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Fibromyalgia Community Newsletter #17
Friday, April 19, 2002 Subscription update: 1530 members and 24 new members.
Welcome!
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Featured link: April is Irritable Bowel Syndrome Awareness Month! IBS is second
only to the common cold as being the most frequent cause of absenteeism from
work and school. A month long special includes new articles about IBS, plus a
new health tip each day!
Check it out:
http://ibscrohns.about.com/library/weekly/blibsspecial.htm
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it here</a>
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This week's news:
1) Notice - Walk For Awareness
2) Article - Intrathecal Calcium Channel Blocker Effective for Severe Chronic
Pain
3) Research - Management of Fibromyalgia: What are the best treatment choices?
4) Abstract - Relationship between body mass index and fibromyalgia features.
5) Abstract - High or Low Intensity Aerobic Fitness Training in Fibromyalgia:
Does It Matter?
6) Research - Long-term follow-up of patients treated for chronic headache with
analgesic overuse.
7) Abstract - Acupuncture and clinical hypnosis for facial and head and neck
pain
8) Article - Lowly Cytokine May Play Role In Controlling Neurotransmitters
9) Article - Fluoxetine Effective In Women With Fibromyalgia
10) Article - First Steps to a Stress Management Plan
11) Article - Poll Indicates Lack of Sleep Affects Mood, Eating Habits
12) Abstract - Trigger points: diagnosis and management.
13) Article - Judge Rules That Bipolar Disorder Is a Physical Illness
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Walk For Awareness: If You Can't Walk, Someone Will Walk For You
Ms. Tracy Loeffler, President and Founder of INMFCM-Invisible No More
FMS-CFIDS-MPS-MCS announced today that participants of the short (2-3 blocks)
Walk for Awareness will carry the names of other FMS, CFIDS, MPS and MCS
survivors who could not attend this year's event. "We want as many of the
patient community as possible to feel a part of our effort,"
Ms. Loeffler said.
The Walk for Awareness will take place in Washington, DC, May 11 at 9:30 AM
beginning at 3rd and Madison and proceeding to Peace Circle with an Outdoor
Meeting starting at 10:00 AM Peace Circle on the Capitol Grounds. The Outdoor
Meeting features Devin Starlanyl, MD; Jacob Teitelbaum, MD; Scott Davis, Esq.;
Sabrina Johnson, President and CEO of Chicago area advocacy group, FACES as well
as several others.
Participants will carry tags that say "I am also walking for _____________,"
stating the patient's name, city and state, or first name and initial if the
patient prefers.
INMFCM also announced that they are preparing a memorial list of patients who
died from complications of Fibromyalgia, Chronic Fatigue Syndrome-Chronic
Fatigue Immune Dysfunction Syndrome, Myofascial Pain Syndrome or Multiple
Chemical Sensitivity. Ms. Loeffler also said, "We would like to thank the
National CFIDS Foundation for graciously allowing us to use their list as a
starting point," Tracy added.
The group encourages submissions of survivors' who would like to have their
names carried at the Walk. INMFCM also encourages patients, friends, and
families to submit the names of those who have died for inclusion in the
memorial list. Information should be sent to: Tracy Loeffler at tloef-@prodigy.net
or Anne-Marie Vidal at shades-@erols.com by April 30, 2002.
Check it out:
http://www.geocities.com/tlloeffler/fibrofight13.html
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Intrathecal Calcium Channel Blocker Effective for Severe Chronic Pain
BALTIMORE (Reuters Health) Mar 18 - Intrathecal ziconotide seems to improve the
sleep pattern in some patients with chronic severe pain, according to
preliminary results presented at the 21st Annual Scientific Meeting of the
American Pain Society (APS). Dr. Mike Royal, with the Pain Evaluation and
Treatment Center in Tulsa, Oklahoma, and colleagues described results in
patients with chronic, severe pain of malignant or nonmalignant origin treated
with intrathecal ziconotide, which is an N-type, voltage-sensitive calcium
channel blocker.
Participants in the trial were treated as outpatients. Treatment consisted of a
ziconotide titration/stabilization period, with an initial dose of 0.1 g/h,
followed by long-term ziconotide infusion.
