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The Fibromyalgia Community Newsletter # 10 Friday, 02/08/2002
http://www.fmscommunity.org
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This week's News Summary:
1) Research: Are patients with fibromyalgia "hypervigilant"?
2) Website: Power-Switch Newsletter
3) Website: Simple Things You Can Do Today to Control Stress
4) Website: Physician Websites Found to Lack Key Information
5) Article: Hypothalamus Hormones Play Key Role In Chronic Migraine
6) Research: Pain Experience and Learned Helplessness in Women with Primary
Sjögren's Syndrome and Women with Fibromyalgia: A Descriptive and Comparative
Study
7) Research: Injections and surgical therapy in chronic pain.
8) Announcement: Success Stories
9) Article: Fibromyalgia study hopefuls by the hundreds visit Kettering
10) Website: Joanna Lund's Healthy Exchanges cookbooks
11) Article: Winning Your Disability Case with the Help of Co-Workers, Family
Members and Friends
12) News Release: FDA Approves Ultracet (Tramadol/Acetaminophen) For Acute Pain
13) Clinical Trial: Behavioral Insomnia Therapy for Fibromyalgia
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Note: Full Stories on some articles are available via web links
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1) Are patients with fibromyalgia "hypervigilant"?
[Article in German]
Schmerz 2001 Feb;15(1):38-47
Dohrenbusch R.
Klinische und Angewandte Psychologie, Psychologisches Institut, Universitat
Bonn.
PMID: 11810328
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.
source:
http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201e&L=co-cure&F=&S=&P=184<a
href="http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201e&L=co-cure&F=&S=&P
=184">Read it here</a>
***********
2) Power-Switch Newsletter
We are women, and we share your intention to live a life that matters-to you and
to people you love. The right support can make a difference.
Everyday life and obligations often shutdown the best intentions.
Rediscovering possibilities for choice can re-energize your life and put you
back on track. We know how to help you find these possibilities.
Your life is your opportunity to live and love, as yourself. Being who you want
to be is something that takes place in the everyday world, in ordinary
circumstances, or it doesn't happen at all. If the intention to live your own
life is taken seriously and supported, you have a much better chance of
realizing your goals.
The newsletter helps women embrace their lives and throw off the burden of
trying to be everything for everyone. Explore the myth of everything and see if
you can find ways to reduce your own personal stress.
http://www.power-switch.org/signup.html<a href="http://www.power-switch.org/signup.html">Read
it here</a>
***********
3) Simple Things You Can Do Today to Control Stress
Simple modifications in posture, habits, thought, and behavior often go a long
way toward reducing feelings of stress and tension. Here are eight simple things
you can do immediately to help keep your stress level under control.
1. Watch for the next instance in which you find yourself becoming annoyed or
angry at something trivial or unimportant, then practice letting go -
make a conscious choice not to become angry or upset. Do not allow yourself to
waste thought and energy where it isn't deserved. Effective anger management is
a tried-and-true stress reducer.
2. Breathe slowly and deeply. Before reacting to the next stressful occurrence,
take three deep breaths and release them slowly. If you have a few minutes, try
out a relaxation technique such as meditation or guided imagery.
3. Whenever you feel overwhelmed by stress , practice speaking more slowly than
usual. You'll find that you think more clearly and react more reasonably to
stressful situations. Stressed people tend to speak fast and breathlessly; by
slowing down your speech you'll also appear less anxious and more in control of
any situation.
4. Jump start an effective time management strategy. Choose one simple thing you
have been putting off (e.g. returning a phone call, making a doctor's
appointment) and do it immediately. Just taking care of one nagging
responsibility can be energizing and can improve your attitude.
5. Get outdoors for a brief break. Our grandparents were right about the healing
power of fresh air. Don't be deterred by foul weather or a full schedule. Even
five minutes on a balcony or terrace can be rejuvenating.
6. Drink plenty of water and eat small, nutritious snacks. Hunger and
dehydration, even before you're aware of them, can provoke aggressiveness and
exacerbate feelings of anxiety and stress.
7. Do a quick posture check. Hold your head and shoulders upright and avoid
stooping or slumping. Bad posture can lead to muscle tension, pain, and
increased stress. If you're stuck at a desk most of the day, avoid repetitive
strain injuries and sore muscles by making sure your workstation reflects good
ergonomic design principles.
