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The Fibromyalgia Community Newsletter # 7 Friday, 01/18/2002
http://www.fibrom-l.org or http://www.fmscommunity.org
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Note: Last week's issue was misnumbered as #5. It should be numbered #6. We apologize for the error.
This week's News Summary:
1) Announcement: Outstanding Website Award for 2002
2) Article: Success Stories," personal accounts of coping and recovery
3) Research: Is pain-related fear a predictor of somatosensory hypervigilance in chronic low back pain patients?
4) Contest: The Fibromyalgia Community's January Contest!
5) Research: Acetaminophen, aspirin, or Ibuprofen in combination analgesic products
6) Research: A double-blind, randomized, controlled study of amitriptyline, nortriptyline and placebo in patients with fibromyalgia. An analysis of outcome measures
7) Article: Pfizer to Offer Drug Discount to Low-Income Elderly
8) News Release:JCAHO TEAMS WITH AMA AND NCQA ON PAIN MANAGEMENT
9) Research: Future directions in pain management
10) Research: A Biopsychosocial overview of pretreatment screening of patients with pain
11) News Release: About Herb Kava Kava
12) Central nervous system mechanisms of pain in fibromyalgia and other musculoskeletal disorders: behavioral and psychologic treatment approaches
13) Research: Myofascial Pain in Athletes
14) Research: Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis
15) Research: Quantitative sensory testing in fibromyalgia patients and in healthy subjects: identification of subgroups
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Note: Full Stories on some articles are available via web links
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1)
Outstanding Website Award for 2002
01/13/2002 - The Fibromyalgia Community has been awarded an Outstanding Website Award for 2002 from Disability Network Inc. http://www.disabilitynetwork.com/awards.html
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2)
Third in the new series "Success Stories," personal accounts of coping and recovery.
Dean Anderson describes his successful 8-year effort to recover from CFIDS in the new feature article at the CFIDS/Fibromyalgia Self-Help website: http://CFIDSselfhelp.org. Read how he used a self-help strategy that focused on accepting his illness and living within its limits, while maintaining an attitude of hope.
The article is the third 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.
Bruce Campbell, Ph.D.,
Director CFIDS/Fibromyalgia Self-Help Program
mailto:Brucepa@flash.net
[AOL: <a href="http://CFIDSselfhelp.org">http://CFIDSselfhelp.org</a>]
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3)
Is pain-related fear a predictor of somatosensory hypervigilance in chronic low back pain patients?
Behav Res Ther 2002 Jan;40(1):85-103 Related Articles, Books, LinkOut
Peters ML, Vlaeyen JW, Kunnen AM.
Department of Medical, Clinical and Experimental Psychology, Maastricht University, The Netherlands. madelon.peters@dep.unimaas.nl
Pain-related fear has been found to be associated with increased disability and increased pain perception in patients with chronic low back pain. A possible mechanism by which pain-related fear could lead to increased pain perception is heightened attention to somatosensory sensations. In the present study, chronic pain patients reporting either a high or low level of pain related fear and control participants performed an auditory reaction time task, while occasionally non-painful electrical stimuli--accompanied by threatening instructions--were given to the arm or back. In the primary task condition, participants had to perform the auditory task while ignoring the electrical stimuli. Next, the task was presented under dual task conditions in which participants had to respond both to tones as well as to detection of electrical stimuli. It was hypothesized that for the primary task, high fearful patients would show greater disruption of performance on the auditory task than low fearful patients and controls when stimuli were presented to the back. For the dual task, slower reaction times for the auditory task, in combination with faster detection of electrical stimuli was expected. The hypotheses were not confirmed but patients scoring high on pain-related fear did show an overall increase in reaction time for all conditions of the primary task, with or without simultaneous stimulation.
Regression analyses demonstrated that high pain-related fear was associated with increased reaction time to tones both in patients and healthy controls, and that within patients pain-related fear was a better predictor of reaction time to tones than present pain intensity. The findings may be interpreted as showing that patients with elevated levels of pain-related fear habitually attend to somatic sensations, giving less priority to other attention-demanding tasks.
PMID: 11764761 [PubMed - in process]
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4)
The Fibromyalgia Community's January Contest!
WIN A COPY OF "The FIBROMYALGIA CHEF" BY MARK PELLIGRINO!
