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The Fibromyalgia Community Newsletter # 23 Saturday, 07/06/2002
http://www.fmscommunity.org
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Featured link: Making a "Not to Do" List
One way to make life more manageable is to use a "Not To Do" list, suggests
guest author Eunice Beck in this week's feature article at the
CFIDS/Fibromyalgia Self-Help website.
Read it here: http://www.CFIDSselfhelp.org AOL users: <a href="http://cfidsselfhelp.org">Read
it here</a>
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This week's news:
1) Discrimination of FM patients from normal controls using levels of
cerebrospinal chemicals
2) Fibromyalgia may be on the increase
3) Fibromyalgia: After the Diagnosis
4) Canaries in the mines: A personal account of MCS
5) Toxic Chemicals Seen Contributing To Increased Childhood Illness
6) Women With Fibromyalgia Have Impaired Growth Hormone Secretion
7) Fibromyalgia pain isn't all in patients' heads, new brain study finds
8) The role of fear of physical movement and activity in chronic fatigue
syndrome
9) Illness experience, depression, and anxiety in chronic fatigue syndrome
10) Self-appraised problem solving and pain-relevant social support as
predictors of the experience of chronic pain
11) Tender Point Injections Revisited
12) An Overview of Fibromyalgia for Newly Diagnosed Patients
13) Rheumatic mimics and selected triggers of fibromyalgia Neuroendocrine
abnormalities in fibromyalgia.
14) Neuroendocrine abnormalities in fibromyalgia
15) Endplate potentials are common to midfiber myofacial trigger points.
16) Neuropharmacologic targets and agents in fibromyalgia.
17) Coping with fibromyalgia. A qualitative study.
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1)
Discrimination of FM patients from normal controls using levels of cerebrospinal
chemicals
In this thought-provoking study, researchers from San Antonio, Texas, set out to
predict which neurochemicals from the cerebrospinal fluid (CSF) could
discriminate FM patients from healthy normal controls.
Drawing on a large bank of CSF samples from medication-free FM patient and
healthy normal controls, they selected a sample of demographically matched FM
patients (28) for their study. The three neurochemicals which they found best
discriminated fibromyalgia from healthy normal controls were: Substance P (SP),
nerve growth factor (NGF), and
5-hydroxyindole acetic acid (5HIAA). The researchers determined that the best
formula for these three neurochemicals was: Log[y/1-y] = -7.156 +
0.359 (SP) + 0.051 [NGF] -0.067 [HIAA]. This formula distinguished FM patients
from healthy controls with 90.6% accuracy, an accuracy comparable to that of
the! ACR's 1990 criteria. The Texas research group noted that the new formula
not only provided a new study tool for fibromyalgia research but also served as
additional evidence of FM as a clinical disorder with objective neurochemical
abnormalities. (MYOPAIN Abstracts by T.S. Kuan, Z. Vukimirovic, Y.M. Xiao, R.A.
Lawrence, and I.J.Russell)
This abstract is reprinted with permission from Fibromyalgia Frontiers, Vol. 9,
# 4, the official publication of the National Fibromyalgia Partnership.
Check it out: http://fmpartnership.org/FMPartnership.htm AOL users: <a
href="http://fmpartnership.org/FMPartnership.htm">Read it here</a>
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2)
Fibromyalgia may be on the increase
Steve Mitchell, UPI Medical Correspondent
Fibromyalgia, a painful but often misunderstood condition affecting millions of
Americans, appears to be popping up in more people -- but limited funding for
research and skepticism among some doctors about the disease have frustrated
patients and inhibited progress toward developing effective treatments.
Check it out: http://www.upi.com/view.cfm?StoryID=03072002-051603-2187r AOL
users: <a href="http://www.upi.com/view.cfm?StoryID=03072002-051603-2187r">Read
it here</a>
3) Fibromyalgia: After the Diagnosis
Although FM does not cause loss of life, it does bring about a loss of our
former lifestyle. It is both normal and necessary for you to grieve any
significant loss. Learn about the five stages of grief and how you can begin to
manage your FM instead of letting your FM manage you.