8. Plan something rewarding for the end of your stressful day, even if only a
relaxing bath or half an hour with a good book. Put aside work, housekeeping or
family concerns for a brief period before bedtime and allow yourself to fully
relax. Don't spend this time planning tomorrow's schedule or doing chores you
didn't get around to during the day. Remember that you need time to recharge and
energize yourself - you'll be much better prepared to face another stressful
day.
http://stress.about.com/library/weekly/aa112600a.htm<a href="http://stress.about.com/library/weekly/aa112600a.htm">Read
it here</a>
***********
4) Physician Websites Found to Lack Key Information
As consumers increasingly turn to the Internet for information on health and
health care, a new study of physician directory websites finds significant gaps
in the accuracy and completeness of the information available. In Accessing
Physician Information on the Internet, new from the Commonwealth Fund,
researchers at the Massachusetts Health Data Consortium report that many of the
sites suffered from incomplete physician listings, few search options, and
empty, inaccurate, or outdated data fields. The researchers also found that
information is often poorly organized and not searchable, and sites often lack
disclosures about how information is gathered or whether fees are paid to be
included in the database. They conclude that, in order to realize the full value
of the Internet, health care accrediting organizations, health plans, hospitals,
and local and national industry organizations and associations need to work
together to improve the physician information available online.
2 WHAT INFORMATION DO CONSUMERS WANT?
Internet users seeking information on physicians and their performance are
likely to come with a variety of needs. Some patients may want to find a
physician who speaks their native language. Other patients may be looking for a
list of the right questions to ask before undergoing a recommended procedure.
Healthy consumers may be more likely to be interested in information about
convenience and logistics. Ill consumers, on the other hand, may be interested
in the doctor’s experience with a certain illness or the number of procedures of
a certain type the physician has performed (and the outcomes). A physician user
may want to refer a patient to a specialist with specific training and board
certification or expertise in a given procedure.
Ideally, a website would have value for different types of users with different
needs.
The information about physicians that visitors to a website want can be
categorized into four main groups: Descriptors/Characteristics,
Convenience/Logistics, Expertise/Knowledge, and Relationship/Bedside Manner:
1. Descriptors/Characteristics: gender, medical school, specialty, years in
practice, language, insurance plans accepted, fees.
2. Convenience/Logistics: office location, hours, parking availability, average
waits for appointments and in the office, friendliness and efficiency of the
office staff.
3. Expertise/Knowledge: training, years of experience, number of specific
procedures performed, outcome measures (survival, deaths, complications,
functional status), complaints or malpractice suits, reputation and ethical
actions, affiliation with specialists and hospitals.
4. Relationship/Bedside Manner: caring, compassion, listening and communication
skills, thoroughness with patients, and practice style (authoritative vs.
collaborative).
The Massachusetts Health Data Consortium held focus groups to discuss the
information and resource needs of consumers and health care professionals.
The groups included the Board of Directors of the Consortium (representing
consumers, providers, insurers, employers, researchers, and government sectors)
as well as an employee group convened by a large financial institution. Based
upon these discussions, health care consumers seem to be most concerned about
“relationship” and “expertise” issues. They want to find doctors with
philosophies similar to theirs with whom they can be comfortable. They want
physicians with good bedside manner who care for patients in their age group or
who have a dedicated interest/expertise in their specific medical problems. The
group discussions also revealed unease over the process of finding a physician.
A number of participants said that only a recommendation from a person they knew
(e.g., a friend, relative, or co-worker) or a medical professional inspired any
level of confidence, especially if the consumer faced a serious medical
condition. Such recommendations are likely to incorporate components of
Expertise/Knowledge and Relationship/Bedside Manner.
http://www.cmwf.org/<a href="http://www.cmwf.org/">Read it here</a>
***********
5) Hypothalamus Hormones Play Key Role In Chronic Migraine By Harvey McConnell
Patterns of the hormones produced by the hypothalamus may have a key role in
chronic migraine.
An abnormal pattern of hypothalamic hormonal secretion in chronic migraine which
comprised a decreased nocturnal prolactin peak, increased cortisol
concentrations, a delayed nocturnal melatonin peak and lower melatonin
concentrations in patients with insomnia, was found in the study by Dr Mario
Peres, and colleagues at the Sao Paulo Headache Center, Sao Paulo, Brazil.
Researchers point out that chronic migraine (CM) is a debilitating disorder that
affects 2-4 percent of the general population and accounts for most
consultations in headache clinics. "Because CM affects people during their peak
productive years, it imposes a significant decrease in their quality of life and
considerable economic burden to society."
Patients with CM often have a history of episodic migraine beginning in their
teenage years. Frequency of headache increases over months or years, and is
associated with symptoms of nausea, vomiting, photophobia, analgesic overuse,
insomnia, depression, and anxiety.
Dr Peres and colleagues took hourly blood samples from 14 women and three men,
average age 31, who were chronic migraine sufferers. These were compared with
hourly samples taken from nine healthy controls of similar age.
