------------------------------------------------------------------------
The Fibromyalgia Community Newsletter # 9 Friday, 02/01/2002
http://www.fibrom-l.org or http://www.fmscommunity.org
------------------------------------------------------------------------
This week's News Summary:
1) Article: ACR: Pain Scores Not an Accurate Reflection of Fibromyalgia Severity
2) Research: Fibromyalgia in patients with irritable bowel syndrome
3) Article: New Guidelines to Help Deal With Doctor-Patient E-Mails
4) Advocacy: Persevere on disability claims
5) Research: MELATONIN FOR CHRONIC WHIPLASH: RANDOMISED, PLACEBO-CONTROLLED TRIAL
6) Research: Migraine Headaches: A Common and Challenging Problem
7) Article: When Drug Side Effects Get Out Of Hand
8) Article: Simple Things You Can Do Today to Control Stress
9) Research: A Review of Multidisciplinary Interventions for Fibromyalgia Patients: Where Do We Go from Here?
10) Research: Neuroendocrine mechanisms in fibromyalgia & chronic fatigue
11) Announcement: It is time for YOU to pick the winners of the FMS Community Recipe Contest!
------------------------------------------------------------------------
Note: Full Stories on some articles are available via web links
------------------------------------------------------------------------
VOLUNTEERS WANTED: The Fibromyalgia Community is looking for Volunteers to help with a number of ongoing projects including an Editor for the Fibromyalgia Community Newsletter. Other volunteer positions involve such simply tasks as submitting current news and/or research material for use in the newsletter and/or website. We also need volunteers to assist in contacting the over 150+ websties with hyperlinks to our site to let them know of our new home address: http://www.fmscommunity.org.
If you are interested in volunteering, please contact either: Chip Davis, mailto:chipdavis@fmscommunity.org or Jane Kohler mailto:turnip@fmscommunity.org
Thanks!
Chip Davis
***********
1)
ACR: Pain Scores Not an Accurate Reflection of Fibromyalgia Severity
By Lynn Haley
SAN FRANCISCO, CA -- November 16, 2001 -- Pain scores used to assess patients with fibromyalgia (FM) appear not to provide an accurate reflection of the severity of the disease.
The findings, by researchers from the University of Pittsburgh, and the University of Washington, in Seattle, were presented at the 2001 Annual Scientific Meeting of the American College of Rheumatology, held here November 10th-15th.
Researchers from 39 centers in the United States collected baseline data from 529 patients who complained of FM based on American College of Rheumatology (ACR) criteria published in 1990, including the presence of widespread pain and the presence of tender points (TP).
Investigators used measurements such as the Manual Tender Point Survey, in which patients rated pain upon palpation at each of 18 TP and three control points on a 0-10 point scale (TP intensity score was the average of 18 TP scores).
Patients were also asked to keep a pain diary for about seven days using an 11-point numerical scale, from 0 (no pain) to 10 (worst pain). Patients also used the Visual Analog Scale (VAS) from the Short-Form McGill Pain Questionnaire, in which patients rated their pain intensity using a 100-mm line with 0 (no pain) to 10 (worst pain).
Results showed that in patients with FM for an average of nine years, the average number of TP was 17.1. Mean intensity score was 6.1, with mean control point intensity of 2.0. Overall, on average, the numerical rating scale for pain intensity was 7.0, and 74.8 mm for VAS.
Investigators concluded that because of the nature of their disease, its long duration, the high number of tender points and the severe levels of pain reported in three separate measures, patients in this population are experiencing high levels of disease severity.
The fact that 73 percent of patients reported pain at 17 of 18 TP, the number of TP does not appear to correlate well with pain scores. While numerical and visual ratings are closely correlated, they are less closely correlated with TP intensity. As a result, physicians should use more than one pain measure since they may be assessing different aspects of pain (i.e., usual pain versus pain on palpation).
Fibromyalgia affects approximately 6 million people in the US alone, the majority of them women. It's etiology remains unknown, and is considered a symptomatic condition with characteristic features of widespread, chronic pain and the presence of TP. As well, patients report disordered sleep, fatigue and morning stiffness.
The ACR criteria for FM, published in 1990, include three or more months of widespread pain, defined as pain present above and below the waist on the right and left sides of the body, and along the midline; and a demonstration of pain in at least 11 of 18 specific tender point sites throughout the body upon palpation with about 4 kg of digital pressure.
