FMS Community Newsletter #28
Monday, September 23, 2002

 

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Featured link: Recovery: What worked for me

This week's feature article at the website of the CFIDS/Fibromyalgia
Self-Help program (www.cfidsselfhelp.org) is "Recovery from CFIDS: What
Worked for Me." The article, the second of a two-part series describing
how I used self-help to recover from CFIDS, is an expanded version of an
article published in the CFIDS Chronicle.

Check it out: http://www.CFIDSselfhelp.org
AOL users: <a href="http://www.CFIDSselfhelp.org">Read it here
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This week's news:
1) Prevalence of post-traumatic stress disorder in fibromyalgia
patients: Overlapping syndromes or post-traumatic fibromyalgia syndrome?
2) Study: Fibromyalgia Less Painful for Older Patients
3) Request for telephone support
4) Reduced basal release of serotonin from the ventrobasal thalamus of
the rat in a model of neuropathic pain
5) Enhanced temporal summation of second pain and its central modulation
in fibromyalgia patients.
6) Oregon makes changes in Medicaid for treatment of "incurable"
disorders
7) Caution: That Dose May Be Too High
8) Women with Fibromyalgia Experience Significant Pain During Routine
Mammography
9) Interview with Lisa Lorden
10) Interview with Aimee Hall
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1) Prevalence of post-traumatic stress disorder in fibromyalgia
patients: Overlapping syndromes or post-traumatic fibromyalgia syndrome?
Semin Arthritis Rheum 2002
Aug;32(1):38-50

Cohen H, Neumann L, Haiman Y, Matar MA, Press J, Buskila D. Ministry of
Health Mental Health Center, Anxiety and Stress Research Unit,
Epidemiology Department, Rheumatic Disease Unit, Department of Medicine,
Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University
of the Negev, Beer Sheva, Israel.

OBJECTIVES: The primary aim of this study was to assess the frequency of
post-traumatic stress disorder (PTSD) in patients with the fibromyalgia
syndrome (FMS). The influence of gender on measures of PTSD in
fibromyalgia
(FM) patients also was examined.

METHODS: Seventy-seven consecutive patients (40 women and 37 men) who
fulfilled the criteria for FM were asked to complete questionnaires
measuring the prevalence and severity of symptoms of PTSD, anxiety, and
depression. The subjects were divided in 2 groups based on the presence
or absence of PTSD symptoms.

RESULTS: In this study, 57% of the FM sample had clinically significant
levels of PTSD symptoms. The FM patients with PTSD reported
significantly greater levels of avoidance, hyperarousal, reexperiencing,
anxiety, and depression than did the patients without clinically
significant levels of PTSD symptoms. The prevalence of PTSD among the FM
patients in this study was significantly higher than in the general
population. Women with FM and PTSD reported a greater number of past
traumatic events than did their male counterparts.

CONCLUSIONS: The results represent the first comprehensive study
applying structured clinical assessment of trauma exposure and PTSD to a
group of FM patients. This study shows a significant overlap between FM
and PTSD, according to the currently accepted diagnostic criteria for
each. Semin Arthritis Rheum 32:38-50.
Copyright 2002, Elsevier Science (USA).
All rights reserved.
PMID: 12219319 [PubMed - in process]
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2) Study: Fibromyalgia Less Painful for Older Patients

NEW YORK (Reuters Health) - Older people with fibromyalgia report less
pain and discomfort than their younger counterparts, according to a new
report.

While it is possible that the severity of the chronic condition declines
with age, the explanation may be more psychological than physical, the
researchers suggest.

Previous studies have indicated that older people tend to perceive their
overall health status more positively than younger adults, even though
the former may have multiple illnesses, said study author Dr. Terry
Cronan of San Diego State University and colleagues. In addition, they
said, because seniors often expect their health to decline, they may
assume that fibromyalgia symptoms such as pain and stiffness are just a
normal consequence of aging and thus not attribute them to the
condition.

"Younger people, on the other hand, expect to be healthy and participate
in an active life; when faced with a chronic health problem they see it
as negative and more disruptive," Cronan and colleagues write in a
recent issue of the Journal of Aging and Health. "Hence, they may
evaluate their health more negatively and are more apt to report their
symptoms or complain," they said. "Thus, the actual health of the person
may not improve with age, but differing perceptions produce decreases in
the overt expression of discomfort."

Fibromyalgia affects about 2% the population, primarily women, according
to the paper. Patients commonly report feeling tenderness, stiffness and
sometimes unbearable pain in various areas of the body. They also may
suffer from fatigue, headaches, gastrointestinal problems and other
symptoms.

