FMS Community Newsletter #31
Monday, November 11, 2002



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FMS Community Newsletter #31
Monday, November 11, 2002
Subscription update: 1972 subscribers and 20 new subscribers. Welcome!
Featured link: Improving Relationships

Serious illness changes relationships, creating frustrations for all
involved. This week's feature article at the website of the
CFIDS/Fibromyalgia Self-Help program describes seven strategies for
improving relationships used by people in our self-help course. The
article is the seventh the series "What Works for Managing CFIDS and

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This week's news:
1) Pregabalin shows promise as FMS treatment
2) Is Pregabalin expected to be all things to all people?
3) Information site for men updated
4) Men, Women and Pain, Are All Things Equal?
5) Chronic Fatigue Syndrome, Fibromyalgia and Associated Syndromes:
Evidence for Their Organic Basis
6) Laser Therapy And Amitriptyline Both Effective For Fibromyalgia
7) Health and Functional Status of Twins with Chronic Regional and
Widespread Pain.
8) Chemical Sensitivity Tied to Anxiety, Depression
9) Brain Study of Back Pain Sufferers Yields Intriguing Results
10) Brain Regions Involved in Fatigue Sensation: Reduced Acetylcarnitine
Uptake into the Brain.
1) Pregabalin shows promise as FMS treatment

Pfizer Inc.'s pregabalin was shown to provide improvement of pain in
patients with fibromyalgia, a chronic and debilitating pain syndrome,
according to data presented on October 26, 2002 at the annual meeting of
the American College of Rheumatology. Pregabalin also was shown to
improve sleep and fatigue levels, the data demonstrate.

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2) Is Pregabalin expected to be all things to all people?

Pfizer developed pregabalin as a followup drug to gabapentin
(neurontin). According to this summary it can be used to treat: seven
major indications (beginning with neuropathic pain and add-on epilepsy),
and has been filed with the FDA as a drug for such.   Filings for
generalized anxiety disorder (GAD), social anxiety disorder and
fibromyalgia are expected to take place in 2002, The link to the
abstract is below.

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3) Information site for men updated

There is not much information on fibromyalgia available that is
specifically tailored to men. A valuable resource for fibromyalgia's
minority,, was recently updated. This site is very
well designed and also includes information for family and friends of
men with FMS, along with a news section that is updated daily.

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4) Men, Women and Pain, Are All Things Equal?

Recently medical science has insisted that men have higher pain
threshholds than women, but is research based on tightening a blood
pressure cuff or thermal tolerance reliable?

The claims that women are not the equal of men in dealing with
discomfort surprised me and prompted me to carefully examine the
material necessary to write this article. During the past ten years
medical research has conducted studies that assert that men may be the
stronger sex, when it comes to pain. A very significant presentation was
made at the 20th meeting of the American Pain Society in the spring of
2001 that stated that men and women had different pain thresholds with
that of women being slightly lower.

The conclusions on gender are those that are examined here and what they
might mean for those of suffering with chronic pain disabilities such as
Fibromyalgia, Chronic Fatigue and Immune
Dysfunction, and Chronic Myofascial Pain Syndromes.

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5) Chronic Fatigue Syndrome, Fibromyalgia and Associated Syndromes:
Evidence for Their Organic Basis

Dr. Andrew J. Wright, reports to his colleagues, "In order to understand
(Chronic Fatigue Syndrome and fibromyalgia), an awareness of some of the
newer specialties, such as Neuroendocrinoimmunolgy, Chronobiology,
Toxicology and Integrative Medicine has been important in formulating
these ideas. Some of the more controversial ideas emerging in medicine
are also described. You will not find the answers in your undergraduate
textbooks! The 'one disease, one diagnosis, one drug approach,' does not
apply with this group of illnesses."

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6) Laser Therapy And Amitriptyline Both Effective For Fibromyalgia

Both active gallium-arsenide laser therapy and low-dose amitriptyline
treatment improve clinical symptoms and quality of life in patients with
fibromyalgia. In a study comparing the two treatments with placebo laser
treatment, active laser therapy improved all the clinical parameters
tested while amitriptyline improved all parameters except fatigue. Laser
therapy also appears to improve pain intensity to a greater degree than
amitriptyline, but amitriptyline has a greater effect on depression.
These results are reported by investigators from the Dicle University
School of Medicine in Diyarbakir and Abant Izzet Baysal University in
DŁzce, Turkey.

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7) Health and Functional Status of Twins with Chronic Regional and
Widespread Pain.