The TP examination is considered a major tool in diagnosing fibromyalgia, as other tests in these patients tend to be unremarkable.
The study was funded by Pfizer Inc.
**********
2)
Fibromyalgia in patients with irritable bowel syndrome
International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery
ISSN: 0179-1958 (printed version)
ISSN: 1432-1262 (electronic version)
An association with the severity of the intestinal disorder
Ennio Lubrano (1), Paola Iovino (2)(3), Fabrizio Tremolaterra (4), Wendy J. Parsons (5), Carolina Ciacci (4), Gabriele Mazzacca (4)
(1) Physical Medicine and Rehabilitation Department, University Federico II, Naples, Italy
(2) Endoscopic Unit, University Federico II, Naples, Italy E-mail: piovino@unina.it Phone: +39-81-7462759 Fax: +39-81-7462759
(3) Via del Rione Sirignano 10, 80121 Naples, Italy
(4) Gastroenterology Unit, University Federico II, Naples, Italy
(5) Research and Development Department, Leeds General Infirmary, Leeds, UK
Abstract. Fibromyalgia (FM) syndrome and irritable bowel syndrome (IBS) are functional disorders in which altered somatic and or visceral perception thresholds have been found. The aim of this study was to evaluate the prevalence of FM in a group of patients with IBS and the possible association of FM with patterns and severity of the intestinal disorder. One hundred thirty consecutive IBS patients were studied. The IBS was divided into four different patterns according to the predominant bowel symptom and into three levels of severity using a functional severity index. All patients underwent rheumatological evaluation for number of positive tender points, number of tender and swollen joints, markers of inflammation, and presence of headache and weakness. Moreover, patients' assessments of diffuse pain, mood and sleep disturbance, anxiety, and fatigue were also measured on a visual analogue scale. The diagnosis of FM was made based on American College of Rheumatology classification criteria. Nonparametric tests were used for statistical analysis. Fibromyalgia was found in 20% of IBS patients. No statistical association was found between the presence of FM and the type of IBS but a significant association was found between the presence of FM and severity of the intestinal disorder. The presence of FM in IBS patients seems to be associated only with the severity of IBS. This result confirms previous studies on the association between the two syndromes.
**********
3)
New Guidelines to Help Deal With Doctor-Patient E-Mails
By LAURA LANDRO
Staff Reporter of THE WALL STREET JOURNAL
AFTER FILLING a prescription for an antibiotic, Diane McElhany read about possible side effects and e-mailed her doctor, Karen Ilika, to ask if there were alternatives. In her electronic reply, Dr. Ilika explained why that drug was best and urged her to start taking it right away. Ms. McElhany has become so accustomed to communicating with Dr. Ilika online that she even e-mailed her from Italy recently to report that a medication prescribed for the trip had worked just fine.
"I feel very plugged in to my doctor, and I can always get the answer in one day to nonurgent questions, without being a pain in the neck or playing phone tag with a nurse," says Ms. McElhany, a Seattle chemist. Using the secure messaging system on Dr. Ilika's Web site, part of a network of doctor sites run by Medem Inc., Ms. McElhany can also make appointments and request prescription refills.
Dr. Ilika says she won't ever charge for routine e-mails, but will consider charging fees for more detailed consultations later this year, when Medem adds the option to bill patients via credit card for online consults.
WHILE ONLY 13% of doctors use e-mail to communicate with patients, according to Harris Interactive, a growing number say they would be more likely to do so if they could charge for online consultations, guarantee patient privacy and avoid taking on any new malpractice risks. To help deal with such issues, Medem and a consortium of leading medical malpractice insurers plan to release a new set of "eRisk" guidelines Tuesday that will, among other things, urge doctors to switch from standard e-mail to secure, password-protected messaging systems.
The group will also issue a second set of guidelines for doctors who want to charge for online consultations, recommending obtaining a patient's consent and disclosing fees beforehand. Medem is a for-profit venture of 45 medical societies, including the American Medical Association and the American College of Obstetrics and Gynecology.
Part of the impetus for the new guidelines is the groundswell of demand from patients. There is also wider acceptance of the idea that doctors deserve to be compensated for the time and effort they put into online consultations. A number of employers and health-care plans are starting to reimburse doctors for e-visits. For example, Blue Shield of California and a group of Silicon Valley employers are testing a program called webVisit from Healinx Corp. that reimburses doctors $20 for certain online consultations.
