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The Fibromyalgia Community Newsletter # 8 Friday, 01/26/2002
http://www.fmscommunity.org
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This week's News Summary:
1) Website: MIND OVER MATTER
2) Article: Pain, the Disease
3) Research: Exercise in the treatment of chronic pain
4) Research: Modafinil in Fibromyalgia Treatment (Letter )
5) News Release: FDA Approves Frova (Frovatriptan Succinate) for Migraines
6) Release: Jury Out On Single-Dose Morphine For Temporomandibular Joint Pain
7) FEATURE OF THE WEEK: Report: Effective Treatments for Fibromyalgia
8) Article: How do I know if I might have chronic fatigue syndrome?
9) Humor: Health Food Alert Wellness Program
10) Links: Tips for making homes more eco-friendly and allergy proof
11) News Release: FDA Approves New Percocet Strengths With Lower Acetaminophen
Doses
12) ArticleTherapy, massage and tailor-made exercise offer respite from the
nagging torment of fibromyalgia
13) Article: Tune In, Zone Out
14) Research: Long-Term follow-up on restless legs syndrome patients treated
with opioids
15) Article: How to safely take medications
16) Announcement: The Fibromyalgia Community's January Contest!
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Note: Full Stories on some articles are available via web links. Some sites
require you to "join". This is usually free of charge.
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1)
MIND OVER MATTER
It doesn't take a stretch of the imagination to realize music's impact on our
lives. There's no doubt it has the power to orchestrate our emotional tone.
Music can trigger just about any emotion - it can bring joy to our hearts or
sadness in anticipation of pain, loss, or separation. In "Music and Medicine:
the universal language of mind, body and soul" Barry Bittman, M.D. also reminds
us that all forms of music are not understood, appreciated or enjoyed by
everyone. Culture and preference must be considered in every form of music
therapy. Enjoyment rather than performance should be emphasized at all ages. For
a certain type of music to be healing, it has to resonate with one's soul - it
must be comprehended deep within.
http://healthy.net/asp/templates/column.asp?PageType=Column&id=33
AOL: <a href="http://healthy.net/asp/templates/column.asp?PageType=Column&id=33">Music
Thearpy</a>
Inner Peace Music features the recordings of Steven Halpern, an internationally
acclaimed composer, recording artist, author and educator whose music is
specifically composed to support relaxation, wellness and personal excellence.
For over 25 years, he has promoted the healing powers of music through his
innovative compositions, selling over 4 million albums worldwide and bringing
his music into homes, hospices, hospitals, and schools worldwide.
One place to find his music sold is at the following web site:
https://healthy.net/asp/stores/InnerPeace/cart.asp?itemnumber=IP-HW
AOL: <a href="https://healthy.net/asp/stores/InnerPeace/cart.asp?itemnumber=IP-HW">Inner
Peace Music</a>
Examples of titles:
Serenity Suite: (Music & Nature) Music for Sound Healing: (The Definitive
Collection) Recollections (soulful Violin & piano duet w/ Daniel Kobialka)
Chakra Suite (Balances the 7 vital energy centers)
***********************
2)
Pain, the Disease
By, MELANIE THERNSTROM
A modern chronicler of hell might look to the lives of chronic-pain patients for
inspiration. Theirs is a special suffering, a separate chamber, the dimensions
of which materialize at the New England Medical Center pain clinic in downtown
Boston. Inside the cement tower, all sights and sounds of the neighborhood --
the swans in the Public Garden, the lanterns of Chinatown -- disappear,
collapsing into a small examining room in which there are only three things: the
doctor, the patient and pain. Of these, as the endless daily parade of
desperation and diagnoses makes evident, it is pain whose presence predominates.
''Yes, yes,'' sighs Dr. Daniel Carr, who is the clinic's medical director.
''Some of my patients are on the border of human life. Chronic pain is like
water damage to a house -- if it goes on long enough, the house collapses. By
the time most patients make their way to a pain clinic, it's very late.'' What
the majority of doctors see in a chronic-pain patient is an overwhelming,
off-putting ruin: a ruined body and a ruined life. It is Carr's job to rescue
the crushed person within, to locate the original source of pain -- the leak,
the structural instability -- and begin to rebuild: psychically,
psychologically, socially.
For leaders in the field like Carr, this year marks a critical watershed. In
January, the Joint Commission on Accreditation of Healthcare Organizations, the
basic national health care review board, implemented the first national
standards requiring pain assessment and control in all hospitals and nursing
homes. Standards for evaluating and managing pain in lab animals have long been
tightly regulated, but curiously there had never before been any legal
equivalent for people.
Maine took the further step last year of passing its own legislation requiring
the aggressive treatment of pain, and California and other states are
considering following suit.
''It's a field on the verge of an explosion,'' Carr says. ''There's no area of
medicine with more growth and more public interest. We've come far enough
scientifically to see how far we have to go.'' Chronic pain -- continuous pain
lasting longer than six months -- afflicts an estimated 30 million to 50 million
Americans, with social costs in disability and lost productivity adding up to
more than $100 billion annually. However, only in recent years has it become a
focus of research. There used to be no pain specialists because pain had always
been understood as a symptom of underlying disease: treat the disease and the
pain should take care of itself. Thus, specializing in pain made no more sense
than specializing in fever. Yet the actual experience of patients frequently
belied this assumption, for chronic pain often outlives its original causes,
worsens over time and appears to take on a puzzling life of its own.
Research has begun to shed light on this: unlike ordinary or acute pain, which
is a function of a healthy nervous system, chronic pain resembles a disease, a
pathology of the nervous system that produces abnormal changes in the brain and
spinal cord. New technology, like functional imaging, which is generating the
first portraits of brains in action, is revealing the nature of pain's
pathology.
Far from being simply an unpleasant experience that people should endure with a
stiff upper lip, pain turns out to be harmful to the body. Pain unleashes a
cascade of negative hormones like cortisol that adversely affect the immune
system and kidney function. Patients treated with morphine heal more quickly
after surgery. A recent study suggests that adequate cancer-pain treatment may
influence the prospects for survival: rats with tumors given morphine actually
live longer than those that do not receive it.
Paradigm shifts occur slowly; if arriving at a new medical conception of pain
has been difficult and protracted, disseminating the knowledge will be more so.
Pain treatment belongs primarily in the hands of ordinary physicians, most of
whom know little about it. Less than 1 percent of them have been trained as pain
specialists, and medical schools and textbooks give the subject very little
attention. The primary painkillers -- opiates, like OxyContin -- are widely
feared, misunderstood and underused. (A 1998 study of elderly women in nursing
homes with metastatic breast cancer found that only a quarter received adequate
pain treatment; one-quarter received no treatment at all.) While the
undertreatment of pain has led to lawsuits -- recently, a California court
issued a judgment against a Bay Area internist for undertreating a terminally
ill patient's cancer pain -- so has the overprescribing of OxyContin in cases of
patient abuse. It takes only a few lawsuits -- along with the threat of Drug
Enforcement Administration oversight and regulation -- to exert a chilling
effect on prescribing practices. ''Doctors feel damned if they do and damned if
they don't,'' says Dr. Scott Fishman, chief of the division of pain medicine at
the University of California at Davis Medical Center. ''The enormous confusion
about pain has led to the hysteria around opiates.'' Dr. James Mickle, a family
doctor in rural Pennsylvania, describes the leeriness most physicians feel about
treating pain: ''Is it objective or subjective? How do you know you're not being
tricked or taken advantage of to get narcotics? And chronic-pain patients are,
generally, well -- a pain. Most doctors' reaction to a patient with chronic pain
is to try to pass them off to someone who's sympathetic.'' And what makes a
doctor sympathetic to pain?
''Someone who has pain himself,'' Mickle says. ''Or has an intellectual interest
-- who isn't interested in immediate results, doesn't want to make money, has a
lot of degrees. There's one in a lot of communities, but then they get all the
pain patients sent to them and eventually they burn out and quit.'' Daniel
Carr's interest in pain began as an intellectual one. After training as an
internist and endocrinologist, he published a landmark study in 1981 of runners,
which showed that exercise stimulates beta-endorphin production, leading to a
''runner's high'' that temporarily anesthetizes the runner. He began to wonder:
if the runner's high is an example of how a healthy body successfully modulates
pain, what abnormality leads to chronic pain? He did a third residency in
anesthesia and pain medicine, became a founder of the multidisciplinary pain
clinic at Massachusetts General Hospital and a director of the American Pain
Society. Six years ago, he moved to Tufts and set up a pain clinic (which loses
money) and created the country's first master's program in pain for health
professionals.