Journal: J Rheumatol 2002 Nov;29(11):2426-2434
Authors: Aaron LA, Arguelles LM, Ashton S, Belcourt M, Herrell R,
Goldberg J, Smith WR, Buchwald D.
Affiliation: Department of Oral Medicine, University of Washington,
Seattle, Washington, USA.
NLM Citation: PMID: 12415604

OBJECTIVE: To examine the independent effects of chronic regional and
widespread pain syndromes on health and functional status after
accounting for comorbid chronic fatigue using a co-twin control design.

METHODS: We identified 95 twin pairs discordant for pain in which one
twin had chronic regional or widespread pain and the other denied
pain. Demographic data, functional and psychological status, health
behaviors, and symptoms based on the 1994 criteria for chronic fatigue
syndrome (CFS) were assessed by questionnaire. Psychiatric diagnoses
based on structured interview. Random effects regression modeling
estimated associations between chronic regional and widespread pain and
each health measure with and without adjustment for CFS.

RESULTS: Significant differences (p </= 0.05) were found within twin
pairs discordant for chronic regional and widespread pain, for general
health perception, and physical and mental health functioning as
by summary scores from the Short Form-36. In addition, differences were
observed within pain discordant pairs in psychological distress as
measured by the General Health Questionnaire as well as the number of
psychiatric diagnoses. Adjustment for CFS eliminated the association
between chronic pain and mental health, but the association between
chronic pain and poor general health, physical functioning, and sleep
quality persisted (p </= 0.01). Only the intra-pair difference in
physical functioning distinguished twins with regional vs widespread
(p </= 0.05).

CONCLUSION: Both chronic regional and widespread pain exact debilitating
effects on perceived general health, physical functioning, and sleep
quality independent of CFS. However, the psychological and psychiatric
influence of chronic pain appears closely tied to CFS. Research should
examine the additive role of CFS-like illnesses in patients with chronic
pain, and its influence on treatment and outcome.
8) Chemical Sensitivity Tied to Anxiety, Depression

NEW YORK (Reuters Health) - Anxiety and depression may be important
features of multiple chemical sensitivity (MCS), a controversial
diagnosis given to some people with apparent allergic reactions to a
range of everyday exposures.

A small study of MCS patients found that they were more likely to suffer
depression than either healthy individuals or people with asthma. And
both asthmatics and those with MCS showed greater-than-average "anxiety
sensitivity," an exaggerated response to anxious feelings that is
characteristic of panic disorder.

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9) Brain Study of Back Pain Sufferers Yields Intriguing Results

Patients with lower back pain that can't be traced to a specific
cause may have abnormal pain-processing pathways in their brains,
to a new study led by University of Michigan researchers.

The effect, which as yet has no explanation, is similar to an altered
perception effect in fibromyalgia patients recently reported by the same
research team.
In fact, the study finds, people with lower back pain say they feel
pain, and have measurable pain signals in their brains, from a gentle
squeeze that barely feels unpleasant to people without lower back pain.
People with fibromyalgia felt about the same pain from a squeeze of the

But the squeeze's force must be increased sharply to cause healthy
people to
feel the same level of pain -- and their pain signals register p in
different brain areas.

The results, which were presented October 27, 2002, at the annual
meeting of
the American College of Rheumatology in New Orleans, may help lead
researchers to important findings on lower back pain, and on enhanced
perception in general.

Senior authors Richard Gracely, Ph.D., and Daniel Clauw, M.D., did the
at Georgetown University Medical Center and the National Institutes of
Health, but are now continuing the work at the University of Michigan
System. In May, they and their colleagues published a paper in the
Arthritis and Rheumatism on pain perception in fibromyalgia patients.

To correlate subjective pain sensation with objective views of brain
signals, the researchers used a super-fast form of MRI brain imaging,
functional MRI or fMRI. They looked at the brains of 15 people with
back pain whose body scans showed no mechanical cause, such as a
disk, for their pain. They also looked at 15 fibromyalgia patients and
normal control subjects.

As a result, they say, the study offers the first objective method for
corroborating what lower back pain patients report they feel, and what's
going on in their brains at the precise moment they feel it. And, it
continues to give researchers a road map of the areas of the brain that
most -- and least -- active when patients feel pain. The researchers
that further study on larger groups of patients will yield more
on altered pain processing.