Check it out: http://fmaware.org/patient/coping/afterthedx.htm AOL users: <a
href="http://fmaware.org/patient/coping/afterthedx.htm">Read it here</a>
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4)
Canaries in the mines: A personal account of MCS
A personal account of the physical, economic and emotional toll left by MCS and
the legal ramifications of one man's struggle.
Check it out:
http://www.universalmetropolis.com/magazine/articles.php?article=Canarie
s_in_the_Mines AOL users: <a href="http://www.universalmetropolis.com/magazine/articles.php?article=C
anaries_in_the_Mines">Read it here</a>
5) Toxic Chemicals Seen Contributing To Increased Childhood Illness
WASHINGTON (Cox News Service) -- Although death rates from many types of cancer
are falling, the reported incidence of cancer and other diseases among America's
children is rising, pediatricians said Tuesday.
Too little is known about possible relationships between childhood disease and
an environmental "soup" of thousands of mostly untested industrial chemicals
that didn't even exist a half-century ago, they said.
"There are 85,000 chemicals registered with the Environmental Protection Agency
for commercial use in America," said Dr. Philip Landrigan, director of the
Center for Children's Health and the Environment at Mount Sinai School of
Medicine in New York.
Virtually all of them did not exist before the 1960s and most have not been
sufficiently tested for their effect on human beings, he added.
Check it out:
http://www.intelihealth.com/IH/ihtIH/WSIHW000/20722/8895/351112.html AOL users:
<a href="http://www.intelihealth.com/IH/ihtIH/WSIHW000/20722/8895/351112.ht
ml">Read it here</a>
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6)
Women With Fibromyalgia Have Impaired Growth Hormone Secretion
Women with fibromyalgia have an impaired growth hormone response to exercise
that is reversible with pyridostigmine. This impaired response exists even in
fibromyalgia patients with normal levels of insulin-like growth factor-one (IGF-one),
Eduardo S. Paiva and colleagues from Oregon Health Sciences University in
Portland have found.
Check it out:
http://www.immunesupport.com/library/bulletinarticle.cfm?ID=3617 AOL: <a
href="http://www.immunesupport.com/library/bulletinarticle.cfm?ID=3617"> Read it
here</a>
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7)
Fibromyalgia pain isn't all in patients' heads, new brain study finds
ANN ARBOR, MI - A new brain-scan study confirms scientifically what fibromyalgia
patients have been telling a skeptical medical community for years: They're
really in pain.
In fact, the study finds, people with fibromyalgia say they feel severe pain,
and have measurable pain signals in their brains, from a gentle finger squeeze
that barely feels unpleasant to people without the disease. The squeeze's force
must be doubled to cause healthy people to feel the same level of pain - and
their pain signals show up in different brain areas.
The results, published in the current issue of Arthritis & Rheumatism, the
journal of the American College of Rheumatology, may offer the proof of
fibromyalgia's physical roots that many doubtful physicians have sought.
Check it out:
http://www.sciencedaily.com/releases/2002/06/020607073056.htm AOL users: <a
href="http://www.sciencedaily.com/releases/2002/06/020607073056.htm">Rea d it
here</a>
Full story and video at:
http://www.detnow.com/healthyliving/0206071701h.html AOL users: <a href="http://www.detnow.com/healthyliving/0206071701h.html">Read
it here</a>
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8)
The role of fear of physical movement and activity in chronic fatigue syndrome
Journal: J Psychosom Res 2002 Jun;52(6):485-93 Authors: Silver A, Haeney M,
Vijayadurai P, Wilks D, Pattrick M, Main CJ.
Affiliation: Department of Psychological Medicine, John Radcliffe Hospital,
Headington, OX3 9DU, Oxford, UK NLM Citation: PMID: 12069873
OBJECTIVE: To examine beliefs in relation to avoidance of activity in chronic
fatigue syndrome (CFS) patients.