Continued at:
http://www.nytimes.com/2001/12/16/magazine/16PAIN.html?ex=1009553878&ei=1&en=3a1a875fe0ab6317
AOL: <a href="http://www.nytimes.com/2001/12/16/magazine/16PAIN.html?ex=1009553878&ei=1&en=3a1a875fe0ab6317">Pain,
the Disease</a>
***********************
3)
Exercise in the treatment of chronic pain.
Clin J Pain 2001 Dec;17(4 Suppl):S77-85
Mior S.
Department of Graduate Studies and Research, Canadian Memorial Chiropractic
College, Toronto, Ontario. mailto:smior@cmcc.ca
PMID: 11783835
OBJECTIVE: The purpose of this review was to determine how effective exercise is
in the treatment of chronic pain.
METHODOLOGY: The literature search identified three systematic reviews and three
randomized controlled trials addressing the effectiveness of exercise for the
management of chronic low back pain, one systematic review and one randomized
controlled trial addressing chronic neck pain, two systematic reviews and three
randomized controlled trials addressing upper extremity pain, and three
randomized controlled trials addressing fibromyalgia.
RESULTS: Randomized controlled trials were better than systematic reviews for
providing details of patient subgroups and of exercise programs, but there was a
general lack of evaluation of the different subgroups. The studies also failed
to assess the different duration and frequency of exercise programs. For chronic
low back pain, a systematic review and two of the three randomized controlled
trials found exercise to be effective:
other findings were uncertain. For chronic neck pain, both the systematic review
and the randomized controlled trial provided generally uncertain results, with
only one positive-result study in the systematic review.
For upper extremity, positive effects of exercise were shown for chronic lateral
epicondylitis and for specific soft tissue shoulder disorders.
For fibromyalgia, two of the three randomized controlled trials showed
effectiveness of exercise.
CONCLUSIONS: Exercise is effective for the management of chronic low back pain
for up to 1 year after treatment and for fibromyalgia syndrome for up to 6
months (level 2). There is conflicting evidence (level 4b) about which exercise
program is effective for chronic low back pain. For chronic neck pain and for
chronic soft tissue shoulder disorders and chronic lateral epicondylitis,
evidence of effectiveness of exercise is limited (level 3).
Source: Co-Cure: http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201b&L=co-cure&F=&S=&P=8200
AOL: <a href="http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201b&L=co-cure&F=&S=&P=8200
">Exercise in the treatment of chronic pain</a>
***********************
4)
Modafinil in Fibromyalgia Treatment (Letter )
Journal: J Neuropsychiatry Clin Neurosci 2001 Nov;13(4):530-531
Authors and Affiliations: JAMES L. SCHALLER, M.D., M.A.R., Chester County
Research Center, West Chester, PA and DAVID BEHAR, M.D., Eastern Pennsylvania
Psychiatric Institute, Philadelphia, PA
NLM Citation: PMID: 11748325
SIR: Modafinil has shown benefits in fatigue-related disorders such as multiple
sclerosis and various forms of neurological fatigue.1,2 We report the successful
use of modafinil for fibromyalgia (FM) fatigue in 4 patients in an open study
with naturalistic on-off experiences. A rheumatologist and another physician
confirmed each diagnosis of FM.
FM affects 2% of the population and is characterized by chronic musculoskeletal
pain (especially at characteristic soft-tissue trigger sites); severe fatigue,
typically lasting >24 h with minimal activity; nonrestorative sleep; and mood
abnormalities.3–5 The American College of Rheumatology adds the criterion of
widespread pain for 3 months with tenderness in at least 11 of 18 specific
trigger-point sites.6
We excluded 2 patients for comorbid secondary major depression (MD) until they
went into full remission on their antidepressants, confirmed by two MD research
scales, to remove the variable of modafinil antidepressant augmentation.7,8All
patients had physical exams and laboratory testing excluding Lyme disease,
Ehrlichia equi and E. chaffeensis, Babesia microti, rheumatoid or spinal
arthritis, major sleep disorders, and abnormal cervical and brain MRIs.
After an average 18 months of medical care, they found minimal relief.
None could stay awake 16 hours on 3 consecutive days, shop routinely, provide
basic childcare, drive over an hour per day, balance a checkbook, maintain a
30-hour work week, or cook routinely. Patient expectations for relief from this
trial were very low because of past failures.
Two FM patients reported some beneficial effects of depression on day one at 100
mg q A.M., which were nevertheless incomplete. Weekly dose adjustments upward in
50-mg increments and the addition of an afternoon dose met with reports of
highly significant benefit by all patients.
After titration adjustments were finalized over 3 weeks, all reported a
sustained increase in functional capacity. Global Assessment of Functioning
average improvement was a change from 55 to 70; that is, from moderate
impairment to minimal impairment.
All patients had a strong desire to continue their treatment because they now
reported being "functional," able to work or to care for their children. Fatigue
improved; all patients reported highly significant improvement in alertness and
a reduced need for disruptive naps. They received unsolicited comments about
their improvement from their children, spouses, employers, or parents, who were
unaware of the modafinil trial. Benefits persisted over 3 continuous months at
the same dose.
Alertness benefits were lost if a breakfast modafinil dose was skipped.
Benefits returned quickly the following day if modafinil was restarted.
Each patient missed at least 2 days of medication because of forgotten doses or
a lost prescription. They reported a full return of fatigue and impairment that
day. These mishaps represent naturalistic "on-off"
experiments, supporting the immediate efficacy of modafinil. This immediate
effect contrasts with our clinical expectations of gradual benefits.
The mean dose was 250 mg per day with a range of 150 to 300 mg. Patients took a
dose of 150–200 mg in the morning, and half of them took an extra
50 mg or 100 mg in the early afternoon. One patient reported slight anxiety
during week one, which resolved with a 50-mg dose reduction. We experienced
inconclusive results in 3 patients, not included in our report, who dropped out
or were lost to follow-up for reasons such as relocation.
The fatigue of FM causes marked impairment and has no definitive single
treatment. Modafinil is a potential treatment option worthy of larger clinical
trials.
Key Words: Disorders • Sleep Disorders
REFERENCES
Rammohan KW, Rosenberg JH, Pollak CP, et al: Provigil (modafinil):
efficacy for the treatment of fatigue in patients with multiple sclerosis.
Neurology 2000; 54:A24
Cochran JW: Effect of modafinil on fatigue associated with neurological
illnesses. J Chronic Fatigue Syndrome 2001; 8:65-70
Matsumoto P: Fibromyalgia syndrome. Nippon Rinsho 1999; 57:364-369
Cathebras P, Lauwers A, Rousset H: Fibromyalgia: a critical review. Ann Med
Interne (Paris) 1998; 149:406-414
White KP, Speechley M, Harth M, et al: The London fibromyalgia epidemiology
study: the prevalence of fibromyalgia syndrome in London, Ontario. J Rheumatol
1999; 26:1570-1576[Medline]
Wolfe F, Smythe HA, Yunus MB, et al: The American College of Rheumatology
1990 criteria for the classification of fibromyalgia: report of the multicenter
criteria committee. Arthritis Rheumatol 1990; 33:160-172
Menza MA, Kaufman KR, Castellanos A: Modafinil augmentation of antidepressant
treatment in depression. J Clin Psychiatry 2000;
61:378-381[Medline]
DeBattista C, Solvason HB, Kendrick E, et al: Modafinil as an adjunctive agent
in the treatment of fatigue and hypersomnia associated with major depression.
New Research Program and Abstracts, American Psychiatric Association 154th
Annual Meeting, May 9, 2001, New Orleans, LA. Abstract NR532:144
Source: Co-Cure:
http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201a&L=co-cure&F=&S=&P=2142
AOL: <a
href="http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201a&L=co-cure&F=&S=&P=2142">Modafinil
in Fibromyalgia Treatment </a>
***********************
5)
FDA Approves Frova (Frovatriptan Succinate) for Migraines
DUBLIN, IRELAND -- November 9, 2001 -- Elan Corporation, plc, announced that the
U.S. Food and Drug Administration (FDA) approved Frova™ (frovatriptan succinate)
2.5 mg tablets, for the acute treatment of migraine attacks with or without aura
in adults.