In total, 13 blood samples were taken from both patients and volunteers between
7 PM and 7 AM. Levels melatonin, prolactin, growth hormone, and cortisol
hormones, all controlled by the hypothalamus, were assessed.
Researchers found hormonal abnormalities among the migraineurs which were not
seen in the healthy volunteers. In almost half of the migraine sufferers, peak
melatonin levels were delayed; and in those with insomnia, peak melatonin levels
were significantly lower than in the controls.
The timing and amount of melatonin production are an integral part of the body's
circadian rhythm, the researchers note, and it is an important free radical
scavenger, protecting neurological processes. However, it is unclear whether
melatonin irregularities are a cause or consequence of chronic migraine.
Cortisol levels were significantly higher in the migraineurs, while prolactin
levels were lower. Growth hormone secretion did not differ from controls.
Dr Peres said: "We hypothesize that there is a sustained nocturnal inhibition of
prolactin by dopamine and, therefore, an indirect increase in dopamine
secretion.
"Many antidopaminergic agents have been successfully used in acute (droperidolchlorpromazine,
prochlorperazine, metoclo-pramide, domperidone, haloperidol), and preventive (flunarizine,
olanzapine [personal communication]) headache treatment. Our findings support
the use of these drugs in CM, but clinical trials are needed to confirm their
efficacy."
Dr Peres and colleagues conclude that, overall, "these results support the
involvement of the hypothalamus in the pathophysiology of CM as shown by a
chronobiological dysregulation, and a possible hyperdopaminergic state in
patients with CM."
J Neurol Neurosurg Psychiatry 2001;71:747-751. "Hypothalamic involvement in
chronic migraine"
***********
6) Pain Experience and Learned Helplessness in Women with Primary Sjögren's
Syndrome and Women with Fibromyalgia: A Descriptive and Comparative Study
Journal: J of Musculoskeletal Pain, Vol. 9(4) 2001, pp. 7-23
Authors: Britta Strömbeck, MScPT; Rolf Manthotpe, MD, PhD; Lennart T. H.
Jacobsson, MD, PhD
Affiliation: Department of Rheumatology, Malmö University Hospital, Malmö,
Sweden
Address correspondence to: Britta Strömbeck, Department of Rheumatology, Malmö
University Hospital, S-205 02 Malmö, Sweden [E-mail:
mailto:britta.s-@skane.se ].
The authors want to thank the Swedish Rheumatism Association for economic
support.
Supported by grants from the Swedish Rheumatism Association.
Submitted: March 29, 2001.
Revision accepted: May 24, 2001.
ABSTRACT.
Objective. To describe the experience of pain and learned helplessness in women
with primary Sjögren's syndrome [prim SS], to compare the experiences with those
of women with fibromyalgia syndrome [FMS] and to investigate the prevalence of
FMS in a random sample from a cohort of prim SS patients.
Methods. Forty-three patients with prim SS, also examined for FMS according to
the American College of Rheumatology 1990 [ACR-90] criteria, and 44 patients
with FMS completed a questionnaire including the Short-Form McGill Pain
Questionnaire [SF-MPQ], a body map for pain drawing, Arthritis Helplessness
Index [AHI], and questions about pain fluctuation, drug use, and functional
status.
Results. Thirty-six [84 percent] of the prim SS patients experienced pain and
eight [19 percent] also fulfilled the ACR criteria for FMS. The patients with
prim SS and pain experienced lower pain intensity than the FMS patients
according to the intensity scores included in SF-MPQ, i.e., visual analog scale
[P = 0.016], present pain intensity [P = 0.004] and intensity of the pain
descriptors I P < 0.001 ]. The prim SS patients also used fewer pain descriptors
[P < 0.001 ] and had a lower pain drawing score I P < 0.001] than the FMS
patients. No differences were seen in AHI, pain fluctuation, and functional
status. The pain distribution differed between the groups with a tendency to a
more central distribution in patients with FMS and a more peripheral
distribution in those with prim SS. The eight subjects fulfilling the ACR-90
criteria for FMS had similar results for pain assessments as the pure FMS group.
Conclusion. The study suggests an increased prevalence of FMS and the presence
of [at least] two patterns of pain in prim SS patients, one that is similar to
FMS and another that is less intensive and has a tendency to a more peripheral
distribution. The therapeutic approach may differ in the two subgroups.
KEYWORDS. Sjögren's syndrome, fibromyalgia, pain, learned helplessness
INTRODUCTION Primary Sjögren's syndrome [prim SS] is a common, chronic,
autoimmune disease associated with hypofunction of the exocrine glands, in
particular the lacrimal and salivary glands, resulting in keraconjunctivitis
sicca and xerostomia ( 1 ). Various classification criteria have been used to
define prim SS (1-3). Due to different methodology and criteria for diagnosis in
different studies there is a variation in prevalence figures.
