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Fibromyalgia Community Newsletter #21
Monday, May 27, 2002
Subscription update: 1610 members and 18 new members.
Welcome!
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Featured link: Finding Your Energy Envelope
This week's feature at the CFIDS/Fibromyalgia Self-Help website is the first of
two articles on controlling symptoms by finding and honoring the body's limits.
This week's article describes a system for understanding your limits and offers
two techniques for expanding them.
Check it out: http://CFIDSselfhelp.org
AOL users: <a href="http://www.CFIDSselfhelp.org">Read
it here</a>
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This week's news:
1) Lehigh Valley Support Group to show award-winning documentary
2) Discovery Channel to air fibromyalgia information
3) First Steps to a Stress Management Plan
4) "As Needed" Zolpidem and Behavioral Therapy Safely Treats Chronic Insomnia
5) Dextromethorphan Effective in Select Patients With Painful Diabetic
Neuropathy
6) Factors explaining variance in perceived pain in women with fibromyalgia
7) Massage alters sleep pattern, reducing pain levels
8) Oregon conference focuses on functionality
9) Caring for a relative with chronic fatigue syndrome: difficulties, cognition
and acceptance over time
10) Sex hormonal factors and chronic widespread pain: a population study among
women
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1) Lehigh Valley Support Group to show award-winning documentary
On May 28, in celebration of their 10-year anniversary, the Chronic Fatigue
Syndrome Association of the Lehigh Valley (CFSALV) will present "I Remember Me,"
an award-winning documentary which explores the history of Chronic Fatigue
Syndrome (CFS). The epic film has garnered rave reviews by film critics,
including the Chicago Sun-Times' Robert Ebert and the New York Times' Stephen
Holden.
The presentation will take place Tuesday, May 28 from 7- 8:30 p.m. in Lecture
Room 1 in the Education Center on Ostrum Street at St. Luke's Hospital-Fountain
Hill in Bethlehem, Pa. Everyone is invited.
Contact: Priscilla deLeon, Co-Founder/Co-Leader Chronic Fatigue Syndrome
Association of Lehigh Valley (Pa.) pmde-@aol.com or (610) 868-8745
Check it out:
http://www.irememberme.com
AOL users: <a href="http://www.irememberme.com">Read it
here</a>
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2) Discovery Channel to air fibromyalgia information
Discovery Health Channel will be airing information about fibromyalgia on May
31, 2002, at 6 am. This corresponds with the She TV listing on the Discovery
Channel's website.
Check it out: http://www.discovery.com
AOL users: <a href="http://www.discovery.com">Read it
here</a>
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3) First Steps to a Stress Management Plan
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.
Check it out:
http://stress.about.com/library/weekly/aa100800a.htm
AOL users: <a href="http://stress.about.com/library/weekly/aa100800a.htm">Read
it here</a>
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4) "As Needed" Zolpidem and Behavioral Therapy Safely Treats Chronic Insomnia
05/06/2002 By David Loshak
Primary care practitioners can use the hypnotic agent zolpidem "as needed" to
treat chronic insomnia.
This approach is safe and effective and can be amended by behavioural therapy in
the form of stimulus control, report investigators at the Universities of
Dresden, Göttingen and Regensburg, Germany.
The investigators commented that discontinuous, non-nightly hypnotic treatment
of chronic insomnia was not only likely to maintain efficacy but would also
avoid the risks of tolerance and dependence associated with unnecessary nightly
use longterm.
Four earlier studies using zolpidem with increasing flexibility in drug intake
schedules had favourable results. This led the investigators to conduct a
prospective, observational open study in 550 German primary care settings of "as
needed" zolpidem pharmacotherapy amended by the optional use of stimulus control
in conditions close to "real life" practice.
The study included 2,690 patients, mean age 59 years, with chronic insomnia.
Two-thirds of the patients were women and half had received pharmacotherapy
pre-treatment.
The patients took up to five zolpidem tablets a week for three weeks according
to an "as-needed" schedule on nights of their own choice, with optional stimulus
control on drug-free nights.
After three weeks, the patients were taking an average 2.6 tablets weekly, 28
percent less than the average 3.7 tablets at baseline. This reduction had no
significant impact on treatment efficacy.
The subjective latency to sleep onset fell from a mean of 74.27 minutes and
total sleep time increased from 5.0 to 6.8 hours. The investigators rated
efficacy of treatment as good or very good in 93 percent of the patients.
Adverse events, mostly mild, were observed in 1.2 percent. There were no serious
adverse events.
Annals of Clinical Psychiatry 2002;14(1):1-7. ""As Needed" Pharmacotherapy
Combined with Stimulus Control Treatment in Chronic Insomnia-Assessment of a
Novel Intervention Strategy in a Primary Care Setting"
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5) Dextromethorphan Effective in Select Patients With Painful Diabetic
Neuropathy
05/22/2002 By Mark Moran
Editor's note: Dextromethorpan is marketed OTC as Delsym cough syrup.