Throughout the study, ziconotide was administered as a continuous,
24-hour infusion via an intrathecal catheter and an internal or external pump
that was programmed to deliver the appropriate dose.
In 99 patients treated for 2 months, ziconotide had a positive effect on
nocturnal sleep duration. Overall, 28.3% of patients had 4 to 6 hours of
uninterrupted sleep before ziconotide therapy versus 37.4% after 2 months of
treatment.
Ambulation measures such as the ability to walk normally or walk with assistance
and the need for wheelchairs remained unchanged.
The effect of pain on daily life, as reported by self-assessment at 2 months of
treatment, showed that 37% of patients believed that pain interfered less with
their daily life. Also, 58.6% of patients felt that pain dominated their life
before therapy versus 49.5% after 2 months of treatment.
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Management of Fibromyalgia: What are the best treatment choices?
Forseth K KO, Gran JT.
Department of Rheumatology, Betanien Hospital, Skien, Norway.
Fibromyalgia still represents an enigma to modern medicine and the
aetiopathogenesis is far from explored. The management of patients with
fibromyalgia is thus mostly based on empirical research, and only a few
controlled studies have been performed. Basic drug therapy rests on the
administration of amitriptyline and conventional analgesics. Such therapy should
be initiated only after careful patient information and delineation of
therapeutic goals are provided. Any drug therapy should be administered in
combination with physical treatment and cognitive behavioral therapy. Because of
the appearing contours of pathogenic mechanisms, hopefully a number of new drugs
will be available to the patients with this complex pain syndrome in the near
future.
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Relationship between body mass index and fibromyalgia features.
Scand J Rheumatol 2002;31(1):27-31
Yunus MB, Arslan S, Aldag JC.
Department of Medicine, University of Illinois College of Medicine at Peoria,
61656, USA. <mailto:yun-@uic.edu>; yun-@uic.edu
PMID: 11922197
OBJECTIVE: to evaluate the relationship between body mass index (BMI) and
features of the fibromyalgia syndrome (FMS).
METHODS: 211 female patients with FMS seen consecutively in our rheumatology
clinic were analyzed. Spearman correlation was used.
Further, FMS features were compared at different levels of BMI (kg/m2), e.g., <
25.00 vs > or = 25.00 (normal vs overweight). P value of < or =
0.01 was accepted as significant.
RESULTS: A significant positive correlation was found between BMI and age
(p<0.001) and a negative correlation between BMI and education (p<0.009).
Health Assessment Questionnaire (HAQ) score was significantly correlated with
BMI (p<0.001), whereas fatigue and number of tender points (TP) showed a trend
(p=0.035 and 0.037, respectively).
CONCLUSION: The HAQ score is significantly associated with BMI in FMS with a
trend towards significance for fatigue and TP. Weight loss may improve physical
functioning in this disorder.
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High or Low Intensity Aerobic Fitness Training in Fibromyalgia: Does It Matter?
J Rheumatol 2002;29:582-7
MARIJKE van SANTEN, PAULIEN BOLWIJN, ROBERT LANDEWÉ, FRANS VERSTAPPEN, CARLA
BAKKER, ALITA HIDDING, DÉSIRÉE van der HEIJDE, HARRY HOUBEN, SJEF van der LINDEN
ABSTRACT.
Objective. To determine the efficacy of training in fibromyalgia (FM), we
compared the effects of high intensity fitness training (HIF) and low intensity
fitness training (LIF).
Methods. Thirty-seven female patients with FM were randomly allocated to either
a HIF group (n = 19) or a LIF group (n = 18). Four patients (1 HIF group, 3 LIF
group) refused to participate after randomization but before the start of the
intervention. They were excluded from the analysis.
Assessments were performed at baseline and after 20 weeks of HIF or LIF.
The primary outcome was patient's global assessment [on 100 mm visual analog
scale (VAS)]. Secondary endpoints were pain, number of tender points, total
myalgic score, physical fitness, health status, and psychological distress.