The new study involved 600 fibromyalgia patients, mostly female, who
were members of a large health maintenance organization.
They were grouped by age: young (20-39); middle-aged (40-59); and older
(60-85). All participants completed a series of questionnaires assessing
pain, sleep quality, depression and other factors relating to their
health.

Results showed that while the older patients had suffered with the
disease for years longer than the other age groups, they reported better
sleep quality and less pain, depression and illness impact than the rest
of the study participants.

SOURCE: Journal of Aging and Health 2002;14:370-384.

Check it out:
http://reuters.com/news_article.jhtml?type=healthnews&StoryID=1470423#
AOL users: <a
://reuters.com/news_article.jhtml?type=healthnews&StoryID=1470423#">Read
it here</a>
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3) Request for telephone support

We have had a special request from an ME/CFIDS patient who does not have
access to a computer. She would like to be in touch with other ME/CFIDS
patients who have had or have breast cancer and she is willing to accept
long-distance calls at her Bay area, California residence. Anybody
willing to do this is asked to e-mail me personally at Gailr-@aol.com
so that I may respond with her name and telephone number. All responses
will be kept confidential.

Gail Kansky
National CFIDS Foundation, Inc.
103 Aletha Rd.
Needham, MA 02492-3931
http://www.NCF-NET.org
AOL users: <a href="http://www.NCF-NET.org">
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4) Reduced basal release of serotonin from the ventrobasal thalamus of
the rat in a model of neuropathic pain.

Pain 2002 Sep;99(1-2):359
Goettl V, Huang Y, Hackshaw K, Stephens R.
Department of Physiology and Cell Biology, College of Medicine and
Public Health, The Ohio State University, 304 Hamilton Hall, 1645 Neil
Avenue, College of Medicine and Public Health, 43210, Columbus, OH, USA
PMID: 12237215

Drugs that inhibit reuptake of monoamines are frequently used to treat
pain syndromes, e.g. neuropathy or fibromyalgia, where mechanical
allodynia is present. Several lines of evidence suggest the involvement
of supraspinal sites of action of these drugs. However, a direct study
of supraspinal serotonin (5-HT) or norepinephrine (NE) release in an
animal model in which allodynia is expressed, e.g. neuropathy, has not
been done.
The ventrobasal (VB) thalamus and the hypothalamus are major supraspinal
projection regions for spinal neurons that transmit nociceptive
information and are innervated by monoaminergic fibers. This study
determined if peripheral neuropathy would induce changes in
extracellular monoamines in VB thalamus and hypothalamus.
Male Sprague-Dawley rats had spinal nerve roots L5 and L6 tightly
ligated (neuropathic rats; NP) or sham (SHAM) surgery; contralateral and
ipsilateral VB thalamus and contralateral hypothalamus were dialyzed
with modified artificial cerebral spinal fluid (aCSF), with and without
fluoxetine.
NP rats had significantly decreased 5-HT content in dialysates of the
contralateral VB thalamus compared with SHAM rats with (82% decrease) or
without (63% decrease) fluoxetine in the perfusion medium over the 180
min of the study. There were no differences in the ipsilateral VB
thalamus. In contrast, release of 5-HT was unchanged in the hypothalamic
dialysates of SHAM vs. NP rats. NE release was not different in
dialysates of either the VB thalamus or hypothalamus of SHAM vs. NP
rats. Synthesis of 5-HT, as assessed by accumulation of
5-hydroxytrytophan after treatment with an L-amino acid decarboxylase
inhibitor, was not different between NP and SHAM rats in VB thalamic and
hypothalamic brain tissue.
This study is the first to demonstrate changes in monoamine release
supraspinally in NP rats. The differential effect between VB thalamus
and hypothalamus suggests that a terminal field change may be involved.
Putative mechanisms for mediating this change include alterations of
GABA-ergic systems and/or plasticity related to alterations in
N-methyl-D-aspartate receptor activation and nitric oxide release
related to afferent hyperactivity induced by neuropathic pain.
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5) Enhanced temporal summation of second pain and its central modulation
in fibromyalgia patients

Pain 2002 Sep;99(1-2):49
Price D, Staud R, Robinson M, Mauderli A, Cannon R, Vierck C.
Department of Oral and Maxillofacial Surgery, University of Florida
College of Dentistry, Box 100416, 32610-0416, Gainesville, FL, USA
PMID: 12237183

We have previously shown that fibromyalgia (FMS) patients have enhanced
temporal summation (windup) and prolonged decay of heat-induced second
pain in comparison to control subjects, consistent with central
sensitization. It has been hypothesized that sensory abnormalities of
FMS patients are related to deficient pain modulatory mechanisms.
Therefore, we conducted several analyses to further characterize
enhanced windup in FMS patients and to determine whether it can be
centrally modulated by placebo, naloxone, or fentanyl.

