Pharmacother 2002 Apr;36(4):707-12 Miller LJ, Kubes KL.
Lisa J Miller PharmD BCPP GCP, Clinical Pharmacy Specialist, Pharmacy
Department, Memorial Hermann Southwest Hospital, Houston, TX.
PMID: 11918524
OBJECTIVE: To evaluate literature that discusses the treatment of fibromyalgia
syndrome (FMS) with agents that involve the neurotransmitter serotonin.
DATA SOURCES: Biomedical literature accessed through MEDLINE (1966-August
2001) and International Pharmaceutical Abstracts.
DATA SYNTHESIS: The cause and pathophysiology of FMS remain elusive, although
abnormalities in the serotonin pathway have been implicated. Several
serotonergic agents have been studied for use in FMS. Trials and case reports
focusing on the use of newer agents: the selective serotonin reuptake
inhibitors, venlafaxine and tramadol, were reviewed.
CONCLUSIONS: Current research suggests that the serotonergic agents may reduce
at least some of the symptoms of FMS. However, medications that act on multiple
neurotransmitters may prove to be more effective in symptom management.
Additional long-term studies are required in order to validate these results.
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8) Abstract - Sulfur in human nutrition and applications in medicine
Journal: Altern Med Rev 2002 Feb;7(1):22-44 Author: Parcell S.
Affiliation: ND candidate, 2002, Bastyr University, Seattle, WA; Research
Associate, American Institute for Biosocial and Medical Research (AIBMR) in
Tacoma, WA; Correspondence address: 6210 35th Ave NE, Seattle, WA 98115; e-mail:
mailto:stevep-@attbi.com
NLM Citation: PMID: 11896744
Because the role of elemental sulfur in human nutrition has not been studied
extensively, it is the purpose of this article to emphasize the importance of
this element in humans and discuss the therapeutic applications of sulfur
compounds in medicine.
Sulfur is the sixth most abundant macromineral in breast milk and the third most
abundant mineral based on percentage of total body weight.
The sulfur-containing amino acids (SAAs) are methionine, cysteine, cystine,
homocysteine, homocystine, and taurine.
Dietary SAA analysis and protein supplementation may be indicated for vegan
athletes, children, or patients with HIV, because of an increased risk for SAA
deficiency in these groups. Methylsulfonylmethane (MSM), a volatile component in
the sulfur cycle, is another source of sulfur found in the human diet. Increases
in serum sulfate may explain some of the therapeutic effects of MSM, DMSO, and
glucosamine sulfate.
Organic sulfur, as SAAs, can be used to increase synthesis of S-adenosylmethionine
(SAMe), glutathione (GSH), taurine, and N-acetylcysteine (NAC). MSM may be
effective for the treatment of allergy, pain syndromes, athletic injuries, and
bladder disorders. Other sulfur compounds such as SAMe, dimethylsulfoxide (DMSO),
taurine, glucosamine or chondroitin sulfate, and reduced glutathione may also
have clinical applications in the treatment of a number of conditions such as
depression, fibromyalgia, arthritis, interstitial cystitis, athletic injuries,
congestive heart failure, diabetes, cancer, and AIDS.
Dosages, mechanisms of action, and rationales for use are discussed. The low
toxicological profiles of these sulfur compounds, combined with promising
therapeutic effects, warrant continued human clinical trials.
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9) Abstract - Exercise program effects on women with fibromyalgia syndrome
Journal: Clin Nurse Spec 2001 Mar;15(2):67-73; quiz 74-5 Authors: Karper W B,
Hopewell R, Hodge M.
Affiliation: Department of Exercise and Sport Science, School of Health and
Human Performance, University of North Carolina at Greensboro, USA.
NLM Citation: PMID: 11855492
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.
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10) Abstract - Trigger Points: Diagnosis and Management
Journal: Am Fam Physician 2002;65:653-60 Authors: DAVID J. ALVAREZ, D.O., and
PAMELA G. ROCKWELL, D.O.
Affiliation: University of Michigan Medical School, Ann Arbor, Michigan
Trigger points are discrete, focal, hyperirritable spots located in a taut band
of skeletal muscle. They produce pain locally and in a referred pattern and
often accompany chronic musculoskeletal disorders. Acute trauma or repetitive
microtrauma may lead to the development of stress on muscle fibers and the
formation of trigger points. Patients may have regional, persistent pain
resulting in a decreased range of motion in the affected muscles. These include
muscles used to maintain body posture, such as those in the neck, shoulders, and
pelvic girdle. Trigger points may also manifest as tension headache, tinnitus,
temporomandibular joint pain, decreased range of motion in the legs, and low
back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of
harder than normal consistency is the physical finding typically associated with
a trigger point. Palpation of the trigger point will elicit pain directly over
the affected area and/or cause radiation of pain toward a zone of reference and
a local twitch response. Various modalities, such as the Spray and Stretch
technique, ultrasonography, manipulative therapy and injection, are used to
inactivate trigger points. Trigger-point injection has been shown to be one of
the most effective treatment modalities to inactivate trigger points and provide
prompt relief of symptoms.
About 23 million persons, or 10 percent of the U.S. population, have one or more
chronic disorders of the musculoskeletal system. [1] Musculoskeletal disorders
are the main cause of disability in the working-age population and are among the
leading causes of disability in other age groups. [2] Myofascial pain syndrome
is a common painful muscle disorder caused by myofascial trigger points. [3]
This must be differentiated from fibromyalgia syndrome, which involves multiple
tender spots or tender points. [3] These pain syndromes are often concomitant
and may interact with one another.
Trigger points are discrete, focal, hyperirritable spots located in a taut band
of skeletal muscle. The spots are painful on compression and can produce
referred pain, referred tenderness, motor dysfunction, and autonomic phenomena.
[4]
Trigger points are classified as being active or latent, depending on their
clinical characteristics. [5] An active trigger point causes pain at rest. It is
tender to palpation with a referred pain pattern that is similar to the
patient's pain complaint. [3,5,6] This referred pain is felt not at the site of
the trigger-point origin, but remote from it. The pain is often described as
spreading or radiating. [7] Referred pain is an important characteristic of a
trigger point. It differentiates a trigger point from a tender point, which is
associated with pain at the site of palpation only (Table 1). [8]
(Am Fam Physician 2002;65:653-60. CopyrightŠ 2002 American Academy of Family
Physicians.)
Check it out:
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