The prevalence of prim SS in a population study in Malmö [Sweden] in the ages
52-72 years was 2.7 percent according to the Copenhagen criteria (4).
Using the [preliminary] European Community [EC] criteria (2) the prevalence of
prim SS in an English population study of adults aged 18-75 years was estimated
to be
3.3 percent (5). Females are affected nine times more frequently than males (6).
Besides the key symptoms dry eyes and dry mouth, the prim SS patients often
suffer from extraordinary fatigue, arthralgia, myalgia, and psychologic problems
(7,8).
The fibromyalgia syndrome [FMS] is a disorder of unknown etiology characterized
by widespread pain, presence of tender points, general fatigue, poor sleep, and
various other dysfunctional symptoms as well as psychologic problems (9,10). As
for prim SS different classification criteria sets have been used for the
diagnosis of the syndrome (11, 12).
The American College of Rheumatology 1990 [ACR-90] criteria (l3) are the most
widely used today. The prevalence of FMS according to the ACR-90 criteria in a
population of chiefly Caucasians in the United States of America was 2 percent
for both sexes, 3.4 percent for women and 0.5 percent for men (14). A recent
study reported a prevalence of 3 percent of FMS according to the ACR-90 criteria
for a population in Canada (15) and the prevalence of FMS in Sweden has been
estimated to be 1 percent (16) diagnosed according to Yunus' criteria (9), and
1.3 percent according to the ACR-90 criteria (17).
Although not the main manifestation as in FMS, many patients with prim SS report
pain (7) and rheumatologist and physiotherapists are often challenged with
reducing the pain in patients with prim SS and FMS as well as in other rheumatic
disorders. Different methods are used to achieve this aim such as analgesic and
antidepressive medication, heat therapy, cryotherapy, acupuncture,
transcutaneous electric nerve stimulation, physical training, education, and
cognitive behavioral therapy. To select the appropriate method of treatment it
is important to have a solid knowledge of the patient's pain experience
[intensity, character, localization] and as far as possible the underlying
mechanisms. It is also of great interest to collect information of the patient's
psychological status, which has importance for their perception of control over
the disease and compliance with therapeutic interventions. One way to do this is
by assessing the patient's learned helplessness, a psychological construct that
is considered to reflect the psychosocial adjustment to the disease in patients
with chronic rheumatic disorders (18,19).
The main purpose of this cross sectional study was to investigate and describe
pain experience and learned helplessness in prim SS women and to compare their
pain experience and learned helplessness with that of women with FMS. Another
purpose was to investigate the presence of FMS according to the ACR-90 criteria
in a random cohort of patients with prim SS.
© 2001 by The Haworth Press, Inc. All rights reserved.
[Article copies available for a fee from The Haworth Document Delivery Service:
1-800-342-9678. E-mail address:
mailto:geti-@haworthpressinc.com Website: http://www.HaworthPress.com ]
Note: It is also possible that your local library can help you obtain a copy of
this article via one of their interlibrary loan agreements.
http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201c&L=co-cure&F=&S=&P=4780< a
href="http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201c&L=co-cure&F=&S=&P
=4780">Read it here</a>
***********
7) Injections and surgical therapy in chronic pain.
Clin J Pain 2001 Dec;17(4 Suppl):S94-104
Bernstein RM.
Family Medicine Centre, Elizabeth Bruyere Health Centre, Ottawa, Ontario,
Canada. mailto:rmbe-@uottawa.ca
PMID: 11783838
OBJECTIVE: The purpose of this review was to determine how effective surgery and
injection therapy are in the management of chronic pain.
METHODOLOGY: A standardized literature search identified seven systematic
reviews of the literature and six randomized controlled trials to provide
evidence about surgery and injection therapy for chronic pain.
RESULTS: Some study subjects had highly specific diagnoses, whereas other study
subject groups had nonspecific pain, including multiple conditions.
The timing of treatment interventions was generally unclear, and few studies
analyzed subgroups. Overall, there was a lack of methodologically sound studies
of surgery and injection therapies.
CONCLUSIONS: Standard discectomy compared with conservative treatment for proven
disc herniation (< or = 1 year) and local triamcinolone injection for lateral
epicondylitis (< or = 12 weeks) are both effective for pain relief (level 2).