15 Winners!!
Details: http://www.fibrom-l.org
This being the time of year when most of us are indoors due to the cold and eating hot meals, we decided our new contest would be Health friendly recipes, or Fibro Friendly. (This contest of course includes those with CMP, CFIDS, Lupus and other "umbrella" disorders.
The criteria for an entry will be.....
It must be fast and easy to prepare, saving on our energy levels.
It should consist of low cost ingredients for those with low incomes.
Preparation should have minimal clean up.
Special dietary needs can be addressed, such as the Zone diet, or a diabetic diet, but this is not a requirement.
That's it, that's all we need! Send us your favorite energy saving recipes.
We will post them at http://www.fibrom-l.org and on Jan. 31, 2001, we will close the contest and open up the vote. Yes, that's right! You'll be voting for your favorite recipes and the top 15 each receive "The Fibromyalgia Chef" by Mark Pelligrino!
Enter Today! Send your entries to mailto:fibroml@earthlink.net
These contests are only possible due to Donations from individuals and businesses. Our books, CD's and gift certificates are all from donations. If you have anything you are able to donate to keep this site alive and help a fellow FM'er please contact us at: mailto:fibroml@earthlink.net or go to:
http://fibrom-l.org/help.htm for more information.
[AOL: <a href="http://www.fibrom-l.org">The Fibromyalgia Community Contest</a>]
We're moving to our new home at the end of March, The Fibromyalgia Community (http://www.fmscommunity.org).
[AOL: <a href="http://www.fmscommunity.org">The New Fibromyalgia Community Website</a>]
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5)
Acetaminophen, aspirin, or Ibuprofen in combination analgesic products.
Barkin, R. L. (2001).
American Journal of Therapeutics 8(6): 433-42.
Pain of multiple etiologies remains a substantial problem for many patients presenting in the clinical setting. Improved pain relief can be demonstrated, and adverse effects minimized, by multimodal analgesic combinations as the method to improve pain treatment. Substantial evidence supports combining analgesics for the management of pain and, in some instances, they have a heterogenous pharmacologic sparing effect. Fixed-dose combination analgesics with demonstrated efficacy and safety are widely useful for pain management. However, work needs to continue to further explore which analgesics at which doses can be combined with a coanalgesic in a patient-specific manner to achieve additive, if not synergistic, multimodal pain relief with the fewest possible adverse consequences.
Unsupervised consumption of over-the-counter drugs that contain acetaminophen, aspirin, or ibuprofen offers clinical challenges to both the patient and health care providers. Couple this often undisclosed over-the-counter medication consumption event with prescription medications, which many contain similar combination ingredients, and the potential for a therapeutic misadventure may precipitate. This article will address the safety and efficacy of acetaminophen, aspirin, and ibuprofen independently and in combination with currently available prescription dosage forms with a focus on pharmacology, pharmacotherapeutics, pharmacodynamics, and pharmacokinetics, including drug interactions at the CYP450 system.
Patient-specific cautions are presented for opiate/opioid combinations, codeine, hydrocodone, oxycodone, and propoxyphene, and there is a discussion of COX I/COX II agents.
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6)
A double-blind, randomized, controlled study of amitriptyline, nortriptyline and placebo in patients with fibromyalgia. An analysis of outcome measures.
Journal: Clin Exp Rheumatol 2001 Nov-Dec;19(6):697-702
Authors: Heymann RE, Helfenstein M, Feldman D.
Affiliation: Department of Medicine, Federal University of Sao Paulo, Escola Paulista de Medicina, SP, Brazil.
NLM Citation: PMID: 11791642
OBJECTIVE: To study the efficacy and tolerability of amitriptyline and nortriptyline in a Brazilian population with fibromyalgia and to evaluate the instruments used to measure the efficacy of the treatment.
METHODS: A total of 118 fibromyalgia patients were randomly assigned to 3 groups: amitriptyline (AM, n = 40), nortriptyline (NOR, n =38) and placebo (PL, n = 40), and were blindly given 25 mg at bedtime of the assigned treatment for 8 weeks. Clinical evaluation before and at the end of the study included the number of tender points (NTP), FIQ score (FIQ), and global improvement as reported by the patients on a verbal scale (VSGI).