Ohio family practitioner Rivka Ann Sanders uses the Healinx system to charge patients for a range of services, including writing out a new set of prescriptions when a patient changes insurers and explaining radiology reports. She spends up to an hour each day on such messages. "If patients don't want to come in and see me, we can do it on the Internet," Dr. Sanders says. "But either way, I need to be compensated for my time."
SOME MORE Web-savvy doctors and hospital groups such as nonprofit Kaiser Permanente and the Harvard-affiliated CareGroup have been using e-mail with patients for several years. All have strict internal procedures to guard against unauthorized use of patient information. Most require that electronic correspondence be saved as part of a patient's permanent medical record. But the medical world has become increasingly wary of the legal risks because regular e-mail is so easy to forward and may be accessed by an employer if a patient uses the e-mail system at work.
With new federal privacy legislation going into effect next year, doctors and hospitals are scrambling to establish secure networks that encrypt data and authenticate the identity of patients. Such networks can offer password-protected Web sites with secure messaging systems such as those designed by Medem and Healinx. "It's a common-sense approach," says Medem Chief Executive Edward Fotsch. "You wouldn't use standard e-mail to trade stocks or even buy a book online. Why would you consider transmitting medical information in this manner?"
Some doctors disagree. Daniel Sands, an internist at CareGroup and an assistant professor of medicine at Harvard, fears that encouraging doctors to avoid regular e-mail will have a chilling effect on doctor-patient online communication because it's the only option for many patients. He notes that encouraging the use of secure messaging systems that are available only through their networks is in the financial interest of companies like Medem. Patients "need to know there is a risk to sending unsecured messages via e-mail, but those risks may be worth it" if it means more access to doctors, says Dr. Sands, who also manages a Web site devoted to the medical, ethical and legal issues of e-mail communication (e-pcc.org).
But insurers warn that doctors face their own risks. "We're standing on the threshold of another revolution in the doctor-patient relationship," says Mark Gorney, medical director for the insurer Doctors Co. His company agreed to help develop the eRisk guidelines "because we saw a whole field of possible litigation opening up," Dr. Gorney says. He hopes the guidelines will make it clear to doctors "that there are risks in using standard e-mail, and charging for an online consultation likely increases those risks."
**********
4)
Persevere on disability claims
Scott E. Davis, Disability expert
The application and appeals process for Social Security Disability Insurance benefits can be so overwhelming and intimidating that roughly half of all applicants give up after they are first denied benefits by the Social Security Administration (SSA). The process can make you feel like you are David fighting Goliath. But if you prepare you case with the right legal and medical documentation, and if you persevere, you can significantly increase your odds of obtaining benefits. Proper preparation of your case is critical, as SSA has made it increasingly more difficult to obtain benefits over the past several years.
The following are questions I’m frequently asked regarding the disability system in general and specifically about cases involving CFIDS and fibromyalgia.
Q: SSA denied my claim. What’s the point of appealing? I don’t have any new evidence, so I don’t see how I can fight this huge agency with all of their experts and their complicated regulations.
A: If this is you, you’re feeling exactly the way SSA wants you to feel – defeated. DON’T QUIT! Keep in mind that 75% of all disability applicants are denied benefits during the first step of the SSA process. SSA knows that about half of those denied benefits will give up and not appeal. However,
55%-60% or about three in five of those who do appeal and go before an administrative law judge (ALJ) will obtain benefits.
If you are denied benefits, don’t delay! You must appeal any denial letter from SSA within 60 days. Following your appeal, the second step is similar to the first, in that it is “merely” a paper review of your claim. You still will not meet with anyone. The review, like the initial decision, is based primarily on forms you completed and your medical records. The SSA employees at these first two steps of the process often are looking for reasons to deny your application. While a very high percentage of applications are denied at this review stage—80%--don’t despair. By appealing this denial, you move closer to a hearing before an ALJ.
Q: Do I need an attorney? How can I afford to hire an attorney? Will an attorney really improve my chances of winning benefits?
A: I am asked this question frequently and my reply is always, “Do you know what you have to prove in order to obtain benefits?” The response is always, “I have no idea.”
You can hire an attorney at any stage of the process. Practically all disability attorneys work on a contingency basis, which means no money up front and you pay the attorney for his or her time only if you obtain benefits. Federal law sets a maximum amount for that fee, and in almost every case it is a very small amount compared to the benefits a person will receive.