There was limited evidence of effectiveness (level 3) of intraoperative steroid
at discectomy, epidural steroid injection for sciatica with low back pain,
caudal steroid injection for low back pain, local glycosaminoglycan
polyphosphate injection for lateral epicondylitis, intraarticular steroid
injection for shoulder arthritis, subacromial steroid injections for rotator
cuff tendinitis, nonspecific injections for painful shoulder, systemic growth
hormone for fibromyalgia, and intravenous adenosine for fibromyalgia. There was
limited evidence (level 3) that there is no additional benefit of adding steroid
to local anesthetic in caudal epidural injections. There is limited evidence
(level 3) that intravenous adenosine is ineffective for fibromyalgia. The
remaining evidence was inadequate (level 4a) or contradictory (level 4b).
http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201b&L=co-cure&F=&S=&P=8076< a
href="http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201b&L=co-cure&F=&S=&P
=8076">Read it here</a>
***********
8) Success Stories
Can gratitude be life-transforming? Read FMS patient Joan Buchman s account of
the impact of gratitude on her life in the new feature article at the
CFIDS/Fibromyalgia Self-Help website: <http://CFIDSselfhelp.org>.
The article is the fourth in our new series "Success Stories," personal accounts
of coping and recovery. Also, review the complete list of bi-weekly features in
the Articles Archive, which is divided into four sections: Ten Keys to Coping
and Recovery, Success Stories, coping strategies, and articles about our
self-help program.
http://CFIDSselfhelp.org<a href="http://CFIDSselfhelp.org">Read it here</a>
***********
9) Fibromyalgia study hopefuls by the hundreds visit Kettering
Flint - It was standing room only last week at Kettering University's McKinnon
Theater.
More than 500 people showed up hoping to help in the search for a cure for
fibromyalgia, a disease of unknown origin that causes body pain, chronic
fatigue, sleeplessness and cognitive dysfunction, especially in women.
Dr. Jeff Hargrove, who is leading the clinical trial on fibromyalgia treatment,
said the school has received calls from across the country -and people are still
calling.
"My phone is busy," Hargrove said. "I have a backlog of telephone calls,
e-mails, regular mails, and I do wish to and like to respond. But it's going to
take so long to do it, frankly, I'm afraid half of the county will be annoyed."
People who contact the team will receive an informational kit in the mail.
The packet includes an application that must be completed and returned.
Hargrove said applicants will be interviewed before the study's 160 participants
are chosen.
"It'll take time," he said. "We're just getting all the names we possibly can.
We expect to start interviewing sometime in the spring. Our goal is to start the
research this summer."
Kettering and McLaren Regional Medical Center are coordinating the study with
researchers in Washington, D.C., and Atlanta. Similar studies have been
conducted in other cities, but the three-month trial is the first of its kind in
Michigan.
"There's such a tremendous need for this kind of relief," he said. "In our area
alone, 18,000 are unfortunately running around with these diagnoses (of
fibromyalgia). And then a lot of people aren't told what to do from there."
Those eligible for the Kettering clinical trial must be age 18-62 and have a
diagnosis of fibromyalgia using the American College of Rheumatology criteria.
Those criteria state a person is considered to have fibromyalgia if he or she
has widespread pain and tenderness in 11 of 18 specific "tender points."
Tender points are parts of the body that support and move bones, such as the
neck, spine, shoulders and hips. Those selected will help the group examine the
use of neurostimulation, or low-level electrical pulses, to treat chronic pain.
An estimated 3 million to 6 million Americans have the illness.
"We're looking to go beyond this study and develop a clinical entity, clinical
research and practice at the university," Hargrove said. "What we're doing with
the study is one thing, but that's just 160 people.
There are thousands who need help. That's my long-term goal."
For more information about the study, call (810) 762-9791.
Shena Abercrombie covers colleges and universities. She can be reached at (810)
766-6307 or saberc-@flintjournal.com.
Source: Flint Journal Date: February 1, 2002 Author: Shena Abercrombie URL:
http://www.mlive.com/news/fljournal/index.ssf?/xml/story.ssf/html_standard.x sl?/base/news/1012592401186330.xml<a
href="http://www.mlive.com/news/fljournal/index.ssf?/xml/story.ssf/html_stan
dard.xsl?/base/news/1012592401186330.xml">Read it here</a>
http://listserv.nodak.edu/scripts/wa.exe?A2=ind0202a&L=co-cure&F=&S=&P=1799< a
href="http://listserv.nodak.edu/scripts/wa.exe?A2=ind0202a&L=co-cure&F=&S=&P
=1799">Read it here</a>
***********
10) Joanna Lund's Healthy Exchanges cookbooks
Looking for some ideas on how to prepare healthier foods? Check out this
website: http://www.healthyexchanges.com/
The recipes are wonderful, easy to make and made from normal ingredients anyone
can find in any supermarket. They are all low fat, sugar free and followed by
complete nutritional information. She also has a monthly newsletter that's full
of new ideas and recipes.
http://www.healthyexchanges.com/<a href="http://www.healthyexchanges.com/">Read
it here</a>
***********
11) Winning Your Disability Case with the Help of Co-Workers, Family Members and
Friends by Scott E. Davis, Disability Attorney
In a social security disability claim, the credibility of the client is often
the determining factor of whether the claim is approved or denied. For cases
involving chronic pain or fatigue, such as fibromyalgia or chronic fatigue
syndrome, the credibility of the client is usually crucial to success. The
reason for this of course is due to the fact that those diagnoses involve
subjective symptoms and limitations that usually cannot be objectively
quantified by medical or laboratory tests.