RESULTS: The 3 groups were comparable at baseline for all the parameters studied. After 8 weeks, the 3 groups improved in all parameters: (36.5% AM, 26.7% NOR and 24% PL patients improved on FIQ; 13.9% AM, 19.5% NOR and 8.57% PL patients improved on NTP; 86.5% AM, 72.2% NOR and 57.6% PL patients improved on VSGI). Only the AM group differed from the PL group on VSGI. Side effects were noted among the groups, but none were serious (16 in the AM group, 31 in the NOR group, and 25 in the PL group).
CONCLUSION: All three groups improved after treatment. Only the patient's subjective global assessment of improvement differed between the AM patients and the PL group (p < or = 0.03). In fibromyalgia, placebo groups are important in drug trials. Different measures of therapeutic effect are not better than the patient's self assessment.
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7)
Pfizer to Offer Drug Discount to Low-Income Elderly
Pfizer said it would offer its drugs to low-income elderly
people for a flat fee of $15 a month for each prescription.
http://www.nytimes.com/2002/01/16/business/16DRUG.html?todaysheadlines
[AOL: <a href="http://www.nytimes.com/2002/01/16/business/16DRUG.html?todaysheadlines">Pfizer to Offer Drug Discount to Low-Income Elderly</a>]
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8)
*this is of importance because of the weight that JCAHO has with hospitals and other medical centers.
JCAHO TEAMS WITH AMA AND NCQA ON PAIN MANAGEMENT
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the American Medical Association (AMA), and the National Committee for Quality Assurance (NCQA) recently announced a two-year project to develop standardized pain management performance measures. The organizations will convene a panel made up of practicing physicians, pain management experts, and performance measurement experts to define important aspects of pain management to be measured. They will then develop and test these measures across multiple care settings. JCAHO will be the administrative center for the project.
A news release from JCAHO is available at:
http://www.jcaho.org/news/nb350.html
[AOL: <a href="http://www.jcaho.org/news/nb350.html">ACAHO News Release</a>]
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9)
Future directions in pain management.
.
Clinical & Experimental Rheumatology 19(6 Suppl 25): Nov-Dec.
Furst, D. (2001)
Relevant aspects of pain physiology and anatomy are reviewed, including hyperalgesia (an exaggerated response to normally mild stimuli) and allodynia (pain in response to normally non-noxious stimuli). Although the principal animal models do an excellent job at separating thermal, mechanoreceptor, and visceral aspects of pain, they are not very good predictive models because human pain is more complex. Human pain includes overlapping aspects of specific pain types, such as spontaneous and induced pain, and is modified by gender, stress, states of vigilance, and depression. Nonsteroidal anti-inflammatory drugs (NSAIDs) have both peripheral and central analgesic effects. While prostaglandin-mediated effects are clearly operative, there are also other potential mechanisms involved in many cases and these may be quite important in certain patients.
Effects mediated by cyclooxygenase-1, leukotriene B4, and intracellular transcription elements such as peroxisomal proliferator-activated receptors gamma (PPARgamma) may account for part of the spectrum of NSAID actions.
Future directions for analgesic research are many, but include the use of nitric oxide (NO) NSAIDs; the possibility of decreasing NO in the central nervous system; inhibiting the vanilloid receptor-1; inhibiting adenosine kinase; activating PPARgamma; and mimicking superoxide dismutase, as well as combinations of complementary-acting analgesics.
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10)
A Biopsychosocial overview of pretreatment screening of patients with pain.
Clinical Journal of Pain 17(3): 192-9.
Gatchel, R. J. (2001).
The prevalence and excessive cost of pain, especially when the pain becomes chronic, remains a major health-care problem in the United States.
Currently, a biopsychosocial perspective of pain has been found to be the most heuristic approach to understanding and managing it. Using this perspective, an important advance has been made in the possibility of individually tailoring treatment for each patient, with the result being better outcomes. The author reviews the extant literature demonstrating a robust "psychosocial disability factor" among injured workers that is important not only in pain perception, but also in the subsequent development of chronic pain-related disability. Such results emphasize the importance of taking into account how psychosocial and physical factors are intertwined in a complex way in determining pain symptomatology. On the basis of these findings, a number of surgical pre-screening approaches have been developed and found to be effective for maximizing surgical outcomes as described by Carragee, Epker, and Block in other papers in this special topics series. Recently, several organizations in the U.S. have also developed new standards for the evaluation of pain. For example, the Joint Commission on Accreditation of Health Organizations (JCAHO) now requires that physicians consider pain as a "5th vital sign" in evaluating patients.