Results. One patient in the HIF group (n = 18) and 2 in the LIF group (n =
15) stopped training sessions during the course of the study. Nine of 18
patients in the HIF group compared to 8 of 15 patients in the LIF group achieved
a participation rate of 67% or more. Most important reasons for nonadherence
were postexercise pain and fatigue, time consumption, and stress. The VAS for
global well being improved slightly from 64 to 56 mm in the HIF group, and did
not change in the LIF group (58 to 61 mm) (p =
0.07).
The Wmax (physical fitness) changed modestly from 110 to 123 watt in the HIF
group, and from 97 to 103 watt in the LIF group (p = 0.3). VAS for pain
increased from 53 to 64 mm in the HIF group and from 52 to 54 mm in the LIF
group. The large standard deviations around mean change in global assessments,
number of tender points, total myalgic score, and psychological distress (by
SCL-90) severely influenced the power to detect within- and between-group
differences. Analysis limited to those patients who accomplished a high
attendance rate (> 67%) showed similar results.
Conclusion. High intensity physical fitness training compared to low intensity
physical fitness training leads to only modest improvements in physical fitness
and general well being in patients with FM, and does not positively affect
psychological status and general health. (J Rheumatol
2002;29:582-7)
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Long-term follow-up of patients treated for chronic headache with analgesic
overuse.
Pini LA, Cicero A, Sandrini M.
Clinical Pharmacology Unit, Internal Medicine and Pharmacology Section,
Biomedical Science Department, University of Modena and Reggio Emilia, Modena,
Italy.
The study aim is to describe the long-term clinical outcome of 102 chronic
headache patients with analgesic daily use. They were assessed for daily drug
intake (DDI), headache index (HI) and quality of life (QoL) and compared with a
parallel group of patients with active chronic daily headache but no analgesic
overuse. For the primary study group, baseline 1995 DDI was 1.80 +/- 1.87 and
did not differ significantly in
1999. Patients who daily continued to use analgesics had a higher 1995 baseline
DDI (t = 2.275, P = 0.025), a longer drug abuse history (t =
2.282, P = 0.025) and a higher DDI (t = 4.042, P < 0.001) 4 years later.
At 4 years of follow-up, only one-third of patients initially treated for
chronic daily headache and analgesic overuse are successful in refraining from
chronic overuse. Those subjects appear to have a persistence for combination
analgesic agents; however, their QoL is slightly better than that of patients
who revert to episodic headache or continue with chronic daily headache but do
not overuse analgesic agents. Persistent analgesic overuse seems to be linked to
the length of abuse and to the number of drugs ingested.
Cephalalgia 2001 Nov;21(9):878-83
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Acupuncture and clinical hypnosis for facial and head and neck pain: a single
crossover comparison.
American Journal of Clinical Hypnosis 44(2): 141-8.
Lu, D. P., G. P. Lu, et al. (2001).
Despite their long histories, acupuncture and hypnosis have only recently been
acknowledged as valuable by the medical establishment in the U.S. Few studies
have used rigorous prospective measurement to evaluate the individual or
relative merits of hypnosis and acupuncture in specific clinical settings. In
this study, 25 patients with various head and neck pain were studied. Each had
an initial assessment of their pain, as well as of their attitudes and
expectations. All patients received acupuncture, followed by a reassessment of
their pain. After a washout period they received another assessment of pain
before and after hypnosis therapy.
Preferences for therapy were sought following the hypnotic intervention.
Both acupuncture and hypnosis were effective at relieving pain under these
conditions. The average relief in pain reported was 4.2 units on a ten point
scale, with hypnosis reducing pain by a mean of 4.8 units, compared to
3.7 for acupuncture (p = 0.26). Patient characteristics appeared to impact the
effectiveness of treatment: patients with acute pain benefited most from
acupuncture treatment, whereas patients with psychogenic pain were more likely
to benefit from hypnosis. Patients with chronic pain had more variation in their
results. Patients who received healing suggestions from a tape during a hypnotic
trance benefited more than those who received no such suggestion, and
acupuncture patients who were needle phobic benefited less than those who were
not fearful of needles. This study demonstrates the benefits of well designed
studies of the effectiveness of these alternative modalities. More work is
needed to help practitioners identify which patients are most likely to benefit
from these complementary therapies.