Now that you can afford an attorney, should you hire one? Absolutely. The earlier you hire an attorney, the sooner he or she can begin preparing your case. You should substantially increase your chances of winning by working with an attorney who specializes in disability law. The system is complex, and an attorney will develop your case by obtaining the necessary medical and vocational records and opinions from your doctors that are critical to providing disability.
An attorney is especially important in the appeals process and in presenting your case to the judge, but he or she can be helpful earlier, too. If you have a treating physician, your attorney can fight to have your doctor perform a disability evaluation rather than an SSA doctor, who will almost always tell the judge you are not disabled. Also, the application requires a dizzying array of forms requesting all sorts of information, and your attorney should help you fill them out as they are important to your case.
You won’t win your case with the information you give on the forms, but you could lose it. Your answers should be honest and somewhat brief. It is critical to focus on your exertional and non-exertional limitations and restrictions when completing the forms.
Q: My doctor believes in CFIDS and that I am too sick to work, but is the SSA going to believe my doctor?
A: Your doctor is not thinking about your disability claim when he or she is treating you. You need to tell your doctor you’ve filed a claim for disability and measures his or her response. If you are certain your doctor supports your claim, a reference in the records that you are unable to work is very helpful.
You must be a very detailed historian. Keep notes about the severity and frequency of your pain, fatigue and other symptoms and about what you are able to do—or not able to do—from day to day. Give this information to your doctor and tell him or her that you want it included in your records. Then get and keep copies of all your medical records. Do not assume SSA will have all your records; 95% of the time, critical records are missing.
Q: My doctor has suggested a lot of different treatments, but there are a few I’m not sure about and a few I’d like to try that he doesn’t think will help. How could this affect my case?
A: Exhausting all the possible treatments is good for your disability case.
It makes your testimony and that of your doctor more credible and supports the severity of your symptoms because you will have tried everything to find relief. I always advise clients to undergo and try any treatment the specialist prescribes, including non-traditional treatment. You don’t want to give an ALJ any reason to wonder whether your condition might be so severe if you had only followed your own doctor’s instructions. The SSA’s doctors will usually tell the judge that your symptoms would improve and allow you to work if you would undergo some type of treatment, and that’s an opportunity for the judge to deny your claim.
It’s important not to panic and not to give up. The SSA and ALJs are increasingly familiar with fibromyalgia and CFIDS, and many people do win their disability case based on those diagnoses. You will need perseverance and knowledge of the system to win your case, but you must not give up!
Appeal every denial, hire an attorney and keep fighting.
**********
5)
MELATONIN FOR CHRONIC WHIPLASH: RANDOMISED, PLACEBO-CONTROLLED TRIAL
Chronic whiplash syndrome (CWS) is a poorly defined, pathophysiologically unexplained complex of symptoms that develops shortly after a sudden forceful flexion and extension (whiplash) trauma of the cervical spine and that is present for longer than 6 months after the whiplash trauma. The symptoms, including insomnia, impaired concentration and memory, fatigue, neck pain and headache, are often so pronounced that many patients with CWS cannot resume their daily activities.
http://www.medscape.com/46972.rhtml?srcmp=ms-011102<a href="http://www.medscape.com/46972.rhtml?srcmp=ms-011102">Read it here</a>
**********
6)
Migraine Headaches: A Common and Challenging Problem
This is an excellent article on migraines. There is not necessarily new info here for those who who "migraine pros". But for those who are still working on figuring their headaches out this is a good primer. Good info on pain medications for migraines and why certain meds don't work well.
Also an interesting section of the phases of a migraine.
http://www.medscape.com/CNO/2001/NCNP3<a href="http://www.medscape.com/CNO/2001/NCNP3">Read it here</a>
**********
Group Therapy May Help Fibromyalgia Patients
By Charnicia E. Huggins
NEW YORK (Reuters Health) - Group psychotherapy may decrease depression and fatigue among individuals with fibromyalgia, new study findings suggest.
And some patients may even feel less pain after the therapy, according to researchers.
Fibromyalgia, a chronic condition estimated to affect 2% of Americans, is marked by pain in the muscles and around the joints and is often accompanied by depression and fatigue. The cause is unknown, but researchers have found pain-processing abnormalities in the spines and brain stems of some people with the condition.
``Persons with fibromyalgia...should ask their healthcare provider for psychological services available to them to possibly assist in improving physical symptoms as well as psychological distress,'' lead researcher Dr. Frances J. Anderson, of St. John's Regional Health Center in Springfield, Missouri, told Reuters Health.