Dextromethorphan appears to be effective in a dose-related fashion in select
patients with painful diabetic neuropathy, but not in patients with
post-herpetic neuralgia.
The varying effectiveness of the drug suggests a difference in pain mechanisms
for the two conditions. For that reason, selective approaches to pain-relevant
N-methyl-D-aspartate receptors would appear to be warranted, say Canadian and
American researchers.
They studied patients with painful diabetic neuropathy (DN) and postherpetic
neuralgia (PHN) in two crossover trials. The first was an efficacy trial
comparing dextromethorphan, memantine, and lorazepam, which served as an active
placebo. The second was a dose-response trial of the preferred active drug in
responders from the first study, testing the drug at 0, 25, 50 and 100 percent
of each patient's maximally tolerated dose.
Pain intensity was measured on a 20-point scale.
Nineteen patients with DN and 17 patients with PHN completed the efficacy trial.
Median doses for DN were 400 mg/day dextromethorphan, 55 mg/day memantine, and
1.8 mg/day lorazepam. Median does for PHN were 400 mg/day dextromethorphan, 35
mg/day memantine, and 1.2 mg/day lorazepam.
Among patients with DN in the efficacy trial, dextromethorphan reduced pain
intensity by a mean of 33 percent from baseline, memantine reduced pain
intensity by a mean of 17 percent, and lorazepam reduced pain intensity by a
mean of 16 percent. The proportions of subjects achieving greater than moderate
pain relief were 68 percent with dextromethorphan, 47 percent with memantine,
and 37 percent with lorazepam.
Among patients with PHN, mean reductions in pain intensity were six percent with
dextromethorphan, two percent with memantine, and 0 percent with lorazepam. No
comparison with placebo reached statistical significance in the efficacy trial.
In ten subjects with DN who responded to dextromethorphan, there was a
significant dose-response effect on pain intensity, with the highest dose
significantly better than that of lorazepam.
Anesthesiology 2002;96:1053-1061.
Check it out:
http://www.docguide.com/gpc.nsf/doc?CreateDocument&n=95&id=A0C15EBDF4D14E648525691A00552163&cond=Anaesthesiology%20Other&t=10-30-08;PM&l=News&u=/news/content.nsf/PaperFrameSet?OpenForm&id=A0C15EBDF4D14E648525691A00552163&newsid=8525697700573E1885256BB100693AFD&u=http://ipsapp002.lwwonline.com/content/getfile/3941/127/5/abstract.htm&ref=/news/content.nsf/news/8525697700573E1885256BB100693AFD?OpenDocument&id=A0C15EBDF4D14E648525691A00552163&c=Anaesthesiology%20Other&count=10
AOL users: <a href="http://www.docguide.com/gpc.nsf/doc?CreateDocument&n=95&id=A0C15EBDF4D14E648525691A00552163&cond=Anaesthesiology%20Other&t=10-30-08;PM&l=News&u=/news/content.nsf/PaperFrameSet?OpenForm&id=A0C15EBDF4D14E648525691A00552163&newsid=8525697700573E1885256BB100693AFD&u=http://ipsapp002.lwwonline.com/content/getfile/3941/127/5/abstract.htm&ref=/news/content.nsf/news/8525697700573E1885256BB100693AFD?OpenDocument&id=A0C15EBDF4D14E648525691A00552163&c=Anaesthesiology%20Other&count=10">Read
it here</a>
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6) Factors explaining variance in perceived pain in women with fibromyalgia
BMC Musculoskelet Disord 2002 Apr 25;3(1):12
Malt E, Olafsson S, Lund A, Ursin H.
Department of Psychiatry, University of Bergen Haukeland University Hospital,
N-5022 Bergen, Norway. eva.alb-@psych.uib.no
BACKGROUND: We hypothesized that a substantial proportion of the subjectively
experienced variance in pain in fibromyalgia patients would be explained by
psychological factors alone, but that a combined model, including neuroendocrine
and autonomic factors, would give the most parsimonious explanation of variance
in pain.
METHODS: Psychometric assessment included McGill Pain Questionnaire, General
Health Questionnaire, Hospital Anxiety and Depression Rating Scale, Eysenck
personality Inventory, Neuroticism and Lie subscales, Toronto Alexithymia Scale,
and Multidimensional Health Locus of Control Scale and was performed in 42
female patients with fibromyalgia and 48 female age matched random sample
population controls. A subgroup of the original sample (22 fibromyalgia patients
and 13 controls) underwent a pharmacological challenge test with buspirone to
assess autonomic and adrenocortical reactivity to serotonergic challenge.
RESULTS: Although fibromyalgia patients scored high on neuroticism, anxiety,
depression and general distress, only a minor part of variance in pain was
explained by psychological factors alone. High pain score was associated with
high neuroticism, low baseline cortisol level and small drop in systolic blood
pressure after buspirone challenge test. This model explained 41.5% of total
pain in fibromyalgia patients. In population controls, psychological factors
alone were significant predictors for variance in pain.