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Lowly Cytokine May Play Role In Controlling Neurotransmitters
COLUMBUS, Ohio -- Researchers here in collaboration with a group in California
have discovered that a protein normally thought only to be a component in the
immune system actually plays a key role in regulating neurotransmission in the
central nervous system -- the CNS -- as well.
The protein, tumor necrosis factor alpha, or TNF-alpha, has long been known to
be a key player in controlling cell death but this new finding offers new
insights into how cells interact within the human nervous system.
Understanding this new role of TNF-alpha may provide researchers with possible
new approaches to treating illnesses such as dementia, Alzheimer's disease,
stroke, epilepsy and spinal cord injury. The report was published in the latest
issue of the journal Science.
The findings by Jacqueline Bresnahan, professor of neurosciences at Ohio State
University; Michael Beattie, professor and chair of the same department, and
colleagues at Stanford University, show that TNF-alpha is vital for controlling
the strength of signal transmission between nerve cells. And the level of signal
strength may play an important role in determining how nerve cells respond to
injury.
Researchers have long believed that neurons were the most important cells in the
nervous system because they controlled the passage of signals throughout the
CNS. They thought that glial cells -- astrocytes, oligodendrocytes and microglia
-- only performed a support role for those neurons, providing oxygen and
nutrients to the neurons, shielding neurons from each other, and basically
cleaning up dead neurons.
The new research, however, points to a much greater role for the glial cells
since they can manufacture and release TNF-alpha into the CNS environment.
The TNF-alpha apparently is able to regulate the expression of certain
neurotransmitter receptors on the surface of neurons. The more of these
receptors there are on the surface of the neuron, the more signals it can
transmit.
In this case, the signals arise from the binding of glutamate molecules from the
fluid surrounding the cell to these receptors. When the glutamate and receptor
meet, a nerve impulse, or signal, is produced. The more receptors present, the
more signals are increased.
Normally, the cytokine TNF-alpha is released as part of the inflammatory process
following an injury to the cells. Based on discussions with other Ohio State
colleagues on how the brainstem sends "nausea signals" to the stomach, Beattie
and Bresnahan remembered that when TNF-alpha and glutamate are both present,
cell signaling activity seemed to increase.
"We wondered that since there was glutamate and TNF-alpha present in the spinal
cord after injury, then maybe TNF-alpha is actually enhancing the killing effect
of the normal neurotransmitter," Beattie said.
In testing this, they exposed nerve cells first to glutamate and then to TNF-alpha.
Separately, neither had an impact on the normal killing effect.
But when they exposed the cells to even small amounts of both compounds, the
killing effect increased 120 percent.
"This was a complete surprise and validated our hypothesis," Bresnahan said.
The real question, however, was in the details of the process -- how exactly was
the killing effect enhanced. For help with the answer, they turned to Beattie's
brother Eric, a post-doctoral researcher at Stanford. The lab in which Eric
Beattie was conducting research was looking at the role glutamate played in
signal transmission in learning and memory.
"We wanted to know if TNF-alpha was regulating the number of receptors on the
cell surface," Bresnahan explained. "If the number of receptors increased, and
if there was glutamate nearby to bind to them, that would allow more calcium
into the cells, killing them."
Experiments at the Stanford lab were able to show that controlling the presence
or activity of TNF-alpha had a direct relationship to the numbers of glutamate
receptors on the cell surface and therefore on the amount of synaptic
transmission.
"This showed that TNF-alpha, this cytokine that is supposed to come from the
immune system and not have a role in transmitting information, is actually a
potent modulator of neurotransmitter interaction," Beattie said.
Beattie and Bresnahan's work has now turned to how this process affects the
speed at which nerve cells die, adding that a host of illnesses are caused by a
degeneration of neurons.
Their work was supported by grants from the National Institutes of Health.
Article: Ohio State University 23-Mar-02 Check it out:
http://www.newswise.com/articles/2002/3/TNF.OSU.html
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Contact: Michael Beattie, (614) 688-8327; <mailto:beatt-@osu.edu>; beatt-@osu.edu
Jacqueline Bresnahan, (614) 292-2206; <mailto:bresna-@osu.edu>; bresna-@osu.edu
Robert Malenka, <mailto:male-@stanford.edu>; male-@stanford.edu.