Thus, SSA and judges will listen to the client’s story about why they are unable
to work due to the frequency, severity and duration of their symptoms; but they
will also look for corroborating evidence from other sources such as doctors or
individuals who know the client.
As you may know, my practice is exclusively disability law and I specialize in
chronic pain and fatigue cases representing clients throughout the United
States. Over the past several years I have been very successful in winning
disability cases before SSA and judges throughout the United States. While
winning hundreds of cases and losing only a small percentage of them, I have
learned a great deal about how to win chronic pain and fatigue disability cases
as well as the importance of a client’s credibility.
A tool I have used extensively for the past several years is to obtain
affidavits or statements from a client’s former co-worker (or preferably a
supervisor), family member or long-time friends. What is an affidavit? It is
simply a notarized document that essentially is a narrative letter regarding a
person’s observations of problems the client has functioning on a daily basis
due the symptoms and limitations, with a conclusion that they are unable to work
in any occupation as a result. In my opinion, it is essential that SSA and a
judge have corroborating evidence from those who know a client the best and the
affidavit performs that function.
Because I view a client’s credibility as paramount to the case, I want to
protect it, develop it and support it from as many different independent sources
as possible. The quality of the affidavits or statements and from whom they are
from matters more than having a large volume of them by people who do not know
the client well. I know thoughtful affidavits have a big impact on SSA and
judges because I have seen countless judges from all over the country reference
them as a reason why they approved my client’s claim.
I have also talked with judges after a hearing and they have told me the
affidavits provided persuasive support of my client’s allegations regarding
their limitations.
It must be noted that it is unlikely an affidavit alone will win a disability
case; but along with other corroborating medical records and doctor’s opinions
it can be a powerful tool. Use this article as a foundation for developing this
important part of your claim.
Tip #1 The Affidavit should be Brief
To avoid lulling weary SSA personnel or a judge to sleep, I believe the
affidavit should be no more than two (2) pages in length. Please remember your
file will contain several hundreds of pages of records…you want the affidavit to
be read and be factored into your claim.
Tip #2 The Affidavit should be on regular paper and be Notarized
The document itself can be on any regular paper (preferably 8 ½ x 11 inches),
preferably typewritten and should be titled “Affidavit.” However, any paper will
do and a handwritten one is better than nothing. It should be notarized because
this will confirm that the person who purported to draft the affidavit actually
signed it before a notary public. The notary stamp and signature should go at
the end of the text and after your signature (remember not to sign it until you
are before the notary!).
Having the affidavit notarized eliminates any question with regard to
authenticity of the document (i.e. you are not trying to pull one over on SSA or
a judge!). If it is not possible to obtain a notary then simply submit a
handwritten statement.
Tip #3 The Content of the Affidavit is Critical
The contents of the affidavit determine whether it is a piece of evidence that
will be persuasive in the case. The affidavit should always conclude with a
sentence that the client is unable to engage in any occupation and due to what
reasons.
The contents should be organized by paragraph, numbered and should discuss the
following in a separate paragraph or less: the background of the person making
the affidavit (i.e. occupational status and title, address); how long they have
known the client, how they met (family, work, friends), and how often they have
in person or telephone contact; discuss what the client’s activity/work (work
ethic) level was like before they became unable to work.
The bulk of the affidavit and several paragraphs should be devoted to discussing
the physical or psychological changes that the client exhibited at the time they
last worked (i.e. observations of chronic pain and fatigue, spending days in
bed, dramatic changes in appearance, lack of stamina, absences from work, being
unreliable); discuss the physical limitations they have (the ability to sit,
stand, walk, or do anything for only short periods of time); a medical
treatment/medications/therapy they have tried without success; discuss how
limited the are in activities of daily living.
The last two (2) paragraphs must conclude with a statement that due to the above
discussed reasons the client is not able to work in any occupation and that you
are willing to discuss your affidavit with the judge if necessary.
Tip #4 How Many Affidavits should you Obtain?