METHODS: The first phase consisted of modifying an existing chronic pain measure
of kinesiophobia-fear of physical movement and activity-and validating it on the
CFS population [Tampa Scale of Kinesiophobia-Fatigue (TSK-F); n=129;
test-retest: r=.89, P<.001; alpha=.68]. Subscales of Illness Beliefs (alpha=.78)
and Beliefs about Activity (alpha=.70) were identified. The second phase
consisted of evaluating whether behavioural persistence was predicted by the TSK-F
(n=33). Participants were asked to ride an exercise bike for as long as they
felt able.
RESULTS: Analyses indicated that behavioural persistence did not correlate with
maximal heart rate or resting heart rate, level of tiredness, symptom severity,
illness identity or emotional distress.
However, the TSK-F did correlate highly with distance travelled and added a
significant 15% of the variance in distance after adjustments for gender and
physical functioning (PF). The TSK-F Beliefs about Activity subscale appears to
be the predictive factor, explaining 12% of the variance in excise performance
or rather 12% of the avoidance of exercise.
CONCLUSION: Beliefs about Activity appear to be an important variable in
predicting behaviour and avoidance of exercise. As avoidance has been suggested
as a key to the maintenance of symptoms, disability and distress in CFS
patients, this research has important theoretical, clinical and research
implications.
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9)
Illness experience, depression, and anxiety in chronic fatigue syndrome
Journal: J Psychosom Res 2002 Jun;52(6):461-5 Authors: Lehman AM, Lehman DR,
Hemphill KJ, Mandel DR, Cooper LM.
Affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC,
Canada NLM Citation: PMID: 12069870
OBJECTIVE: Given the high rate of psychiatric comorbidity with chronic fatigue
syndrome (CFS), we considered two possible correlates of anxiety and depression:
lack of illness legitimization and beliefs about limiting physical activity.
METHOD: A total of 105 people diagnosed with CFS reported on their experiences
with medical professionals and their beliefs about recovery and completed the
depression and anxiety subscales of the Brief Symptom Inventory.
RESULTS: Those who said that their physician did not legitimize their illness
(36%) had higher depression and anxiety scores (P's<.05) than their
counterparts. Those who believed that limiting their physical exertion was the
path to recovery (55%) had lower depression and anxiety scores (P's<.01) than
their counterparts.
CONCLUSION: Lack of illness legitimization ranked high as a source of
dissatisfaction for CFS patients, and it may aggravate psychiatric morbidity.
Many CFS patients believed that staying within what they felt to be their
physical limits would improve their condition. This belief, and possibly an
accompanying sense of control over their symptoms, may alleviate psychiatric
morbidity.
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10)
Self-appraised problem solving and pain-relevant social support as predictors of
the experience of chronic pain.
Kerns RD, Rosenberg R, Otis JD.
Psychology Service, VA Connecticut Healthcare System and Yale University School
of Medicine, West Haven 06516, USA.
The purpose of this study was to examine the contributions of self-appraised
problem-solving competence and pain-relevant social support to the prediction of
pain, depression, and disability. The 234 chronic pain patients referred for
participation in a comprehensive pain management program were administered
self-report measures of pain, depression, disability, pain-relevant social
support, and problem solving. Hierarchical multiple-regression analyses revealed
that lower self-appraised problem-solving competence was related to increased
pain, depression, and disability. Pain-relevant social support was directly
related to pain and disability but indirectly related to depression.
High levels of pain-relevant social support were found to buffer the relation
between poorer self-appraised problem-solving competence and depressive
symptoms. The results support the assessment of problem-solving skills in
chronic pain patients and the investigation and utility of interventions aimed
at increasing adaptive pain-relevant social support.