Such initiatives have created a new mandate to regularly assess and manage all types of pain. The use of opioids, as well as implantable pain-management modalities, are among the options. The author notes that the literature on these modalities focuses on interdisciplinary patient-screening approaches prior to their administration as a way of maximizing treatment outcomes. The papers by Praeger, Jacobs, and Robinson et al. in this special topics series describe the approach to pretreatment assessment for these modalities in detail. Finally, the author presents a stepwise, biopsychosocial approach as the basis for assessment before decisions regarding surgery, opioid maintenance therapy, and implantable pain-management modalities. The author suggests that systematic pretreatment interventions will facilitate a more structured standard of care in the evaluation and treatment of patients with pain and ultimately better outcomes.
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11)
About Herb Kava Kava
The Food and Drug Administration (FDA) needs your help. The agency is investigating whether the use of dietary supplements containing kava (also known as kava kava or Piper methysticum) is associated with liver toxicity.
To help us determine whether there is a problem in the United States, we are asking that you review your cases of liver toxicity to determine if any may be related to the use of kava-containing dietary supplements.
Products containing herbal extracts of kava have been implicated in cases of serious liver toxicity in Germany and Switzerland. Approximately 25 reports of hepatic toxicity associated with the use of products containing kava extracts have been reported in these countries. Serious hepatic adverse effects include hepatitis, cirrhosis, and liver failure. At least one patient required a liver transplant. Based on their assessment of the adverse events reported to them, the regulatory authority in Switzerland has prohibited the sale of products containing the kava extract associated with the adverse effects. Last month, the German authorities issued a proposal to remove all kava extract-containing products from the market.
FDA is investigating whether the use of kava-containing dietary supplements in the United States poses similar public health concerns. The agency has received several reports of serious injury allegedly associated with the use of kava-containing dietary supplements, with at least one report of hepatic failure requiring liver transplantation in a previously healthy young female.
Dietary supplements containing kava are promoted for a variety of uses, including relaxation (e.g., to relieve stress, anxiety, and tension), insomnia, and postmenstrual syndrome (PMS). The products are marketed to all segments of the population, including children, women, men, and the elderly.
Due to the potentially serious nature of these concerns, we urge you to report any cases of hepatic toxicity that you think may be related to the use of kava-containing dietary supplements. Adverse events associated with the use of dietary supplements should be reported as soon as possible to FDA's MedWatch program by telephone (1-800-332-1088) or through the Internet (http://www.fda.gov/medwatch/).
Thank you in advance for your cooperation in assisting the FDA in investigating this potentially serious public health issue. For additional information, contact Steven Gitterman, M.D., Ph.D. at (301) 436-2371.
Christine Lewis Taylor, Ph.D.
Director Office of Nutritional Products, Labeling and Dietary Supplements Center for Food Safety and Applied Nutrition
[AOL: <a href="http://www.fda.gov/medwatch">FDA's MedWatch program</a>]
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12)
Central nervous system mechanisms of pain in fibromyalgia and other musculoskeletal disorders: behavioral and psychologic treatment approaches.
Curr Opin Rheumatol 2002 Jan;14(1):45-51
Bradley LA, McKendree-Smith NL.
Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
PMID: 11790996
Pain is one of the most important and challenging consequences of musculoskeletal disorders.
This article examines the role of central nervous system structures in the physiology of pain. It also describes the neuromatrix, a construct that provides a framework for understanding the interaction between physiologic mechanisms and psychosocial factors in the development and maintenance of chronic pain.
This construct suggests that behavioral and psychologic interventions may alter the pain experience primarily through their effects on emotional states and cognitive processes. The literature on cognitive-behavioral interventions for patients with rheumatoid arthritis and osteoarthritis indicates that they are well-established treatments for these disorders.
However, the efficacy of these interventions for patients with fibromyalgia has not been established. It is anticipated that the development of valid measures of readiness for behavioral change may allow investigators to identify the patients with musculoskeletal disorders who are most likely to benefit from cognitive-behavioral intervention.