Anderson and her colleagues investigated the effect of group psychotherapy in a study of 59 people with fibromyalgia. All participated in a one-year outpatient fibromyalgia treatment program and an 8-week course on coping skills. In addition, 35 elected to participate in a 90-minute psychotherapy session each week for 14 weeks. The remaining patients were used as a comparison group.
At the end of the 14 weeks, the psychotherapy group reported less depression, fatigue and morning tiredness than they had at the start of the study, according to the investigators. Further, in comparison to their initial reports, they had a more positive attitude about their condition and also perceived themselves more positively. They also had an improved outlook on their interactions with others and felt they had a greater ``support system,'' the study findings show.
What's more, some individuals also reported feeling less pain after the psychotherapy, the researchers note.
The ``simplistic'' explanation for this finding is that ``the more isolated you are and the more you focus on your pain, the more pain you're going to experience,'' Anderson said. ``With social support, people feel more connected, (have) more meaning in life, feel less depressed (and), therefore, experience less pain.''
In light of the findings, ``people with fibromyalgia, particularly when experiencing depression, might benefit from participation in group psychotherapy, in combination with other aspects of a fibromyalgia treatment program, including coping skills classes,'' Anderson said.
Anderson's results are not surprising, according to Dr. Sandra Sephton of the University of Louisville School of Medicine in Kentucky, who was not involved in the study.
It ``makes sense'' that psychotherapy would have effects such as decreasing depression since it is ``specifically targeted to depression,'' she told Reuters Health.
On the other hand, Sephton pointed out, the study had a ''strong bias'' because the study group chose to receive the psychotherapy instead of being randomly assigned to receive it.
``People who want to do it are much more likely to benefit from it,'' she said.
The findings were presented recently in San Francisco at the annual meeting of the Association of Rheumatology Health Professionals.
http://dailynews.yahoo.com/h/nm/20020125/hl/therapy_2.html<a href="http://dailynews.yahoo.com/h/nm/20020125/hl/therapy_2.html">Read it here</a>
**********
Depression: What You Need to Know
Introduction There were days I couldn't get out of bed. Nothing made me feel better-- not playing with my dog, reading my favorite books, or visiting with friends. No matter how much I slept, I always woke reluctantly, still tired and listless. Days at work were difficult; I couldn't concentrate, nothing made sense, and I felt unqualified for my job, one that I'd had for over a year.
I couldn't see a way out of this, and sometimes I was so overcome by my feelings of hopelessness and despair that I couldn't even crack a smile. I left the house counting the minutes until I could get back into my bed. I could barely remember a time when I woke up feeling excited and energetic.
Depression is a serious medical condition. In contrast to the normal emotional experiences of sadness, loss, or passing mood states, clinical depression is persistent and can interfere significantly with an individual's ability to function. There are three main types of depressive disorders: major depressive disorder, dysthymic disorder, and bipolar disorder (manic-depressive illness).
Symptoms and Types of Depression Symptoms of depression include sad mood, loss of interest or pleasure in activities that were once enjoyed, change in appetite or weight, difficulty sleeping or oversleeping, physical slowing or agitation, energy loss, feelings of worthlessness or inappropriate guilt, difficulty thinking or concentrating, and recurrent thoughts of death or suicide. A diagnosis of major depressive disorder is made if a person has 5 or more of these symptoms and impairment in usual functioning nearly every day during the same two-week period. Major depression often begins between ages 15 to 30 but also can appear in children. Episodes typically recur.
Some people have a chronic but less severe form of depression, called dysthymic disorder, which is diagnosed when [the] depressed mood persists for at least 2 years (1 year in children) and is accompanied by at least 2 other symptoms of depression. Many people with dysthymia develop major depressive episodes.
Episodes of depression also occur in people with bipolar disorder. In this disorder, depression alternates with mania, which is characterized by abnormally and persistently elevated mood or irritability and symptoms including overly-inflated self-esteem, decreased need for sleep, increased talkativeness, racing thoughts, distractibility, physical agitation, and excessive risk taking. Because bipolar disorder requires different treatment than major depressive disorder or dysthymia, obtaining an accurate diagnosis is extremely important.
Facts About Depression
Major depression is the leading cause of disability in the U.S. and worldwide.