Approximately 10 percent of the U.S. population suffer from migraine attacks. Of
these 27 million sufferers, over 50 percent remain under-diagnosed or
under-treated. The U.S. market in 2001 for migraine therapy is expected to be
approximately $1.4 billion for the overall triptan class with the oral triptans
representing $1.2 billion.
The efficacy and tolerability of Frova was demonstrated in five randomized,
double blind, placebo-controlled trials. According to Arthur Elkind, MD,
Director of the Elkind Headache Center, Mt. Vernon, New York, "My experience
with frovatriptan in a long-term, open label trial indicates it is an effective
treatment and provides a high degree of patient satisfaction."
In a market in which only 29 percent of patients report they are very satisfied
with their migraine therapy, the benefits of Frova make it an important
alternative therapy in the treatment of migraine for many patients. Migraine
attacks typically last four to seventy-two hours. Frova
2.5 mg tablets have a 26-hour half-life. Frova may represent an important
advancement in the treatment of migraine headache as no other currently marketed
triptan has a half-life of more than six hours. Stephen Silberstein, MD,
Director, Jefferson Headache Center, Philadelphia, Pennsylvania said, "The
addition of frovatriptan, with its long half-life, gives physicians another
alternative to managing patients."
Frova is a 5-HT receptor agonist that binds with a high affinity for the
5HT(1B) and 5HT(1D) receptors and is believed to act on extracerebral,
intracranial arteries and to inhibit excessive dilation of these vessels in
migraine. Frova was well-tolerated in clinical trials. The side effects that
occurred most frequently following administration of Frova 2.5 mg tablets (in at
least 2 percent of patients, and at an incidence of greater than or equal to 1
percent compared to placebo) were dizziness, paresthesia, headache, dry mouth,
fatigue, flushing, hot or cold sensation and chest pain.
SOURCE: Elan Corporation, plc http://www.elan.com/
AOL: <a href="http://www.elan.com/">Elan Corporation, plc</a>
***********************
6)
Jury Out On Single-Dose Morphine For Temporomandibular Joint Pain
12/18/2001 By Anne MacLennan
The question remains open as to the analgesic property of a single
intra-articular injection of morphine in patients with temporomandibular joint
arthralgia/osteoarthritis.
In this study, one intra-articular (i.a.) dose of 0.1 mg morphine significantly
increased the pain pressure threshold and mouth opening ability in patients with
this condition. However, no dose-effect relation and no significant short-term
analgesic property were seen.
Although the finding was statistically significant, the magnitude of the reduced
visual analog scales (VAS) pain intensity score was not clinically relevant at
one-week follow-up, study authors report.
Objective of the multicentre project was to determine the analgesic efficacy of
a single dose i.a. injection of morphine in 53 patients with unilateral
arthralgia/osteoarthritis of the temporomandibular joint (TMJ).
The study included a screening visit, a treatment visit and a follow-up visit
one week after treatment. The researchers made recordings of VAS pain intensity
scores at maximum mouth opening (main efficacy variable) and at jaw rest
directly before dosing the patients.
Patients received a 1-ml i.a. injection into one TMJ of 1.0mg morphine-HC1,
0.1mg morphine-HC1 or saline (placebo).
Pain intensity was recorded at the follow-up and in a diary three days before
and five days after the injection.
The VAS pain score at maximum mouth opening was considerably reduced between one
and 10 hours after injection but without significant differences between the
groups.
At follow-up, the median VAS pain score at maximal mouth opening was
significantly lower in the 0.1-mg morphine group than in the 1.0-mg morphine or
the saline group.
A significant increase in pain pressure threshold over the affected joint was
seen in the 0.1-mg morphine group versus the saline group at the follow-up but
not one and two hours post-injection.
Incidence of adverse events was small and did not differ between the treatment
groups.
Thus, although one i.a. injection of 0.1mg morphine significantly increased the
pain pressure threshold and mouth opening ability in these patients, evidence
for the analgesic property of the locally applied opioid was inconclusive, the
authors note.
Thomas List and colleagues from TMD Unit, Specialist Centre for Oral
Rehabilitation, Linkoping; the Departments of Stomatognathic Physiology, Central
Hospital, Vasteras and Boras Hospital, Boras; and AstraZeneca Clinical R&D,
Sodertalje, all in Sweden, did this randomised, double blind, parallel group
study.
PAIN(r), Vol. 94 (3) (2001) pp. 275-282. "Intra-articular morphine as analgesic
in temporomandibular joint arthralgia/osteoarthritis"
***********************
7)
FEATURE OF THE WEEK:
Report: Effective Treatments for Fibromyalgia
by Leon Chaitow N.D., D.O., M.R.O.
Leon Chaitow, N.D., D.O., MRO, is Editor-in-Chief of the Journal of Therapeutic
Bodywork; Senior lecturer, University of Westminster, London.
Author of Fibromyalgia Syndrome: A Practitioner's Guide to Treatment (2000),
published by Churchill Livingstone, New York (ISBN 0-443-06227-7), and
Fibromyalgia and Muscle Pain: Your Self-Treatment Guide (2001, 2nd edition)
published by Thorsons, London, National Book Network, USA (ISBN
0-00-711502-4).
Author's Note:
Because examination of a particular method is included in this review, it should
not be taken as a recommendation for its use. This discussion is an exercise in
reporting what is being claimed in what appear to be responsible publications,
by a wide range of therapists and practitioners, however there is no absolute
'quality control' or ability to adequately compare the accuracy of the reports
on which these discussions are based.
Aerobic Exercise(1)
Cardiovascular exercise is stated to be helpful in rehabilitation from
Fibromyalgia.
The guidelines most commonly given involve the patient performing active aerobic
exercise three times weekly (some say four times) for at least 20 (some say 15)
minutes during which time they are required to achieve between
60 and 85% of their maximum predicted heart rate. The methods of exercise best
suited to Fibromyalgia patients are said to be cycling (static cycle) walking or
swimming.
Appropriate warmup and warmdown periods are suggested and a slow incremental
program is needed to reach the prescribed length and frequency of exercising.
The release of hormone-like substances (endogenous endorphins) during aerobic
exercise is thought to offer the means whereby pain relief and well-being are
enhanced, along with the obvious increased self-esteem and psychological boost
which comes with increased fitness.
A study involving 34 patients with fibromyalgia had some of the patients perform
aerobic exercise (cycle exercise which was designed to achieve a heart rate of
150 per minute) or flexibility exercises (achieving no more than 115 beats per
minute) three times a week for 20 weeks. At the end of this period those
patients doing the aerobic routines achieved far greater reduction in pain than
the flexibility group.
People with CFS (ME) may be unable to do any exercise at all in some stages of
their illness.
See the discussion below on cognitive/behavioral treatment in which tasks and
routines (which have been agreed and negotiated between the CFS patient and the
therapist) are performed daily with slight increments over time, whatever the
patient feels (and whether they are having a good day or a bad day) always
staying without strain.
Acupuncture(2,3,4)
Acupuncture in general and electroacupuncture in particular has an excellent
track record in treatment of pain.
One of the leading experts in use of acupuncture in pain relief is Dr. P.
Baldry after asserting categorically that acupuncture is certainly the treatment
of choice for dealing with Myofascial Pain Syndrome or trigger point problems
states:
"The pain in Fibromyalgia, which would seem to be due to some as yet
unidentified noxious substance in the circulation giving rise to neural
hyperactivity at tender points and trigger points takes a protracted course and
it is only possible by means of acupuncture to suppress this neural
hyperactivity for short periods."
As is clear there are other ways, however if acupuncture is used for
Fibromyalgia Baldry believes that it is necessary to repeat treatment every
2 to 3 weeks for months or even years, which he regards as unsatisfactory, "but
nevertheless some patients insist that it improves the quality of their lives."
Relief from pain for weeks on end and an enhanced quality of life would seem
quite a desirable objective, perhaps helping ease the pain burden while more
fundamental approaches are dealing with constitutional and causative issues.