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13)
Myofascial Pain in Athletes
eMedicine Journal, October 18 2001, Volume 2, Number 10
Auri A Bruno, M.D., M.S., Chief of Outpatients Clinic, Clinical Assistant, Discipline of Physical Medicine and Rehabilitation, Sao Paulo Federal University, Brazil
Voluntary (skeletal) muscle is the largest single organ of the human body and accounts for nearly 50% of body weight. The number of muscles counted in the body depends on the degree of subdivision that is considered one muscle and on the number of variable muscles that are included. Not counting heads, bellies, and other divisions of muscles, the Nomina Anatomica reported by the International Anatomical Nomenclature Committee under the Berne Convention, lists 200 paired muscles, or a total of 400 muscles. Any one of these muscles can develop myofascial trigger points (TrPs) that refer pain and motor dysfunction, often to another location....more: http://www.emedicine.com/sports/topic158.htm
[AOL: <a href="http://www.emedicine.com/sports/topic158.htm">Myofascial Pain in Athletes</a>]
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14)
Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis.
Lancet 2001 Dec 8;358(9297):1946-54
White PD, Thomas JM, Kangro HO, Bruce-Jones WD, Amess J, Crawford DH, Grover SA, Clare AW.
Department of Psychological Medicine, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK. P.D. White@qmul.ac.uk
BACKGROUND: Certain infections can trigger chronic fatigue syndromes (CFS) in a minority of people infected, but the reason is unknown. We describe some factors that predict or are associated with prolonged fatigue after infectious mononucleosis and contrast these factors with those that predicted mood disorders after the same infection.
METHODS: We prospectively studied a cohort of 250 primary-care patients with infectious mononucleosis or ordinary upper-respiratory-tract infections until 6 months after clinical onset. We sought predictors of both acute and chronic fatigue syndromes and mood disorders from clinical, laboratory, and psychosocial measures.
FINDINGS: An empirically defined fatigue syndrome 6 months after onset, which excluded comorbid psychiatric disorders, was most reliably predicted by a positive Monospot test at onset (odds ratio 2.1 [95% CI 1.4-3.3]) and lower physical fitness (0.35 [0.15-0.8]). Cervical lymphadenopathy and initial bed rest were associated with, or predicted, a fatigue syndrome up to 2 months after onset. By contrast, mood disorders were predicted by a premorbid psychiatric history (2.3 [1.4-3.9]), an emotional personality score (1.21 [1.11-1.35]), and social adversity (1.7 [1.0-2.9]). Definitions of CFS that included comorbid mood disorders were predicted by a mixture of those factors that predicted either the empirically defined fatigue syndrome or mood disorders.
INTERPRETATION: The predictors of a prolonged fatigue syndrome after an infection differ with both definition and time, depending particularly on the presence or absence of comorbid mood disorders. The particular infection and its consequent immune reaction may have an early role, but physical deconditioning may also be important. By contrast, mood disorders are predicted by factors that predict mood disorders in general.
PMID: 11747919 [PubMed - in process]
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15)
Quantitative sensory testing in fibromyalgia patients and in healthy subjects: identification of subgroups.
Clin J Pain 2001 Dec;17(4):316-22
Hurtig IM, Raak RI, Kendall SA, Gerdle B, Wahren LK.
Department of Medicine and Care, Pharmacology, Faculty of Health Sciences, Linkoping, Sweden. mailto:ingrid@hurtig@far.liu.se
PMID: 11783811
OBJECTIVE: To determine perception and pain thresholds in patients with fibromyalgia syndrome and in healthy controls, and to investigate whether patients with fibromyalgia syndrome can be grouped with respect to thermal hyperalgesia and whether these subgroups differ from healthy controls and in clinical appearance.
DESIGN: The authors conducted a quasi-experimental clinical study.
SUBJECTS: Twenty-nine women patients with fibromyalgia syndrome and 21 healthy pain-free age-matched women participated in the study.
METHODS: Quantitative sensory testing using a Thermotest instrument was performed on the dorsum of the left hand. Sleep and pain intensity were rated using visual analog scales.
RESULTS: Cold and heat pain but not perception thresholds differed significantly between patients with fibromyalgia syndrome and healthy subjects. Based on thermal pain thresholds, two subgroups could be identified in fibromyalgia syndrome using cluster analysis.
CONCLUSION: Patients with fibromyalgia syndrome were subgrouped by quantitative sensory testing (i.e., thermal pain thresholds). Subgroups show clinical differences in pain intensities, number of tender points, and sleep quality. Cold pain threshold was especially linked to these clinical aspects.
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