Depressive disorders affect an estimated 9.5 percent of adult Americans ages
18 and over in a given year, or about 18.8 million people in 1998.
Nearly twice as many women (12 percent) as men (7 percent) are affected by a depressive disorder each year.
Depression can be devastating to family relationships, friendships, and the ability to work or go to school. Many people still believe that the emotional symptoms caused by depression are "not real," and that a person should be able to shake off the symptoms. Because of these inaccurate beliefs, people with depression either may not recognize that they have a treatable disorder or may be discouraged from seeking or staying on treatment due to feelings of shame and stigma.
Too often, untreated or inadequately treated depression is associated with suicide.
Treatments Antidepressant medications are widely used, effective treatments for depression. Existing antidepressants influence the functioning of certain chemicals in the brain called neurotransmitters. The newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), tend to have fewer side effects than the older drugs, which include tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). Although both generations of medications are effective in relieving depression, some people will respond to one type of drug, but not another. Other types of antidepressants are now in development.
Certain types of psychotherapy, specifically cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been found helpful for depression. Research indicates that mild to moderate depression often can be treated successfully with either therapy alone; however, severe depression appears more likely to respond to a combination of psychotherapy and medication. More than 80 percent of people with depressive disorders improve when they receive appropriate treatment.
In situations where medication, psychotherapy, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis (e.g., hallucinations, delusional thinking) or suicidal tendencies, electroconvulsive therapy (ECT) may be considered. ECT is a highly effective treatment for severe depressive episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.
One herbal supplement, hypericum or St. John's wort, has been promoted as having antidepressant properties. Results from the first large-scale, controlled study of St. John's wort for major depression, which was funded in part by NIMH, are expected in 2001. Note: There is evidence that St.
John's wort can reduce the effectiveness of certain medications. Use of any herbal or natural supplements should always be discussed with your doctor before they are tried.
Research Findings
Brain imaging research is revealing that in depression, neural circuits responsible for moods, thinking, sleep, appetite, and behavior fail to function properly, and that the regulation of critical neurotransmitters is impaired.
Genetics research, including studies of twins, indicates that genes play a role in depression. Vulnerability to depression appears to result from the influence of multiple genes acting together with environmental factors.
Other research has shown that stressful life events, particularly in the form of loss such as the death of a close family member, may trigger major depression in susceptible individuals.
The hypothalamic-pituitary-adrenal (HPA) axis, the hormonal system that regulates the body's response to stress, is overactive in many people with depression. Research findings suggest that persistent overactivation of this system may lay the groundwork for depression.
Studies of brain chemistry, mechanisms of action of antidepressant medications, and the cognitive distortions and disturbed interpersonal relationships commonly associated with depression, continue to inform the development of new and better treatments.
Adapted from NIH Publication No. 01-4591 January 2001
Source: National Institutes of Health (NIH) Posted On Site: Feb. 2001 Publication Date: Feb. 2001
http://health.medscape.com/cx/viewarticle/233478<a href="http://health.medscape.com/cx/viewarticle/233478">Read it here</a>
**********
7)
When Drug Side Effects Get Out Of Hand
After being nearly hospitalized last week with severe neurological reactions to an antibiotic, Thyroid Disease Guide Mary Shomon is still feeling the effects. When you have an adverse effect to a drug what can -- and should -- you do?
http://thyroid.about.com/library/weekly/aa011102a.htm<a href="http://thyroid.about.com/library/weekly/aa011102a.htm">Read it here</a>
**********
8)
Simple Things You Can Do Today to Control Stress
Simple Things You Can Do Today to Control Stress http://stress.about.com/library/weekly/aa112600a.htm Simple modifications in posture, habits, thought, and behavior often go a long way toward reducing feelings of stress and tension. Here are eight simple things you can do immediately to help keep your stress level under control.
1. Watch for the next instance in which you find yourself becoming annoyed or angry at something trivial or unimportant, then practice letting go -
make a conscious choice not to become angry or upset. Do not allow yourself to waste thought and energy where it isn't deserved. Effective anger management is a tried-and-true stress reducer.
2. Breathe slowly and deeply. Before reacting to the next stressful occurrence, take three deep breaths and release them slowly. If you have a few minutes, try out a relaxation technique such as meditation or guided imagery.
3. Whenever you feel overwhelmed by stress , practice speaking more slowly than usual. You'll find that you think more clearly and react more reasonably to stressful situations. Stressed people tend to speak fast and breathlessly; by slowing down your speech you'll also appear less anxious and more in control of any situation.