A Swiss research team in Geneva has examined the effectiveness of
electro-acupuncture in treating Fibromyalgia. 70 patients (54 women) who all met
the American College of Rheumatology criteria for Fibromyalgia received either
sham acupuncture ('wrong' points used) or the real thing. Various methods were
used for patients to record their level of symptom activity and the amount of
medication they used before and after treatment. Sleep quality, morning
stiffness and pain were all monitored.
Over a three week period the electroacupuncture treatment was administered with
only the doctor giving the treatment knowing whether or not the needles were
being placed correctly and whether the amount and type of electrical current
being passed through the needles was correct.
Seven out of the eight measurements showed that only the acupuncture group and
not the placebo (dummy acupuncture) group had benefits (as in all such studies a
few minor improvements are always noted in the dummy or placebo group, but these
were only slight).
The acupuncture group, after treatment, required far more pressure on tender
points to produce pain while use of pain killing medication was virtually halved
as was these patient's assessment of regional pain levels. There was also a
significant increase in quality of sleep. The length of time morning stiffness
was experienced only improved a small amount.
Around 25% of the treated group did not improve significantly while all the
others showed a remarkable amount of improvement with some having almost
complete relief of all symptoms.
The duration of the improvement was noted to be 'several weeks' in most patients
which seems to be in line with Dr. Baldry's observation of it being necessary to
repeat treatment every few weeks.
The fact that there are virtually no side effects from electroacupuncture make
it attractive when compared with pain killing and/or antidepressant medication.
Dry Needling and Injection into Trigger Points
There have been few clinical trials involving bodywork in treating fibromyalgia
however there is abundant evidence of the successful use of various methods for
treating trigger points including injection of saline of procaine or even of
simply 'dry needling' the trigger points. In one study
46% of those people with MPS treated found that this approach offered them the
longest lasting relief of symptoms compared with other forms of treatment they
had received. 69% required less medication for some time afterwards.
Chiropractic
There is a mass of anecdotal reporting of benefit from use of chiropractic in
treatment of Fibromyalgia and CFS (ME). Few clinical studies support these
claims but since the manipulative methodology of osteopathy and chiropractic
have become ever closer, and since the methods of osteopathy which focus on
muscles notably Strain Counterstrain and Muscle Energy Technique are now widely
used by massage therapists, and since there are indeed clinical studies
involving osteopathic manipulative therapy (OMT) and massage, see below, it is
safe to assume that the anecdotal claims are accurate.
Those forms of chiropractic which focus on muscles, such as Morter Bio Energetic
Synchronization Technique (BEST) are more likely to be helpful in Fibromyalgia
cases than the more active adjustment methods although these do have their place
when joint restrictions are a feature.
Cognitive/Behavioral Treatment(5,6)
It is generally agreed that the difference between CFS (ME) and Fibromyalgia are
marginal at best and that many, probably most, patients in each category could
just as easily be diagnosed as having the other condition/diagnosis.
One model of these conditions suggests that whatever the trigger (trauma, viral
infection, toxicity etc) there need also to be perpetuating factors such as
emotional stress, inadequate rest patterns, concurrent depression etc. The
treatment approach suggested would tackle the behavioral and cognitive aspects,
using agreed (between therapist and patient) targets for changing the behavior
pattern which has become established by the illness.
Careful planning and preparation are required with a lot of attention to
engaging the patient in the process of recovery. The patient is not led to
believe that this is all there is to treatment but is encouraged to see that
while underlying factors (viral or yeast infection etc) are being dealt with the
perpetuating factors can begin to be modified. A gradual increase in activity is
the aim with equally gradual reduction in rest periods and time.
The key to success is not to do too much too soon, staying within what is a
manageable level for the patient. A structured schedule evolves via negotiation
and discussion over 20 to 30 sessions. The same degree of activity is suggested
on good and bad days, with perhaps no increase in activity initially but a
structured pattern emerging. Very gradually activity increases and
responsibility for what happens is transferred fully to the patient. Does it
work? Some claim it does but it takes dedication on everyone's part.
Herbal Medicine(7)
There have been no clinical trials involving herbal treatment of Fibromyalgia
however at least one very well researched herb is being used clinically to help
circulation to the brain: Ginkgo biloba (see above).
In addition leading herbalists are on record as claiming benefits from an
approach which tries to 'support the nervous system with herbal nerve tonics and
adaptogens' (substances which help the body cope with stress).
Additionally herbal methods try to help the defense mechanisms by using known
immune system enhancers such as echinacea, astragalus and ginseng.
Various nervine herbs would also be included in a combination aimed at helping
normalize sleep disturbances.
A herbal combination formula is suggested which consists of:
· 2 parts Panax quinquefolium (American Ginseng)
· 2 parts Astragalus mongolicus
· 2 parts Angelica sinensis (Dong quai)
· 1 part Ginkgo biloba
· 1 part Cimicifuga racemosa (Black cohosh)
· 1/2 part passiflora incarnata (Passion flower)
· 1/2 part Betonica officinalis (Wood betony)
· 1/2 part Matricaria chamomila (Chamomile)
· 1/2 part Zizyphus sativa (Jujube red dates)
This formulation is claimed to be a tonic which will support people with chronic
weakness, anxiety, headaches, sleep disturbances and general fatigue as well as
diminished blood flow to the extremities. The person who needs this will
probably have a weak pulse, weak digestive system, have headaches and will be
fatigued. A dose of between half and one teaspoon (infusion) two or three times
daily taken between meals is suggested.
Homeopathy(8,9)
Several studies have looked at the effects of a specific homoeopathic remedy
Rhus Tox in treating Fibromyalgia and 'fibrositis' with varying results.
Although treatment of painful rheumatic conditions by homeopathy often involves
the use of Rhus tox it is therefore not suitable for all people with such
conditions, but only those with the profile of the medicine.
The ideal person for using Rhus tox is:
Restless, continually changing position, having a great deal of apprehension
especially at night and finds it difficult to stay in bed. The head will feel
heavy, and the jaws may be noisy, creaking, with TMJ pain.
The tongue tends to be coated except for a red triangular area near the tip and
there is a frequently bitter taste in the mouth and a desire for milky drinks.
There is often a drowsy feeling after eating.
There may be a nagging dry cough and a sense of palpitation most noticeable when
sitting still. The back tends be stiff and normally feels better for moving
about; limbs are stiff and any exposure to cold makes the skin feel sensitive or
painful.
Cold, wet weather makes symptoms worse as does sleep and resting. What helps
most as far as symptoms are concerned is warm, dry weather, movement, rubbing
the uncomfortable areas, warm applications and stretching. The remedy is Rhus
tox in the 6C potency.
Trials - In Britain a study found that using the 6C dilution of Rhus Tox was
effective in moderating the symptoms of patients with Fibromyalgia whereas a
trial in the Australia, involving just three patients who fitted all the
criteria including the profile for Rhus tox, there was no benefit when a 6X
dilution was used.
The difference between 6X and 6C may seem unimportant, but the dilution
difference if enormous.
With one study using Rhus tox 6C and claiming marked benefits for Fibromyalgia
patients and one using Rhus tox 6X showing no benefit, the jury is still out.
However since there is absolutely no chance of side effects with homeopathy
there is little to be lost in trying, but try the 6C first.
Hypnotherapy(10)
In controlled trials it has been found that hypnotherapy helps more than
physical therapy in those patients who do not seem to respond well to most other
forms of treatment. Pain is reduced, fatigue and stiffness on waking is improved
and general feeling of well-being better.
Medication(11, 12,13,14)
The most widespread treatment approach to Fibromyalgia involves the use of
various pharmacological agents and it is useful to evaluate the results of
studies as to their efficacy. Tricyclic antidepressant medications increases the
amount of serotonin in the central nervous system and increases the delta-wave
sleep stage and is found to consistently improve the symptoms of fibromyalgia,
though not by acting as an anti-depressant and not in all patients treated.
Studies involving various forms of antidepressant medication tend to support use
of Amitripyline (25 to 50mg daily) with pain scores, stiffness, sleep and
fatigue all improving on average but by no means in all patients.
In one study 77% of Fibromyalgia patients receiving Amitripyline reported
general improvement after 5 weeks as against only 43% of those receiving placebo
medication. Side effects from the antidepressant were however measurable with a
selection of drowsiness, confusion, seizure, agitation, nightmares, blurred
vision, hallucinations, uneven heartbeat, gastrointestinal upsets, low blood
pressure, constipation, urinary retention, impotence and mouth dryness all being
observed or reported.