With regard to quantity, less is better, the nature of the relationship with the
client and content of the affidavit are the issues. I like to obtain as many as
we can from former co-workers or supervisors. Then I like to obtain one from a
spouse or long-time significant other, family members and then finally long-time
friends. Generally, the complete story of the client can be told with three (3)
or at most four (4) affidavits from those people who know them the best.
Best of luck in your pursuit of disability benefits and remember never to quit!
Scott E. Davis is a social security and long-term disability insurance attorney
in Phoenix, Arizona. Mr. Davis represents clients throughout the United States.
Although Mr. Davis has experience representing clients with a broad spectrum of
physical and/or psychological disorders, the majority of his practice is devoted
to representing individuals with chronic pain and chronic fatigue disorders. In
almost every case, a fee is charged only if his client obtains benefits. Mr.
Davis invites your questions and inquiries regarding representation via
telephone (602) 482-4300, or email:
harris-@azbar.org.
http://www.healthyexchanges.com/<a href="http://www.healthyexchanges.com/">Read
it here</a>
***********
12) FDA Approves Ultracet (Tramadol/Acetaminophen) For Acute Pain
The U.S. Food and Drug Administration has approved Ultracet™ (37.5 mg tramadol
hydrochloride/325 mg acetaminophen tablets), a new centrally acting prescription
pain medication.
Ultracet provides long-lasting pain relief and flexible dosing. Ortho-McNeil
Pharmaceutical, Inc. will market the product in the United States.
Ultracet combines Ultram® (tramadol hydrochloride), a leading prescription pain
reliever, with acetaminophen, the most commonly recommended nonprescription pain
treatment. Clinical trials demonstrated that the combination offers better pain
relief over either medication alone. In the trials, Ultracet consistently began
working faster than tramadol alone, and pain relief with Ultracet lasted
significantly longer than with acetaminophen alone.
Ultracet is indicated for the short-term (five days or less) management of acute
pain.
"Pain is one of the most prevalent medical symptoms in the United States,"
said Warren A. Katz, MD, chief of Rheumatology at Presbyterian Medical
Center/University of Pennsylvania Healthcare System in Philadelphia.
"Millions of people suffer from acute pain without relief, in part because their
medications don't work or have side-effects that interfere with treatment. With
Ultracet, we have a product that offers effective relief and a positive
side-effect profile."
Ultracet™ is a centrally acting analgesic that controls pain via different
mechanisms of action than non-steroidal anti-inflammatory drugs (NSAIDs), the
most commonly used pain medications. Ultracet is not an NSAID, and is not
associated with potentially life-threatening gastrointestinal ulcers or bleeding
that can occur with NSAIDs and the newer COX-2 NSAIDs.
In addition, Ultracet does not compromise the efficacy of certain
antihypertensive agents, like NSAIDs and COX-2 NSAIDs. Ultracet can also be
prescribed in sulfa-sensitive patients. The most frequently reported side
effects with Ultracet were constipation, somnolence (sleepiness) and increased
sweating.
Ultracet should not be used concomitantly with alcohol. The use of Ultracet in
patients with liver disease is not recommended. In addition, acetaminophen may
cause liver damage.
Cases of abuse and dependence on tramadol have been reported. Tramadol should
not be used in opioid-dependent patients. Since tramadol can reinitiate physical
dependence, Ultracet is not recommended for patients with a tendency to drug or
alcohol abuse, a history of drug or alcohol dependence or a history of chronic
opioid use.
Patients with a history of severe, life-threatening allergic (anaphylactoid)
reactions to codeine and other opioids may be at increased risk and therefore
should not receive Ultracet.
Seizures have been reported in patients receiving tramadol. The risk of seizures
is increased with doses of tramadol above the recommended range.
Tramadol increases the seizure risk in patients taking certain medications
(e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors,
opioids) and may enhance the seizure risk in patients taking MAO inhibitors,
neuroleptics, or other drugs that reduce the seizure threshold or in patients
with epilepsy, those with a history of seizures, or in patients with a
recognized risk for seizure (such as head trauma, metabolic disorders, alcohol
and drug withdrawal, and CNS infections). See WARNINGS in the full Prescribing
Information.
http://www.ortho-mcneil.com/news/archive/pr/news_ultracet.htm<a
href="http://www.ortho-mcneil.com/news/archive/pr/news_ultracet.htm">Read it
here</a>
***********
13) Behavioral Insomnia Therapy for Fibromyalgia
This study tests the effectiveness of a nondrug treatment for the insomnia that
often occurs in people with fibromyalgia. The treatment is a type of
psychotherapy called cognitive-behavioral therapy. Cognitive-behavioral therapy
combines cognitive therapy, which can modify or eliminate thought patterns
contributing to the person's symptoms, and behavioral therapy, which aims to
help the person change his or her behavior.