Written by Earle Holland, (614) 292-8384; <mailto:Holla-@osu.edu>; Holla-@osu.edu.
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Fluoxetine Effective In Women With Fibromyalgia
By Robert Short
The American Journal of Medicine 2002;112(3):191-197 "A randomized,
placebo-controlled, double-blind, flexible-dose study of fluoxetine in the
treatment of women with fibromyalgia"
The SSRI fluoxetine is effective and generally well tolerated in women with
fibromyalgia.
A randomized, placebo-controlled, double-blind flexible-dose study of fluoxetine
in 60 women with fibromyalgia was carried out by Dr Lesley Arnold and
colleagues. Dr Arnold is based at the Women's Health Research program,
Department of Psychiatry, University of Cincinnati Medical Center, Cincinnati,
Ohio, United States.
The intent-to-treat analysis in women who had received fluoxetine showed
significant improvement in the Fibromyalgia Impact Questionnaire (FIQ) total
score, compared with women who received placebo (difference of
-12). The FIQ pain score was also 2.2 points lower in fluoxetine-treated women
compared with the control group. Similarly, the FIQ fatigue and depression
scores were lower in the treated group compared with women who received placebo.
Fluoxetine-treated women also showed significant improvement in the McGill Pain
Questionnaire, relative to the ! placebo group of women.
The effects of fluoxetine on tender points and myalgic scores were not so
clear-cut. Said Dr Arnold, "Although counts for the number of tender points and
total myalgic scores improved more in the fluoxetine group than in the placebo
group, these differences were not statistically significant."
Dr Arnold concluded, "Fluoxetine was found to be effective on most outcome
measures and generally well tolerated in women with fibromyalgia."
Check it out:
http://www.cardiosource.com/journal/journal/article?acronym=AJM&format=abstract&uid=PIIS0002934301010890
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First Steps to a Stress Management Plan
Check it out:
http://stress.about.com/library/weekly/aa100800a.htm
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it here</a>
With the wealth of stress management information and resources available, it can
be hard to know where to start in forming your personal stress management plan.
We've all heard lots of good anti-stress advice: Exercise. Eat right. Get
organized. Improve your time management skills. Spend more time with your
family. Spend more time on yourself. It can begin to sound contradictory,
confusing, and even overwhelming. You may give up, deciding that that this whole
business of managing stress is only increasing your feelings of worry and
tension.
If you'd like to start taking control of the stress in your life but are unsure
where to begin, consider the following suggestions for creating your personal
stress management plan.
1) Realize that managing stress is a process which requires time, evaluation,
and possibly re-working and revision. Don't expect instant results, and don't
blame yourself for setbacks.
2) Identify the major stressors in your life. Think about when, and why, you
feel stressed. If you need help recognizing the primary sources of stress in
your life, try the <http://stress.about.com/cs/selfassessment3/index.htm>
self-assessment tools on the Stress Management site, including <http://stress.about.com/gi/dynamic/offsite.htm?site=http://www.wellness
net.com/teststrs.htm> The Lifestyle Risk Assessment from the Wellness
International Network, Inc., which will provide clues about stress risks in your
lifestyle and assess your risk for "hidden" stress.
3) Start small. Don't forget the little things. Make one or two deliberate
positive choices each day, such as substituting a healthy snack for junk food or
making time for a short walk. You'll be surprised at how these tiny improvements
"spill over" into your perspectives on the major issues. Receiving weekly
<http://stress.about.com/library/blsignup.htm> stress tips and information by
email can be an entertaining and helpful reminder.
4) Concentrate on only one or two main areas at a time. Trying to overhaul all
areas of your life at once is likely to be a prescription for failure. It isn't
necessary to tackle the greatest or most difficult stressors first; it's more
important that you choose a point of focus.
For example, if your <http://stress.about.com/cs/workplacestress/index.htm> job
is the major stressor in your life, making improvements in other arenas such as
health, nutrition, or family life might give you the energy you need to take on
the bigger problems later in the process.
4) Set realistic - and attainable - goals. Eliminating stress entirely is not
only impossible, but unwise. Be specific. Decide what changes you'd like to make
in the coming three months, six months, and year.
Celebrate your progress and remain flexible.