When combined with osteopathic manipulative methods (mainly soft tissue
techniques - see below) anti-depressant medication offered greater relief.
A study involving the use of systemic corticosteroids (prednisone 15mg daily)
showed that there were no measurable improvements, and since side effects with
such medication is usual this approach is clearly not desirable. Indeed if it
were to produce an improvement it would be sensible to question whether
fibromyalgia was indeed the correct diagnosis. Some other rheumatic condition is
a more likely to improve symptomatically with its use.
When muscle relaxants were tested in Fibromyalgia patients most were found to be
useless but cyclobenzaprine was found to improve pain levels, sleep and tender
point count (10 to 40 mg daily given at night to prevent daytime drowsiness) and
this is thought to be because it has a chemical similarity to Amitripyline.
Many other drugs are currently being researched and tried in treatment of
Fibromyalgia ranging from antiviral agents to substances which modulate the
immune system. Various cocktails of antidepressant and sedative medications are
being tried out as well. Even aspirin has been tried and is said to be mildly
useful!
Osteopathy(15)
Osteopathic medicine, from which both SCS (Strain/Counterstrain) and Muscle
Energy Technique (MET) derive, has conducted many studies involving
Fibromyalgia, including:
1. Doctors at Chicago College of Osteopathic Medicine let by Drs. A. Stotz and
R. Keppler measured the effects of osteopathic manipulative therapy (OMT - which
includes SCS and MET) on the intensity of pain felt in the diagnostic tender
points in 18 patients who met all the criteria for Fibromyalgia.
Each had six visits/treatments and it was found over a one year period that
12 of the patients responded well in that there tender points became less
sensitive (14% reduction in intensity as against a 34% increase in the six
patients who did not respond well) Most of the patients, the responders and the
non-responders to OMT, showed that there tender points were more symmetrically
spread after the course (using thermographic imaging) than before. Activities of
daily living were significantly improved and general pain symptoms decreased
overall.
2. Doctors at Texas College of Osteopathic Medicine selected three groups of
Fibromyalgia patients, one of which received OMT, another had OMT plus
self-teaching (learning about the condition and self-help measures) and a third
group received only moist-heat treatment. The group with the least reported pain
after six months of care was that receiving OMT, although some benefit was noted
in the self-teaching group.
3. Another group of doctors from Texas tested the difference in results
involving 37 patients with Fibromyalgia of using a/ drugs only (ibuprofen,
alprazolam) or b/ OMT plus medication c/ a dummy medication (placebo) plus OMT
or d/ a placebo only. The results showed that drug therapy alone resulted in
significantly less tenderness being reported than did drugs and manipulation or
the use of placebo and OMT or placebo alone.
Patients receiving placebo plus manipulation reported significantly less fatigue
than the other groups. The group receiving medication and OMT showed the
greatest improvement in their quality of life.
4. 19 patients with all the criteria of Fibromyalgia were treated once a week
for four weeks at Kirksville, Missouri College of Osteopathic Medicine using
OMT. 84.2% showed improved sleep patterns, 94.7% reported less pain and most
patients had fewer tender points on palpation.
Supplementation(16)
Magnesium is often found to be deficient in people with Fibromyalgia/CFS (ME).
In a study 15 patients with Fibromyalgia were supplemented with 300 to
600mg daily of magnesium and 1200 to 1400mg per day of malic acid.
Pain levels were greatly reduced. Benefits took some weeks or even months to be
noticed.
This study replicates a previous study which showed that magnesium deficiency
was a feature of many patients with CFS(ME).
Additional supplementation strategies which are recommended after clinical study
include use of vitamin B3 and B6 which together with magnesium and tryptophan
(obtainable from a good protein meal) are needed to manufacture serotonin.
The amino acids ornithine and arginine can be used to promote Growth Hormone
production. Calcium and zinc supplementation is commonly found to help sleep
patterns return to normal.
General nutritional status support can usefully include supplementation with
B-complex and vitamin C as well as essential fatty acids derived from flaxseeds
or evening primrose.
Dr. Travell(17) has confirmed that a variety of factors can all help to maintain
and enhance trigger point activity: nutritional deficiency especially vitamins
C, B-complex and iron; hormonal imbalances (low thyroid hormone production,
menopausal or premenstrual situations); infections (bacteria, viruses or yeast);
allergies (wheat and dairy in particular); low oxygenation of tissues
(aggravated by tension, stress, inactivity, poor respiration).
Vibrational Therapy (Massage/Percussion Analgesia)
Rapid low level vibration has been shown to provide a speedy, safe and effective
method for easing pain. A hand held vibrator is suitable for this purpose and
may require firm pressure contact of the vibrator for up to half an hour before
relief is strongly noticed. Vibration (100 to 200 cycles per second) should
continue for 45 minutes at least. Relief of even chronic pain can last for many
hours and in some instances for days. A high frequency works best (100Hz) if
applied near to or below the area of pain (or according to Richard van Why to an
antagonistic muscle or directly to a trigger point or reference zone).(18)
Manually applied vibration or rhythmic rocking ('Harmonic Technique'19) is
extremely soothing and helpful in chronic pain conditions with a tradition going
back to the American Civil War where the method was used to help the pain of
amputees.
Research at the University of California, Irvine, has shown that when a range of
physical methods were tested in treatment of myofascial pain including placebo
ultrasound, spray and stretch, hydrocollator, real ultrasound and massage
(ischemic compression/NMT) it was massage which came out ahead in providing
immediate relief. (20)
References:
1. McCain G Role of physical fitness training in fibrositis/fibromyalgia
syndrome American Journal of Medicine 1986 (supplement 3A)pp73-77
2. Dr. P. Baldry Acupuncture, Trigger Points and Musculoskeletal Pain (Churchill
Livingstone, Edinburgh, 1993
3. DeLuze C et al Electroacupuncture in fibromyalgia British Medical Journal
21 October 1992 pp1249-1252
4. Sandford Kiser R et al Acupuncture relief of chronic pain syndrome correlates
with increased plasma metenkephalin concentrations Lancet
1983;ii:1394-1396
5. Beck A et al Cognitive therapy in depression Guildford press New York
1979
6. Deale A Wessley S Cognitive-behavioral approach to CFS The Therapist
2(1)1994 pp11-14
7. Kacera W Fibromyalgia and chronic fatigue - a different strain of the same
disease? Canadian Journal of Herbalism October 1993 Vol.XlV no lV pp20-29
8. Fisher P et al Effect of homoeopathic treatment of fibrositis (primary
fibromyalgia) British Medical Journal 32pp365-366 1989
9. Gemmell H et al Homoeopathic Rhus Toxicodendron in treatment of Fibromyalgia
Chiropractic Journal of Australia Vol.21 No1 March 1991pp2-6
10.Haanen H et al Controlled trial of hypnotherapy in treatment of refractory
fibromyalgia Journal of Rheumatology 18pp72-75 1991
11. Goldenberg D et al Randomized, controlled trial of Amitripyline anproxine in
treatment of patients with fibromyalgia Arthritis/Rheum
1986;29:pp1371-1377
12. Clark S et al Double blind crossover trial of prednisone in treatment of
fibrositis J Rheumatol 1985;12(5)pp980-983
13. Campbell S et al A double blind study of cyclobenzaprine in patients with
primary fibromyalgia Arthritis Rhem 1985;28:S40
14. Carette S et al Evaluation of Amitripyline in primary fibrositis Arthritis
Rhem 1986:29pp655-659
15a. Stoltz A Effects of OMT on the tender points f Fibromyalgia Report in
Journal of American Osteopathic Association 93(8)p866 August 1993
15b. Jiminez C et al Treatment of Fibromyalgia with OMT and self-learned
techniques Report in Journal of American Osteopathic Association 93(8)p870
August 1993
15c. Rubin B et al Treatment options in fibromyalgia syndrome Report in Journal
of American Osteopathic Association 90(9)September 1990 pp844-5
16. Abraham G et al Management of Fibromyalgia - rationale for the use of
magnesium and malic acid Journal of Nutritional Medicine 3:49-59 1992
17. Travell J Simons D as cited previously.
18. van Why R 'Fibromyalgia and Massage' symposium notes 1994
19. Lederman E DO Harmonic Tecnique Arnica House London
20. Hong C-Z et al Immediate effects of various physical medicine modalities on
pain threshold of active myofascial trigger points. J Musculoskeletal Pain
1(2)pp37-53 1993
©1995 Leon Chaitow N.D., D.O., MRO.