Condition Treatment or Intervention Phase Fibromyalgia Insomnia Behavior:
Behavioral insomnia therapy Phase II
MEDLINEplus related topics: Fibromyalgia; Sleep Disorders
Study Type: Interventional Study Design: Treatment, Randomized, Single Blind,
Active Control, Parallel Assignment, Efficacy Study
Official Title: Behavioral Insomnia Therapy for Fibromyalgia Patients
Further Study Details:
Fibromyalgia (FM) is a prevalent and debilitating condition that contributes to
impaired occupational and social functioning and increased disability among
affected individuals. The vast majority of people with FM experience persistent
sleep disturbances (e.g., onset difficulty, repeated or extended awakenings,
nonrestorative sleep) that worsen other FM-related symptoms (e.g., chronic pain,
fatigue) and sustain their general dysfunction.
Pharmacologic treatments (e.g., antidepressants, hypnotics) may reduce symptoms
for some people with FM, but many FM patients display little enduring
improvement in their sleep and other FM-related symptoms in response to such
agents.
Our clinical observations and initial pilot work suggest that factors common
among other insomnia subtypes such as conditioned bedtime arousal, erratic
sleep/wake scheduling, and spending too much time in bed likely perpetuate the
sleep problems of these medication-refractory FM patients. Over the past decade,
we have developed, refined, and repeatedly tested a cognitive-behavioral therapy
(CBT) that has proven effective for reducing sleep disturbances perpetuated by
such underlying cognitive/behavioral mechanisms. The major objectives of this
project are to conduct a prospective randomized clinical trial to confirm these
preliminary findings and to determine the efficacy of CBT insomnia treatment for
interrupting the disturbed nocturnal sleep and daytime pain, fatigue, and
distress symptom complex that defines FM.
One arm of this study's three-by-four factorial design will compare CBT with
both a contact control treatment and standard care. The other arm in the design
is a repeated-measures factor consisting of four time points (i.e., baseline,
mid-treatment, post-treatment, and 6-month follow-up periods) at which we will
assess outcome. We will assess participants at all four time points with
objective (wrist actigraphy) and subjective (sleep logs, Insomnia Symptom
Questionnaire) measures of sleep improvements, measures of subjective pain, and
questionnaires that assess mood (State-Trait Anxiety and Beck Depression Scales)
and general quality of life (SF-36). We will conduct multivariate statistical
analyses and tests of clinical significance with these various measures. We will
also conduct exploratory analyses to determine if polysomnographically-derived
sleep measures obtained prior to treatment correlate with initial levels of pain
and distress or eventual treatment outcome.
Results should provide information about the usefulness of CBT for treating
FM-related sleep difficulties. Results should also improve understanding of the
FM syndrome in general and provide new information about the potential role of
behavioral therapy in the overall management of this disorder.
Individuals interested in participating in this study should live within
reasonable commuting distance from the Duke University Medical Center (Durham,
NC), because this research requires multiple outpatient visits for screening and
treatment.
Eligibility
Ages Eligible for Study: 21 Years - 65 Years, Genders Eligible for Study: Both
Criteria Inclusion Criteria:
Insomnia for more than 1 month Fibromyalgia diagnosis Exclusion Criteria:
Terminal illness Major psychiatric disorder Substance abuse Dependence on
hypnotic drugs Other sleep disorders (sleep apnea, restless legs, etc.) Other
sleep-disturbing medical disorders (painful arthritis, thyroid condition, etc.)
Expected Total Enrollment: 60
Location and Contact Information:
Jack D Edinger, Ph.D. 919-286-0411 jack.e-@duke.edu Duke University Medical
Center, Durham, North Carolina, 27710, United States;
Recruiting:
William K Wohlgemuth, Ph.D. 919-684-4368
Study chairs or principal investigators:
Jack D. Edinger, Ph.D., Principal Investigator VA Medical Center-Brooklyn
More Information:
Study ID Numbers NIAMS-039; R21 AR46094 Date study started July 1999; Study
Completion Date June 2002 Record last reviewed March 2001 NLM Identifier
NCT00000397
http://www.clinicaltrials.gov/ct/gui/c/a1r/show/NCT00000397?order=2&JServSes
sionIdzone_ct=se67179uw1<a
href="http://www.clinicaltrials.gov/ct/gui/c/a1r/show/NCT00000397?order=2&JS
ervSessionIdzone_ct=se67179uw1">Read it here</a>
***********************
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non-profit corporation)
maintained by
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1997-2002 The Fibromyalgia Community.
All Rights Reserved.
Page Updated:
August 03, 2004
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