Pre-drug baseline ratings of FMS and normal control (NC) groups were
compared with determine whether FMS had higher pain sensitivity in
response to several types of thermal tests used to predominantly
activate A-delta heat, C heat, or cold nociceptors.

Our results confirmed and extended our earlier study in showing that FMS
patients had larger magnitudes of heat tap as well as cold tap-induced
windup when compared with age- and sex-matched NC subjects. The groups
differed less in their ratings of sensory tests that rely predominantly
on A-delta-nociceptive afferent input. Heat and cold-induced windup were
attenuated by saline placebo injections and by fentanyl (0.75 and 1.5
&mgr;g/kg).

However, naloxone injection had the same magnitudes of effect on first
or second pain as that produced by placebo injection. Hypoalgesic
effects of saline placebo and fentanyl on windup were at least as large
in FMS as compared to NC subjects and therefore do not support the
hypothesis that pain modulatory mechanisms are deficient in FMS.

To the extent that temporal summation of second pain (windup)
contributes to processes underlying hyperalgesia and persistent pain
states, these results indirectly suggest that these processes can be
centrally modulated in FMS patients by endogenous and exogenous
analgesic manipulations.
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6) Oregon makes changes in Medicaid for treatment of "incurable"
disorders

From a newsletter reader in Oregon:

I work in a dental office that accepts Medicaid and we get all
healthcare newsletters from the state. We got a notice last week that
effective 9/1/02, fibromyalgia, myalgia, myositis, phantom limb
syndrome, tendonitis, sprains, insomnia, sleep disorders, IBS, TMJ,
allergies, and several other healthcare concerns now fall below the line
of coverage and are excluded for treatment and/or medication. Any
treatment or prescriptions are the sole responsibility of the patient.

After talking with someone in the Medicaid department I was told that
treatment was deemed not necessary as there are no known "cures" for
these problems and are no longer covered under Medicaid. Most of this
information is available from the Oregon state website at:
www.omap.hr.state.or.us/
AOL users: <a href="http://www.omap.hr.state.or.us/">Read it here</a>
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7) Caution: That Dose May Be Too High

The New York Times
Sept. 17, 2002

By ABIGAIL ZUGER

Twenty percent of prescription drugs are marketed with instructions for
use that must later be corrected by the manufacturer, researchers say -
almost always to lower the recommended dose or to warn that the drug may
be hazardous to certain patients.

Check it out: http://www.nytimes.com/2002/09/17/health/17DOSE.html
AOL users: <a
href="http://www.nytimes.com/2002/09/17/health/17DOSE.html">Read it
here</a>
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8) Women with Fibromyalgia Experience Significant Pain During Routine
Mammography

By Peggy Peck Special to DG News

SAN DIEGO, CA -- August 22, 2002 -- Results of a survey of women with
fibromyalgia suggest that women with fibromyalgia experience significant
pain during mammography and thus may avoid routine screening, according
to results presented August 21st at the 10th World Congress on Pain.

Check it out:
http://www.docguide.com/news/content.nsf/NewsPrint/8525697700573E1885256C1D006DE68B

AOL users: <a
href="http://www.docguide.com/news/content.nsf/NewsPrint/8525697700573E1885256C1D006DE68B

">Read it here</a>
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9) Interview with Lisa Lorden

Lisa Lorden, a well-known writer on a variety of subjects important to
those
with Chronic Fatigue and Immune Dysfunction (CFIDS) and Fibromyalgia
(FMS),
took time to speak with OFCW via telephone on a warm afternoon in
August.
Lisa is very familiar with the array of health, social and interpersonal
issues affecting patients with invisible disabilities. She has coped
beautifully with a life interrupted and offers some insights into
maintaining a productive and happy personal life that many of us will
find
helpful.

Check it out: http://www.ourfm-cfidsworld.org/html/lisa_lorden.html
AOL users: <a
href="http://www.ourfm-cfidsworld.org/html/lisa_lorden.html">Read it
here</a>
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10) Interview with Aimee Hall

Meet Aimee Hall, an advocate and organizer who overcame her own ill
health to start a support group. Aimee's support group quickly became
several groups with over 200 members in the metropolitan Philadelphia
area. Her organizational skills are amazing, as you will see here. She
is a firm
believer in laughter, joy and advocacy and proof that one person can
make a difference.

Check it out: http://www.ourfm-cfidsworld.org/html/aimee_hall.html
AOL users: <a
href="http://www.ourfm-cfidsworld.org/html/aimee_hall.html">Read it
here</a>
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If you have enjoyed this newsletter, please go to
http://www.fmscommunity.org/contributions.htm to see how you can help
The Fibromyalgia Community stay alive.
AOL users: <a href="http://www.fmscommunity.org/contributions.htm">Read
it here</a>

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