Source: Immune Support: http://www.immunesupport.com/library/print.cfm?ID=3271
AOL: <a href="http://www.immunesupport.com/library/print.cfm?ID=3271">Report:
Effective Treatments for Fibromyalgia</a>
***********************
8)
How do I know if I might have chronic fatigue syndrome?
If you answer yes to any of the questions listed below, you may have chronic
fatigue syndrome (CFS), which is also called chronic fatigue immune dysfunction
syndrome (CFIDS).
Have you been tired (fatigued) for a long time--more than 6 months--even though
you are getting enough rest and are not working too hard?
Has your doctor been unable to find illnesses that could explain your symptoms?
Are you able to do less than half of what you used to do, because you feel
tired?
Have you had recurrent or persistent problems for 6 months or more with 4 or
more of the signs and symptoms listed below?
Sore throat Tender or painful lymph nodes in neck or armpits Unexplained muscle
soreness Pain that moves from joint to joint but doesn't include redness or
swelling Headaches that are different from the kind you usually get, or
headaches that make your whole head hurt Trouble with short-term memory or
concentration Feeling very tired for more than 24 hours after exercise that
didn't bother you before Trouble sleeping People with CFS may have other
symptoms as well. Complete
Story.....http://www.familydoctor.org/handouts/031.html
AOL: <a href="http://www.familydoctor.org/handouts/031.html">Complete Story</a>
***********************
9)
Humor: Health Food Alert Wellness Program
Chocolate is derived from cocoa beans. Bean = vegetable. Sugar is derived from
either sugar CANE or sugar BEETS. Both are plants, which places them in the
vegetable category. Thus, chocolate is a vegetable.
To go one step further, chocolate candy bars also contain milk, which is a dairy
food. So candy bars are a health food. Chocolate-covered raisins, cherries,
orange slices and strawberries all count as fruit, so eat as many as you want.
If you've got melted chocolate all over your hands, you're eating it too slowly.
The Problem How to get 2 pounds of chocolate home from the store in a hot car.
The solution: Eat it in the parking lot.
Diet tip Eat a chocolate bar before each meal. It'll take the edge off your
appetite, and you'll eat less.
If calories are an issue, store your chocolate on top of the fridge.
Calories are afraid of heights, and they will jump out of the chocolate to
protect themselves. (We're testing this with other snack foods as well.) If I
eat equal amounts of dark chocolate and white chocolate, is that a balanced
diet? Don't they actually counteract each other?
Chocolate has many preservatives. Preservatives make you look younger.
Therefore, you need to eat more chocolate.
Put "eat chocolate" at the top of your list of things to do today. That way,
you'll get at least one thing done.
A nice box of chocolates can provide your total daily intake of calories in one
place. Now, isn't that handy?
If you can't eat all your chocolate, it will keep in the freezer. But if you
can't eat all your chocolate, what's wrong with you?
If not for chocolate, there would be no need for control top pantyhose. An
entire garment industry would be devastated. You can't let that happen, can you?
MEDICAL NEWS FLASH:
"Stressed" spelled backward is "desserts." :-)
***********************
10)
Tips for making homes more eco-friendly and allergy proof
For people with multiple chemical sensitivities, allergies, etc. the following
web site has many useful tips for making homes more eco-friendly and allergy
proof.
http://www.care2.com
AOL: <a href="http://www.care2.com">Tips for making homes more eco-friendly and
allergy proof</a>
***********************
11)
FDA Approves New Percocet Strengths With Lower Acetaminophen Doses
CHADDS FORD, PA -- November 26, 2001 -- Endo Pharmaceuticals Holdings
Inc.announced the Food and Drug Administration's approval of the abbreviated new
drug application to market Percocet® 7.5/325 and 10/325 oxycodone/acetaminophen
tablets that was filed by Endo Pharmaceuticals Inc., a wholly owned subsidiary
of Endo Pharmaceuticals Holdings.
Percocet, the leading brand of oxycodone/acetaminophen on the market, is
indicated for the treatment of moderate to moderately severe pain. The new
reformulated Percocet 7.5/325 and 10/325 strengths offer proven pain relief with
reduced acetaminophen content as compared with previously available formulations
of the pain-relieving drug.
Carol A. Ammon, president and CEO of Endo Pharmaceuticals stated, "The new
reformulated Percocet 7.5/325 and 10/325 underscore the strengths of Endo in the
marketplace. We believe that we have a a robust pipeline that feeds into our
growing marketing and sales organization, and the gold standard in pain
management with our Percocet products.
"These new formulations were developed in response to physician demand. These
formulations combine the higher strengths of 7.5 and 10 milligrams of oxycodone
that physicians have increasingly adopted, with up to 50% less acetaminophen per
day than previous formulations. This reinforces Endo's commitment to providing a
broad range of safe and effective pain management products," Ms. Ammon said.
"With this new formulation, physicians can still take advantage of the
synergistic action of the two analgesics combined, but without worrying about
exceeding the daily limit of acetaminophen," said Nathaniel Katz, MD, Assistant
Professor of Anesthesia at Harvard Medical School. "This will really be helpful
to patients who may need higher doses of oxycodone to relieve their pain."
The new reformulated strengths, which are expected to be available in pharmacies
within the next week to ten days, will potentially enable patients to take their
Percocet on a simpler dosing schedule, allowing them to take fewer tablets per
day, and less frequently than the original 5mg tablet. And due to the lower
acetaminophen levels, these new strengths may allow physicians to prescribe
Percocet 7.5/325 and 10/325 for more long-term use than previously acceptable.
"The new strengths continue to deliver the dual benefits of oxycodone and
acetaminophen, while lowering the risk of excessive acetaminophen exposure,"
said Lori Reisner, Pharm.D. and Associate Clinical Professor of Pharmacy at the
University of California in San Francisco. "The ever-increasing number of
acetaminophen-containing products and other over-the-counter pain relievers
requires pharmacists to be diligent in reminding physicians and patients about
the appropriate level of usage."
The most frequently reported side effects of Percocet include lightheadedness,
dizziness, sedation, nausea and vomiting. Oxycodone can produce drug dependence
and has the potential for being abused. Physicians are reminded that the total
daily dose of acetaminophen must be carefully considered in the use of any
combination product.
SOURCE Endo Pharmaceuticals Holdings Inc.
http://www.endo.com/
AOL: <a href="http://www.endo.com/">FDA Approves New Percocet Strengths With
Lower Acetaminophen Doses</a>
***********************
12)
Therapy, massage and tailor-made exercise offer respite from the nagging torment
of fibromyalgia
Shedding a tear at the movies may not seem so strange, but imagine breaking down
crying while watching a health video. That's what happened to Delores Longo when
she saw a tape that described the chronic pain she'd been living with most of
her life. Finally she had found the answer to her suffering.
'It took me 30 years to find out I have fibromyalgia. I tried just about
everything,' says Longo, a Miami business consultant. 'Suddenly, I just cried
and cried.'
Fibromyalgia is a condition without a known cause and without a cure. It's been
called the invisible disability, the irritable everything, supermom syndrome and
even whining women's disease.
Dr. Trumane Ropos calls it 'the bane of the rheumatologists' existence, of every
physician's existence.' 'There's no anatomic abnormality, no concrete physical
cause,' says Ropos, a rheumatologist at Cleveland Clinic in Weston. Yet patients
present a wide range of symptoms, including chronic, sometimes excruciating
pain.
Longo's pain began when she was 18: First, her knees ached so much while on an
errand for her first employer she thought she wouldn't be able to go on.
After about a week, the pain migrated to her hands, then her wrists. Doctors
gave her arthritis medication, but it didn't do any good.
The pain persisted for about 10 years before moving into her back and neck,
sometimes incapacitating her to the point she couldn't walk at all. Soon it was
ankles, elbows, shoulders -- 'just about everywhere.' And still no remedy.
'It was awful because a lot of people around me thought it was all in my head,
and I ended up believing that. How could I be hurting in a different place every
day? I couldn't make plans, couldn't volunteer in school because how would I
know if I'd be able to walk that day?' says Longo, now 50.