CONCLUSION: Fibromyalgia patients may have reduced reactivity in the central
sympathetic system or perturbations in the sympathetic-parasympathetic balance.
This study shows that a biopsychosocial model, including psychological factors
as well as factors related to perturbations of the autonomic nervous system and
hypothalamic-pituitary-adrenal axis, is needed to explain perceived pain in
fibromyalgia patients.
PMID: 12019032
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7) Massage alters sleep pattern, reducing pain levels
Many fibromyalgia symptoms -- pain, stiffness, fatigue, depression -- can be
relieved with massage therapy. Now, researchers say they understand why. Massage
alters the sleep pattern, which reduces levels of the chemical messenger for
pain.
Check it out:
http://my.webmd.com/content/article/1673.50941\
AOL users: <a href="http://my.webmd.com/content/article/1673.50941">Read
it here</a>
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8) Oregon conference focuses on functionality
The Oregon Fibromylagia Foundation (OFF) and the Arthritis Foundation of Oregon
are sponsoring a unique one day conference in Portland, Oregon on June 15 at the
University of Portland.
The focus of this conference is functionality, not medical research. Although
the illness model used for this conference is fibromyalgia, it is appropriate
for anyone with chronic pain or severe fatigue issues.
Lectures and workshops will explore the many facets of coping with chronic
illness while rebuilding your life, from simple adaptations to reinventing
yourself.
The topics covered will include how to negotiate the medical and legal systems
when chronic pain and fatigue impact your ability to work.
For more information on this conference, visit the OFF website at
www.myalgia.com [AOL users: <a href="http://www.myalgia.com">Read it here</a>]
or call 360-906-0637. This is a voice mail line, leave a name and number and
someone will call you back as quickly as possible. If you need to time the call
to your energy, volunteers will be answering this line Monday, Wednesday and
Friday from
11AM to 3PM Pacific Standard time, starting Monday May 19.
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9) Caring for a relative with chronic fatigue syndrome: difficulties, cognition
and acceptance over time.
J R Soc Health 2002 Mar;122(1):35-42 Ax S, Gregg VH, Jones D.
School of Health, Liverpool John Moores University, 79 Tithebarn Street,
Liverpool L2 2ER, England. hea-@yahoo.com
The present study explored the difficulties experienced by carers of chronic
fatigue syndrome (CFS) sufferers, their cognitions, and their efforts to accept
the illness. Semi-structured interviews were conducted with 17 carers to study
these issues, retrospectively, over three stages: before the diagnosis of CFS,
shortly after the diagnosis, and at present. Surprisingly, the results suggested
that carers, several of them absent from home during the day, felt that their
lives were only minimally constrained by the illness. Nevertheless, all carers
reported specific coping efforts to manage both the illness and their own
distress, and indicated that they learned to accept the illness over time.
However, acceptance appeared to be a form of resignation rather than a positive
appreciation of the illness. In light of the uncertainties surrounding the
origin of CFS and carers' apparent confusion, the results obtained in the
present study are significant in that they increase our understanding of CFS
carers' quality of life, their efforts to cope with the illness, and the
physical and emotional help they may provide to the sufferer. Such information
can be usefully employed in the increasing development of counselling
interventions and instrumental support networks that involve both sufferers and
their carers.
PMID: 11989141 [PubMed - in process]
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10) Sex hormonal factors and chronic widespread pain: a population study among
women
05/01/2002 By Anne MacLennan Rheumatology Online
The higher rate of chronic widespread pain in women, the cardinal feature of
fibromyalgia, does not appear to be linked to sex hormonal factors, despite
earlier suggestions they may be.
This is the finding of a population-based study of 1,178 women in north-west
England by T. V. Macfarlane and colleagues from the University Dental Hospital
of Manchester and University of Manchester, Manchester.
Although there has been little evidence to support such an association, the
observation of higher rates of chronic widespread pain in women has led to
hypotheses about the possible role of hormonal factors.
However, among both pre- and peri-menopausal women in this postal survey, risk
of chronic widespread pain was unrelated either to the length of the menstrual
cycle or the usual length of menstrual period.
Risk of pain was also similar in both current users and non-users of the oral
contraceptive pill and, in pill users, was not related to duration of pill use.
Although reporting of chronic widespread pain did show an association with total
score on a questionnaire relating to premenstrual symptoms, this was explained
by pain symptoms. Nor was there any relationship found in post-menopausal women
between reporting of chronic widespread pain and age at menopause.
An increased risk of pain related to current hormone replacement therapy (HRT)
was found to be non-significant and could be a consequence of HRT's being
prescribed for menopausal symptoms, the authors suggest.
Rheumatology 2002; 41: 454-457. "Sex hormonal factors and chronic widespread
pain: a population study among women"
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