PMID: 12054314 [PubMed - in process] Ann Behav Med 2002 Spring;24(2):100-5
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11)
Tender Point Injections Revisited
by Lynne Matallana Copyright C 2002 National Fibromyalgia Association (NFA)
When a doctor looks at a Fibromyalgia patient and says, "There is nothing I can
do for you," it is obvious that they have not read an article published in the
Journal of Musculoskeletal Pain, [Vol. 8 (4),
2000] entitled, "Tender Point Injections Are Beneficial in Fibromyalgia
Syndrome: A Descriptive, Open Study." Doctors Savitha Reddy, Muhammad Yunus,
Fatma Inanici, and Jean Aldag's recent work concludes that tender point (TeP)
injections are a "useful and safe adjunct to other forms of therapy in FMS."
Their study, which took place in a clinical setting, was designed to be the
first detailed study evaluating TeP injections in fibromyalgia.
Check it out: http://fmaware.org/patient/tpinjectionspf.htm AOL users: <a
href="http://fmaware.org/patient/tpinjectionspf.htm">Read it here</a>
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12)
An Overview of Fibromyalgia for Newly Diagnosed Patients
Fibromyalgia (fi-bro-my-AL-ja) syndrome (FMS) is a very common condition of
widespread muscular pain and fatigue. Seven to ten million Americans suffer from
FMS. It affects women much more than men in an approximate ratio of 20:1. It is
seen in all age groups from young children through old age, although in most
patients the problem begins during their 20s or 30s. Recent studies have shown
that fibromyalgia syndrome occurs world wide and has no specific ethnic
predisposition.
Check it out: http://www.myalgia.com/overview2.htm AOL users: <a href="http://www.myalgia.com/overview2.htm">Read
it here</a>
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13)
Rheumatic mimics and selected triggers of fibromyalgia.
Journal: Curr Pain Headache Rep 2002 Aug;6(4):284-8
Authors: Daoud KF, Barkhuizen A.
Affiliation: Oregon Health and Science University, Division of Rheumatology,
3181 SW Sam Jackson Park Road, Portland, OR 97201, USA.
mailto:Bark-@ohsu.edu
NLM Citation: PMID: 12095463
Fibromyalgia is a chronic pain syndrome of unknown etiology characterized by
diffuse pain and tender points, which have been present for more than 3 months.
Many patients with systemic illnesses can have diffuse pain similar to that
found in fibromyalgia, including rheumatic diseases such as polymyalgia
rheumatica, rheumatoid arthritis, idiopathic inflammatory myopathy, systemic
lupus erythematosus, and joint hypermobility.
Osteomalacia and thyroid disease are also in the differential diagnosis of
diffuse pain and are imminently treatable. In addition, there has been interest
throughout the past 10 years in infectious diseases including hepatitis C, Lyme
disease, coxsackie B, HIV, and parvovirus infection, which may cause or trigger
fibromyalgia.
This paper provides a framework to use when identifying these diseases as part
of the evaluation of a patient with chronic widespread musculoskeletal pain.
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14)
Neuroendocrine abnormalities in fibromyalgia.
Journal: Curr Pain Headache Rep 2002 Aug;6(4):289-98
Authors: Adler GK, Manfredsdottir VF, Creskoff KW.
Affiliation: Endocrine-Hypertension Division, Brigham and Women's Hospital,
Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA. mailto:gad-@partners.org
NLM Citation: PMID: 12095464
Fibromyalgia is a disorder of unknown etiology characterized by chronic,
widespread musculoskeletal pain and symptoms such as fatigue, poor sleep,
gastrointestinal complaints, and psychologic problems that are similar to those
experienced by patients with hormone deficiencies.
This review summarizes the available data on the neuroendocrine function in
fibromyalgia, including data on hormone secretion, circadian phase, and
autonomic nervous system function.
Studies suggest that there may be lower activity of a number of
hypothalamic-pituitary-peripheral gland axes and altered autonomic nervous
system function in patients with fibromyalgia. These reductions in activity are
mild to moderate and do not result from alterations in circadian rhythms.
The reduced hormonal and autonomic responses appear to reflect an impairment in
the hypothalamic or central nervous system response to stimuli rather than a
primary defect at the level of the pituitary gland or the peripheral glands.