'You doubt yourself and you wonder whether you're losing your mind.'
Ropos treats patients for the condition, but like all physicians, can't diagnose
it until tests have ruled out several other diseases.
An estimated 4 million to 10 million Americans, 80 percent of whom are women, of
all ages and all races, have fibromyalgia, doctors report. And sufferers often
have other conditions as well, such as migraine headaches, irritable bladder and
bowel, chronic fatigue, multiple chemical sensitivity, anxiety and depression --
a long list of tension- and stress-related ailments that pile up to create a
miserable way of life. 'It's a product of our society,' Ropos says.
'It's pretty frustrating when you have pain and you know you're hurting, but
even the doctors will not take you seriously. You've got to find a doctor that
will listen to you,' says Delores Burke, who visited more than a dozen doctors
before finding Ropos and determining that she had fibromyalgia. Her worst point
was when she couldn't get out of bed for two weeks.
'Pain,' says MaryJo McPhail-Brown, director of rehabilitation at JFK Medical
Center in Atlantis, 'is not a normal condition.' Pain is a signal that you need
help.
EASING THE PAIN
The good news is that even without cause or cure, there are successful
management techniques that can relieve at least some of the pain of
fibromyalgia. McPhail-Brown offers a customized course, usually about six weeks
long, to help fibromyalgia patients deal will all aspects of the condition.
'Besides popping pills, what can you do to manage this? It's a multi-faceted
syndrome, affected by many things -- poor sleep, hypersensitivity to pain,
touch, smell, noise, lights, temperature,' she says. 'When you don't reach that
deep sleep, you don't get the restoration of hormones in your body, then it
slips into hormone imbalance. That could affect your immune system and your
brain, and your muscles don't act the way they should.'
Fibromyalgia can follow physical trauma -- 45 percent to 70 percent of cases
surface after an accident or injury -- or be brought on by an illness such as
osteoporosis, rheumatoid arthritis, or, as in the case of Burke, from lupus,
with which she was diagnosed 22 years ago.
The 41-year-old Margate mother uses anti-depressants to ensure a good night's
sleep, an important part of treatment for most fibromyalgia patients.
'That and physical therapy is really what got me back on track,' says Burke.
'When I have a flare-up, the first thing I have to do is exercise.
There's a lot of pain, but it's the best thing for you. The muscles become very
hard and knotty, especially when you're tense or under stress -- that makes it
worse.'
STRETCHING, WEIGHTS
Burke has a long-standing date with physical therapist Nancy Croughwell,
co-owner of OrthoSport in Davie. The routine includes regular paces of
stretching and weight training, as well as electrical stimulation to increase
circulation and reduce pain, something that patients can do at home with special
equipment.
Croughwell conducts assessments to help patients identify whether their symptoms
of pain could be fibromyalgia so they can discuss appropriate treatment with
their doctors. She says there are some herbs she might recommend, but that
patients should check dosage with their doctors because of possible interactions
with medication. Burke says a natural vegetable and juice supplement has helped
her tremendously. Acupuncture and acupressure have helped some patients.
Michele Laya, a physical therapist at Parkway Regional Hospital and an
instructor at the University of Miami, uses aquatherapy -- exercising the
patients while they're submerged in a pool of warm water -- to help ease the
muscle pain and tension of fibromyalgia, with good effects.
'They're going to feel terrible when they first do exercises,' Laya says, 'but
it's worth it if they keep it up.'
Another treatment method Laya has used is called CranioSacral Therapy, a
cerebral massage technique developed at the Upledger Institute in Palm Beach
Gardens.
'It's considered an alternative medicine approach that helps to relax the body
and relieve some of the pain that these people are experiencing,' she says.
'I've found it can help them tremendously.'
Even after she'd determined the cause of her pain, it took Longo several years
to find the proper combination of treatments to achieve a comfortable life. One
doctor even treated her for hypochondria when she told him she thought she had
fibromyalgia.
`HIGH ACHIEVERS'
'I've noticed in group sessions that the people are always very high achievers,
great family people who were giving so much they were forgetting themselves,'
says Longo, the mother of 9- and 16-year-old sons.
'You need to take care of yourself. You need to assess your life. My life was a
continuous deadline; stress is a big trigger for fibromyalgia. I've had to
simplify my life quite a bit. I've had to learn that sometimes things will not
be perfect.'
In the end, she says, 'you end up with your own bag of tricks -- not everything
works all of the time, but there is always something that will help.'
Longo uses anti-depressants to help her sleep, and relies on muscle relaxants
when necessary. She swapped her desk chair for a giant rubber ball, which keeps
her moving while at her desk, balancing with perfect posture. She attends Tai
Chi classes at South Miami Hospital twice a week and exercises at home daily for
stress reduction, strengthening and stretching. And she maintains a healthy
diet. But her favorite method of treatment is dancing the tango every weekend.
'It's extremely energizing. I think moving to music has an effect on pain.
Anything that releases your endorphins is beneficial, and dancing certainly
does,' Longo says. 'It's also a form of meditation, which is very important when
you have pain. The first thing you do is take a deep breath and relax.'
HELP FOR FIBROMYALGIA PATIENTS
Several organizations work with fibromyalgia patients and can provide
information and support. Here are some:
* South Miami Hospital Collaborative Medicine Program, (FM, Tai Chi and yoga
support groups, 305-662-5130)
* Women's Health Resource Center of Baptist Hospital (FM support group,
305-598-5981)
* JFK Medical Center (www.jfkmc.com or 561-965-7300)
* National Institute of Arthritis and Musculoskeletal and Skin Diseases
(http://www.nih.gov/niams or 1-877-22-NIAMS)
* National FM Partnership (http://www.fmpartnership.org)
* Upledger Institute (http://www.upledger.com)
Source: Co-Cure:
http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201a&L=co-cure&F=&S=&P=3165
AOL: <a
href="http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201a&L=co-cure&F=&S=&P=3165
">Therapy, massage and tailor-made exercise offer respite from the nagging
torment of fibromyalgia</a>
***********************
13)
Tune In, Zone Out
(HealthScoutNews) -- Couch potatoes, rejoice! Watching television can be good
for you. A study on sleep habits conducted at the Dayton Department of Veterans
Affairs (news - web sites) Medical Center, Wright State University, Ohio,
focused on people who either watched television for 15 minutes, or took a
5-minute walk.
According to the journal Sleep, the people who watched television fell asleep in
half the time it took for the walkers to fall asleep. And the heart rate for the
television viewers was slower than the heart rate of the walkers.
However, the journal did not list what TV shows did the trick.
http://dailynews.yahoo.com/h/hsn/20020101/hl/tune_in_zone_out_1.html
AOL: <a
href="http://dailynews.yahoo.com/h/hsn/20020101/hl/tune_in_zone_out_1.html">Tune
In, Zone Out</a>
***********************
14)
Long-Term follow-up on restless legs syndrome patients treated with opioids.
Nutritional Supplementation with Chlorella pyrenoidosa for Fibromyalgia
Syndrome: A Double-Blind, Placebo Controlled, Crossover Study
Journal: J of Musculoskeletal Pain, Vol. 9(4) 2001, pp. 37-54
Authors: Randall E. Merchant, Cynthia A. Andre and Christopher M. Wise
Affiliations: Randall E. Merchant, PhD, is Professor of Anatomy and
Neurosurgery, Cynthia A. Andre, MSc, is Clinical Research Coordinator and Social
Worker, and Christopher M. Wise, MD, is Professor of Internal Medicine
Rheumatology, Virginia Commonwealth University, Medical College of Virginia,
Richmond, VA.
Address correspondence to: Randall E. Merchant, PhD, Virginia Commonwealth
University, Medical College of Virginia. Richmond, VA
23298-0709 [E-mail: mailto:rmerchan@hsc.vcu.edu ].
This study was supported in part by a contract and grant from Sun Chorella
Corporation of Kyoto, Japan.
Submitted: August 11,2000.
Revision Accepted: July 5, 2001.
ABSTRACT: Objective: To determine if daily dietary supplementation with
Chlorella for three months helps normalize body functions, relieve symptoms, and
improve quality of life in patients with fibromyalgia syndrome [FMS].