"The fMRI technology gave us a unique opportunity to look at the
neurobiology underlying tenderness, which is a hallmark of both lower
pain and fibromyalgia," says Clauw. "These results, combined with other
done by our group and others, have convinced us that some pathologic
is making these patients more sensitive. For some reason, still unknown,
there's a neurobiological amplification of their pain signals."

Lower back pain affects nearly all Americans from time to time,
those who are overweight, sedentary or work in physically demanding
The pain can interfere with life and work; problems stemming from lower
pain are the second most frequent cause of lost work days in adults
the age of 45, ranking below only the common cold.

Much of the pain may be due to pulled muscles, strained ligaments,
joints or small tears in the disks that act as cushions between the
bones of
the spine -- all causes that don't show up well on X-rays but often can
seen on CT or conventional MRI scans. These physical causes often
after a few weeks, but many patients have chronic or recurring

In the study, the lower-back pain patients were examined by CT scan to
out mechanical causes of their pain. Then they, the fibromyalgia
and the healthy control subjects had their brains scanned by fMRI for
than 10 minutes while a small, piston-controlled device applied
calibrated, rapidly pulsing pressure to the base of their left
The pressures were varied over time, using painful and non-painful
that had been set for each patient prior to the scan.

The study's design gave two opportunities to compare patients and
The subjective comparison measured the pressure levels at which the pain
rating given by back pain patients, fibromyalgia patients and control
subjects was the same. The objective comparison looked at the rating
the three types of participants gave when the same level of pressure was

The researchers found that it only took a mild pressure to produce
self-reported feelings of pain in the lower-back pain and fibromyalgia
patients, while the control subjects tolerated the same pressure with

"In both the back pain patients and the fibromyalgia patients, that same
mild pressure also produced measurable brain responses in areas that
the sensation of pain," says Clauw. "But the same kind of brain
weren't seen in control subjects until the pressure on their thumb

Though brain activity increased in many of the same areas in both
and control subjects, there were striking differences, too. All the
had increased activity in eight areas of their brains, but lower-back
patients showed no increased activity in two areas that were active in
fibromyalgia patients and normal control subjects. Meanwhile,
patients showed increased activation in two other areas not active in
pain patients and healthy subjects.

This response suggests that lower-back pain patients have enhanced
to pain in some brain regions, and a diminished response in others,

The study was supported in part by the National Fibromyalgia Research
Association, the U.S. Army and the NIH. In addition to Clauw and
the research team included Thorsten Giesecke and Masilo Grant of UMHS,
Munoz of NIH, Reshma Kumar of Georgetown, and Alf Nachemson of the
University of Gotenberg, Sweden.
10) Brain Regions Involved in Fatigue Sensation: Reduced
Uptake into the Brain.

Journal: Neuroimage 2002 Nov;17(3):1256-1265

Authors: Kuratsune H, Yamaguti K, Lindh G, Evengard B, Hagberg G,
Matsumura K, Iwase M, Onoe H, Takahashi M, Machii T, Kanakura Y, Kitani
T, Langstrom B, Watanabe Y.

Affiliations: Department of Molecular Medicine, Hematology and Oncology,
Osaka University Graduate School of Medicine, C9, 2-2 Yamada-oka, Suita,
Osaka, 565-0871, Japan

NLM Citation: PMID: 12414265

Fatigue is an indispensable sense for ordering rest. However, the
neuronal and molecular mechanisms of fatigue remain unclear. Chronic
fatigue syndrome (CFS) with long-lasting fatigue sensation seems to be a
good model for studying these mechanisms underlying fatigue sensation.
Recently, we found that most patients with CFS showed a low level of
serum acetylcarnitine, which well correlated with the rating score of
fatigue, and that a considerable amount of acetyl moiety of serum
acetylcarnitine is taken up into the brain.

Here we show by metabolite analysis of the mouse brain that an acetyl
moiety taken up into the brain through acetylcarnitine is mainly
for the biosynthesis of glutamate. When we studied the cerebral uptake
acetylcarnitine by using [2-(11)C]acetyl-L-carnitine in 8 patients with
CFS and in 8 normal age- and sex-matched controls, a significant
was found in several regions of the brains of the patient group, namely,
in the prefrontal (Brodmann's area 9/46d) and temporal (BA21 and 41)
cortices, anterior cingulate (BA24 and 33), and cerebellum.

These findings suggest that the levels of biosynthesis of
neurotransmitters through acetylcarnitine might be reduced in some brain
regions of chronic fatigue patients and that this abnormality might be
one of the keys to unveiling the mechanisms of the chronic fatigue
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