A combination of multiple, mild impaired responses may lead to more profound
physiologic and clinical consequences as compared with a defect in only one
system, and could contribute to the symptoms of fibromyalgia.
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15)
Endplate potentials are common to midfiber myofacial trigger points.
Journal: Am J Phys Med Rehabil 2002 Mar;81(3):212-22 Authors: Simons DG, Hong
CZ, Simons LS.
Affiliation: Department of Physical Medicine and Rehabilitation, University of
California-Irvine, USA.
NLM Citation: PMID: 11989519
OBJECTIVES: To compare the prevalence of motor endplate potentials (noise and
spikes) in active central myofascial trigger points, endplate zones, and taut
bands of skeletal muscle to assess the specificity of endplate potentials to
myofascial trigger points.
DESIGN: This nonrandomized, unblinded needle examination of myofascial trigger
points compares the prevalence of three forms of endplate potentials at one test
site and two control sites in 11 muscles of 10 subjects. The endplate zone was
independently determined electrically.
Active central myofascial trigger points were identified by spot tenderness in a
palpable taut band of muscle, a local twitch response to snapping palpation, and
the subject's recognition of pain elicited by pressure on the tender spot.
RESULTS: Endplate noise without spikes occurred in all 11 muscles at
trigger-point sites, in four muscles at endplate zone sites outside of trigger
points (P = 0.024), and did not occur in taut band sites outside of an endplate
zone (P = 0.000034).
CONCLUSIONS: Endplate noise was significantly more prevalent in myofascial
trigger points than in sites that were outside of a trigger point but still
within the endplate zone. Endplate noise seems to be characteristic of, but is
not restricted to, the region of a myofascial trigger point.
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16)
Neuropharmacologic targets and agents in fibromyalgia.
Journal: Curr Pain Headache Rep 2002 Aug;6(4):267-73
Authors: Suzuki R, Dickenson AH.
Affiliation: Department of Pharmacology, University College London, Gower
Street, London, WC1E 6BT, United Kingdom. mailto:uckl-@ucl.ac.uk
NLM Citation: PMID: 12095461
Chronic widespread pain is a primary feature of fibromyalgia and is a symptom
that is poorly managed in many patients. In addition, patients often experience
fatigue, sleep disturbances, and anxiety.
Its etiology is largely unknown. The successful clinical management of this
syndrome relies on a multidisciplinary approach, employing pharmacologic and
nonpharmacologic treatments.
Clinical evidence on the symptoms and characteristics of fibromyalgia suggests a
central mechanism behind the pathogenesis of this syndrome.
It is likely that drugs with central actions will prove to be effective against
a number of symptoms. This article aims to outline some of the potential spinal
pharmacologic targets that may be used to treat this condition.
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17)
Coping with fibromyalgia. A qualitative study.
Scand J Caring Sci 2000;14(1):29-36 Hallberg LR, Carlsson SG.
Department of Psychology, Goteborg University, Goteborg, Sweden.
mailto:lillemor.-@psy.gu.se
This study aims to describe, from the perspective of patients with fibromyalgia
themselves, their experiences of having to live with chronic pain and how they
manage their situation. The sample consists of
22 female patients (22-60 years). Open-ended in-depth interviews were analysed
by a method directed by the tradition of Grounded Theory. Three descriptive
categories were grounded in the data, labelled subjective pain language,
diversified pain coping, and pain communication. These descriptive categories
formed the higher-order, or core, concept preoccupied with pain. Having to live
with chronic pain seems to include that the sufferer becomes self-centred and
preoccupied with the pain:
the pain is mostly present and affects every aspect of life, leading to a
continuous awareness of and coping with the pain. Pain tends to interrupt normal
life, demands attention and is difficult to disengage from. Although coping
should not be evaluated in terms of good and bad, passivity, escape behaviours,
and resignation/catastrophizing, which dominated in the present study sample,
might affect social and psychological functioning negatively. Patients with
fibromyalgia might benefit from psychological support in coping with their pain
and from reinforcement of healthy behaviours.
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