METHODS: A total of 43 subjects with FMS were enrolled and randomized such that
approximately half consumed 50 Sun Chlorella™ tablets and 100 mL of liquid
Chlorella extract known as Wakasa GoId™ each day for three months and the other
half consumed 50 placebo tablets and 100 mL of placebo liquid each day for a
comparable period. Neither the patient nor the physician conducting the
assessments knew which of the dietary supplements the subject was consuming.
Following a one month washout period, subjects crossed-over from Chlorella to
placebo or vice versa.
RESULTS: Thirty-four subjects completed the entire trial. Six parameters of
response were followed while each subject consumed each study diet, subjects
answered questions relating to sleep, pain, global well-being, and fatigue while
the physician assessed tender point index and global well-being. Subjects were
considered as having a positive response to a diet if they demonstrated a 50
percent or more improvement in at least four parameters. Of the 37 FMS subjects
who completed the Chlorella arm, seven [19 percent] were responders versus only
3/34 [9 percent] who completed the placebo arm [P = 0.311]. For the four
self-assessment parameters, significantly more 121/37 or 57 percent] subjects
who completed the Chlorella arm noted a 50 percent or better improvement in at
least two parameters while only 10/34 [29 percent] who completed the placebo arm
did [P = 0.0311. Patient self-assessment of functional abilities by the
Fibromyalgia Impact Questionnaire [FIQ] showed that when they were consuming
Chlorella, there was a steady, statistically significant, drop in the FIQ score
while, when taking placebo, levels of improvement varied and were not
statistically significant at the end of the three-month period. Comparisons of
the FIQ for Chlorella and placebo indicated that the better response of
participants in the Chlorella arm of the crossover was nearly statistically
significant [P = 0.058]. A questionnaire dealing with issues of pain, anxiety,
sleep, and gastrointestinal difficulties indicated that while participants were
consuming Chlorella, there were steady, statistically significant improvements
[P < 0.001] in scores compared to baseline. Comparing the two arms, there was a
statistically significant [P = 0.004] improvement in FMS symptoms while the
subjects were taking Chlorella.
Conclusion: Taken together, the results of this randomized, placebo-controlled,
double-blind crossover study lead us to conclude that dietary Chlorella
supplementation may be useful in relieving symptoms of FMS.
KEYWORDS: Fibromyalgia syndrome, Chlorella, dietary supplement, pain
INTRODUCTION: In the United States it has been estimated that 2-4 percent of the
general population suffers from fibromyalgia syndrome [FMS] (1). The major
complaint of FMS patients is a generalized achiness but its definitive diagnosis
is based on the presence of a minimum of 1 1 tender points in 18 characteristic
locations (2). Other symptoms are also often present, particularly fatigue,
sleep disturbance, morning stiffness, and headaches.
Most patients with FMS can get some relief of symptoms with nonpharmacologic
methods such as increasing the amount of gentle aerobic exercise, getting an
adequate amount of sleep, and maintaining a regular sleep schedule. Low doses of
amitriptyline are often prescribed to improve deep sleep, but the drug can cause
weight gain, dry mouth, and cognitive impairment when given in doses sufficient
to keep FMS symptoms under control (3,4). Also, some tolerance can develop to
its sedative effect, necessitating dose increases in order to maintain any
benefit.
Several other medications have also been shown in controlled studies to help
relieve symptoms of FMS, including cyclobenzaprine, fluoxetine, and alprazolam
(4-7). Corticosteroids, as well as nonsteroidal anti-inflammatory drugs, have
proven to be of no benefit for FMS in placebo-controlled trials (4) and to date,
no "alternative" treatment, food, or herbal preparation has been proven
effective in controlled studies.
Recently, we conducted an open-label pilot study which involved 18 subjects with
FMS who supplemented their diet with 10 grams [50 Sun Chlorella™ tablets] of
Chlorella and 100 mL of the liquid Chlorella extract each day for two months
(8). These products are made from Chlorella pyrenoidosa, a unicellular green
alga that grows in fresh water. The principal components of Chlorella that have
been shown to have certain health benefits are chlorophyll, the organism's cell
walls, beta-carotene, and Chlorella growth factor [CGF]. Chlorella pyrenoidosa
has the highest content of chlorophyll of any known plant and also contains high
concentrations of many vitamins and minerals, as well as dietary fiber, nucleic
acids, amino acids, enzymes, and other substances.
Chlorella growth factor is a water soluble extract and contains a variety of
substances including amino acids, peptides, proteins, vitamins, sugars, and
nucleic acids. A number of scientific reports out of Japan have shown that
broken cell wall preparations and extracts of Chlorella pyrenoidosa and other
Chlorella species when either given orally or injected promotes growth and
healing, stimulates the immune system such that the host is protected from
infection, and exerts significant anticancer activity (9-13).
Dietary supplementation with the two Chlorella products led to a mean net
decrease of two tender points by the end of the study. The mean tender point
index [TPI] which was 32 at baseline fell to 25, representing a statistically
significant decrease in the intensity of pain of 22 percent [P = 0.01]. Although
these results suggested that there may be a health benefit from Chlorella in the
diet for subjects with FMS, it was recognized that these subjects were given
open-label Chlorella and that such data were subject to substantial risk of bias
on the part of both the subject and the investigator. Nevertheless, the
possibility that subjects with FMS could have their level of pain [as measured
by the TPI] significantly decreased by simply adding Chlorella to the diet
suggested that a double-blind, placebo-controlled clinical trial of dietary
Chlorella supplementation was warranted. Therefore, the objective of the present
investigation was to test the hypothesis that FMS subjects benefitted by adding
Chlorella to their diet. As we had in the open-label study, we documented each
patient's clinical status at strategic intervals using validated, semiobjective
and subjective outcome measures and determined the magnitude of any resultant
change in clinical symptoms, particularly pain, and other outcome variables.
© 2001 by The Haworth Press, Inc. All rights reserved.
[Copies of the complete article are available for a fee from The Haworth
Document Delivery Service: 1-800-342-9678. E-mail address:
mailto:getinfo@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 its interlibrary loan agreements.]
source: Co-Cure:
http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201d&L=co-cure&F=&S=&P=3369
AOL: <a
href="http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201d&L=co-cure&F=&S=&P=3369
">Long-Term follow-up on restless legs syndrome patients treated with
opioids</a>
***********************
15)
How to safely take medications
Getting treatment for fibromyalgia, myofascial pain, and the other myriad of
ailments we deal with involves taking medications. Some of us find that we have
a cabinet full of medications for the first time in our lives.
Following is a series of articles from Mayo Clinic that talk about how to safely
take medications.
"About the medicines you are taking"
In the United States, new drugs must pass through a rigorous system of approval
supervised by the Food and Drug Administration.
http://www.mayoclinic.com/invoke.cfm?id=DI00006&si=1029
AOL: <a href="http://www.mayoclinic.com/invoke.cfm?id=DI00006&si=1029">About the
medicines you are taking</a>
"Getting the most out of your medicines"
Talking with your health care team -- physician, dentist, nurse and pharmacist
-- will help you get the most out of your medicines.
http://www.mayoclinic.com/invoke.cfm?id=DI00005&si=1029
AOL: <a href="http://www.mayoclinic.com/invoke.cfm?id=DI00005&si=1029">Getting
the most out of your medicines</a>
"Avoiding medicine mishaps: Tips against tampering"
To avoid medicine mishaps, be sure to know how to notice possible signs of
tampering.
http://www.mayoclinic.com/invoke.cfm?id=DI00004&si=1029
AOL: <a href="http://www.mayoclinic.com/invoke.cfm?id=DI00004&si=1029">Avoiding
medicine mishaps: Tips against tampering</a>
"General information about the use of medicines"
Before using your medicines, be sure you know about storage, proper use,
precautions and side effects.
http://www.mayoclinic.com/invoke.cfm?id=DI00003&si=1029
AOL: <a href="http://www.mayoclinic.com/invoke.cfm?id=DI00003&si=1029">General
information about the use of medicines</a>
***********************
16)
The Fibromyalgia Community's January Contest!
WIN A COPY OF "The FIBROMYALGIA CHEF" BY Mark Pellegrino!
15 WINNERS!!!!
HURRY! The deadline for entries is January 31, 2002
Details: http://www.fibrom-l.org
[AOL: <a href="http://www.fibrom-l.org">Contest Details</a>]
***********************
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