To jump start your stress management plan, see the <http://stress.about.com/library/blstress101a.htm>
Stress 101 start page on the Stress site, or have a look at the collection of
selected links on <http://stress.about.com/cs/copingskills/index.htm> coping
tips from your About Guide.
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Poll Indicates Lack of Sleep Affects Mood, Eating Habits
A new poll on sleep habits suggests that millions of Americans are in a bad
mood, short-tempered and prone to overeat because they are tired.
The National Sleep Foundation Poll, released Tuesday, finds that people say
they're much or somewhat more likely to make mistakes, get impatient or
aggravated when waiting, or get upset with their children or others when they
haven't gotten enough sleep the night before.
One fourth said they were more likely to eat more than usual on days when they
didn't get enough sleep, with slightly more women than men reporting this was
common.
"The poll establishes a direct association between how Americans are sleeping
and their overall behavior, mood and performance,'' said Richard Gelula, the
foundation's executive director. It shows 'you are how you sleep.' And it
indicates that some of the problems that we face as a society, from road rage to
obesity, may be linked to lack of sleep or poor sleep.''
The poll of 1,010 adults, taken between October and early December of last year,
found that nearly a quarter felt they weren't getting the minimum amount of
sleep they need to be alert the next day. Thirty-seven percent said they are so
sleepy during the day that it interferes with their activities a few days each
month; 16 percent said they experience this level of fatigue at least a few days
a week.
"Scientists have documented the link between sleep deprivation, mood and
performance in the lab before, but this is the first large-scale view of the
extent to which insufficient sleep plays out in the real world each day,'' said
James Walsh, executive director and senior scientist at St.
Luke's Hospital Sleep Medicine and Research Center in Chesterfield, Mo., and
president of the foundation.
The foundation is an independent, nonprofit organization dedicated to improving
public health and safety through research and education on sleep problems. It
has conducted a poll on sleep habits each year since
1998, part of a springtime sleep-awareness campaign tied to the return of
daylight-saving time on Sunday, when much of the nation moves clocks ahead an
hour, but doesn't go to bed earlier Saturday to compensate for the lost hour of
snoozing.
Overall, sleep habits have remained fairly steady since the poll began, but the
number of people reporting they sleep less than six hours a night both on
weekdays and weekends rose slightly last fall, to 15 percent and 10 percent,
respectively. On average, people say they are sleeping an average of 6.9 hours
on weeknights and 7.5 hours on weekends.
Adults living in the West were more likely to get eight hours or more sleep on a
workday than those living in the Midwest, South and Northeast.
Those who got fewer than six hours of sleep on weekdays were twice as likely to
describe themselves as stressed or sad.
And people who reported often being sleepy during the day were considerably more
likely than those who were never or rarely sleepy to describe themselves as
dissatisfied with life (21 percent vs. 7 percent) or angry (12 percent vs. 4
percent).
More than half of those surveyed said they experience symptoms of insomnia a few
nights a week or more; 37 percent said they snore frequently and 1 in 10
experiences pauses in breathing while sleeping, both possible symptoms of sleep
apnea.
On the Net:
http://www.sleepfoundation.org
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http://healthy.net/asp/templates/news.asp?Id=4518
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_____
Trigger points: diagnosis and management.
Journal: Am Fam Physician 2002 Feb 15;65(4):653-60
Authors: Alvarez DJ, Rockwell PG.
Affiliation: Department of Family Medicine, University of Michigan Medical
School, Ann Arbor, USA. <mailto:dalv-@umich.edu>; mailto:dalv-@umich.edu
NLM Citation: PMID: 11871683
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.
_____
Judge Rules That Bipolar Disorder Is a Physical Illness
A U.S. District Court judge has ruled that bipolar disorder is a physical
illness and a bipolar woman is entitled to long-term disability benefits under
her employer's insurance policy. Bipolar Disorder Guides Kimberly Bailey &
Marcia Purse report this decision, which could have far-reaching effects in the
fight for mental health coverage.
Check it out:
http://bipolar.about.com/library/weekly/aa-02fittsvfnma.htm
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href="http://bipolar.about.com/library/weekly/aa-02fittsvfnma.htm">Read it
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