4. Jump start an effective time management strategy. Choose one simple thing you have been putting off (e.g. returning a phone call, making a doctor's appointment) and do it immediately. Just taking care of one nagging responsibility can be energizing and can improve your attitude.
5. Get outdoors for a brief break. Our grandparents were right about the healing power of fresh air. Don't be deterred by foul weather or a full schedule. Even five minutes on a balcony or terrace can be rejuvenating.
6. Drink plenty of water and eat small, nutritious snacks. Hunger and dehydration, even before you're aware of them, can provoke aggressiveness and exacerbate feelings of anxiety and stress.
7. Do a quick posture check. Hold your head and shoulders upright and avoid stooping or slumping. Bad posture can lead to muscle tension, pain, and increased stress. If you're stuck at a desk most of the day, avoid repetitive strain injuries and sore muscles by making sure your workstation reflects good ergonomic design principles.
8. Plan something rewarding for the end of your stressful day, even if only a relaxing bath or half an hour with a good book. Put aside work, housekeeping or family concerns for a brief period before bedtime and allow yourself to fully relax. Don't spend this time planning tomorrow's schedule or doing chores you didn't get around to during the day. Remember that you need time to recharge and energize yourself - you'll be much better prepared to face another stressful day.
**********
9)
A Review of Multidisciplinary Interventions for Fibromyalgia Patients: Where Do We Go from Here?
Journal: J of Musculoskeletal Pain, Vol. 9(4) 2001, pp. 63-80
Authors: Karen Oliver, Terry A. Cronan and Heather R. Walen
Affiliations: Karen Oliver, BA [PhD Candidate], San Diego State University/University of California, Sun Diego, Joint Doctoral Program in Clinical Psychology, Project USE, San Diego, CA.
Terry A. Cronan, PhD [Director/Professor], and Heather R. Walen, PhD [Project Director], San Diego State University, Project USE, San Diego, CA.
Address correspondence to: Dr. Terry Cronan, Project USE, 6505 Alvarado Road, Suite 110, San Diego, CA 92120.
The authors thank Drs. Silvia Bigatti, William Hillix, James Sallis, and two anonymous reviewers for comments on earlier drafts.
Preparation of this article was supported by NIH grant AR-44020.
Submitted: January 10, 2001.
Revision accepted: July 9, 2001.
ABSTRACT.
Objectives: This paper reviews multidisciplinary treatment programs designed for people with fibromyalgia [FMS], identifies factors that may be associated with treatment efficacy, and makes recommendations for future FMS interventions.
Findings: Most efficacious interventions included physical activity and cognitive-behavioral therapy. Recommendations for future research studies include: 1. the use of aerobic exercise and cognitive-behavioral therapy training in coping skills and relaxation; 2. individualized exercise training; 3. power analysis conducted a priori to determine appropriate sample size; 4. uniformity in outcome measurement and follow-up assessment; and 5. the use of randomized, controlled trials that can lead to stronger conclusions regarding treatment efficacy.
Conclusions: Multidisciplinary treatment programs for FMS patients are generally effective. Researchers should continue to develop multidisciplinary treatment interventions incorporating the above recommendations.
KEYWORDS. Fibromyalgia, review, multidisciplinary, interventions
INTRODUCTION Fibromyalgia syndrome [FMS] is a chronic condition of unknown origin characterized by fluctuating, but nearly continuous, pain. The major symptoms of FMS include musculoskeletal pain, headaches, sleep disturbance, fatigue, morning stiffness, and irritable bowel syndrome (1). No widely accepted biological marker has been found for FMS, although hypothesized plausible causal mechanisms include neurotransmitter imbalances and muscle fiber irregularities (2). A diagnosis of FMS is based on the American College of Rheumatology criteria of a history of widespread pain [pain on both sides of the body, above and below the waist, axially, and present for at least three months] in 1 1 or more of 18 tender-point sites located throughout the body (3). Fibromyalgia affects an estimated 3.4 percent of women and less than l percent of then, and in women is four times more common than rheumatoid arthritis (4).
The variety of symptoms associated with FMS, the tendency for symptom severity to fluctuate, and the lack of a clear biological cause make it difficult to treat FMS patients effectively. No universally effective treatment programs exist for FMS, although some forms of therapy work better than others (5-7 ). No medication has been consistently successful in treating FMS (6,8,9). Fibromyalgia typically does not respond well to traditional pain treatments used for other forms of rheumatic disease, such as anti-inflammatory drugs and steroids (10-12). Antidepressants such as serotonergic agents have produced some favorable results (13,14), although this claim has been disputed (15,16). Muscle relaxants and natural agents such as s-adenosyl-l-methionine also produce mixed results (17,18).
Behavioral interventions have produced greater improvement in patient reports of FMS symptoms and daily functioning than pharmacological interventions (19). However, behavioral interventions also yield inconsistent rates of success. These interventions have included physical activity, electroacupuneture, hypnotherapy, cognitive-behavioral therapy [CBT], and patient education. Of these interventions, those utilizing physical activity, CBT, or patient education have fared better than those that do not (20,21).
Because pharmacological and behavioral interventions have produced variable rates of success in treating FMS, researchers have examined the possibility that combining singular treatment modalities into multidimensional programs would yield better results than administering individual treatments one at a time (22-24). The findings of a recent meta-analysis examining 49 FMS treatment outcome studies support this notion, with the authors recommending interventions combining education, physical activity, and CBT for managing self-reported FMS symptoms and daily functioning, with appropriate pharmacological treatment as needed for individualized sleep and pain symptoms (19).
While various multidisciplinary FMS interventions have been reviewed elsewhere (e.g., 7,21,25), most multidisciplinary treatment studies have not been evaluated with the objective of guiding future treatment direction for patients with FMS. Therefore, the purpose of the present review is to examine multidisciplinary FMS interventions, to identify commonalties that may be associated with treatment efficacy, and to make recommendations for future treatment programs designed for patients with FMS. Unlike a meta-analysis that evaluates treatment efficacy based on effect sizes, the present review evaluates several aspects of the studies, taking into account not only treatment outcomes, but also related factors such as adherence. Because the studies reviewed will be evaluated post hoc, we do not seek to make definitive conclusions about a relationship between intervention components and treatment efficacy, nor to make direct comparisons across studies. Rather, the aim of this review is to provide suggestions for the direction of future FMS intervention research.
© 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.]
http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201d&L=co-cure&F=&S=&P=5691<a href="http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201d&L=co-cure&F=&S=&P=5691">Read it here</a>
**********
10)
Neuroendocrine mechanisms in fibromyalgia & chronic fatigue.
Journal: Best Pract Res Clin Rheumatol 2001 Dec;15(5):747-758
Authors: Buskila D, Press J.
Affiliation: Rheumatic Disease Unit and Department of Medicine, Soroka Medical Centre and Ben-Gurion University, Beer-Sheva, 84101, Israel
NLM Citation: PMID: 11812019
Fibromyalgia and chronic fatigue syndrome are poorly understood disorders that share similar demographic and clinical characteristics. Because of the clinical similarities between both disorders it was suggested that they share a common pathophysiological mechanism, namely, central nervous system dysfunction.
This chapter presents data demonstrating neurohormonal abnormalities, abnormal pain processing and autonomic nervous system dysfunction in fibromyalgia and chronic fatigue syndrome. The possible contribution of the central nervous system dysfunction to the development and symptomatology of these conditions is discussed.
The chapter concludes by reviewing the effect of current treatments and emerging therapeutic modalities in fibromyalgia and chronic fatigue syndrome.
Copyright 2001 Harcourt Publishers Ltd.
http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201e&L=co-cure&F=&S=&P=61<a href="http://listserv.nodak.edu/scripts/wa.exe?A2=ind0201e&L=co-cure&F=&S=&P=61">Read it here</a>
**********
11) The entries are all in for the Fibromyalgia Community's Recipe Contest!!
It is time for YOU to pick the 15 entries that will receive copies of "The FIBROMYALGIA CHEF" BY MARK PELLEGRINO!
The entry period is now over!! All of the recipes that have been received have been placed at http://www.fibrom-l.org/contest.htm or http://www.fmscommunity.org
<a href="http://www.fibrom-l.org/contest.htm">Read it here</a>
.
Please scan the recipes on the two contest pages and then send us a vote for your top 15 choices.
The vote will be accepted for the next 7 days. Winners will be announced on February 8, 2001.
The lucky 15 who gain the most votes will be sent a copy of "The Fibromyalgia Chef"
Send us your Vote: mailto:fibroml@earthlink.net?subject=contest_vote
